Young Athletes at Risk

Are American children getting fatter or are they getting more exercise? Both, it turns out.

The incidence of obesity among children and adolescents has doubled in the past 30 years, explained Jeffrey Zlotnick, M.D., assistant clinical professor of family medicine and primary care sports medicine at the Robert Wood Johnson Medical School. Record numbers of kids, 35 million of them, are active in sports.

School-based sports keep six to eight million young athletes busy, he told the American Academy of Family Physicians Scientific Assembly. So do a range of non-scholastic clubs that promote soccer, gymnastics, volleyball, basketball, baseball, skating, karate, and more. Parents are hiring personal trainers and coaches for their children and sending them to summer sports camp in growing numbers.

Overall, Dr. Zlotnick said, obesity seems to be winning out. The number of sports-related medical and orthopedic problems among younger athletes and sports participants is on the rise. In some cases, obesity contributes to the injury. For other children, injury means less activity and subsequent weight gain.

"Kids, even obese kids, aren't gorging," he explained. "They are just eating a little more than they need and they don't keep moving. It doesn't take more than a little imbalance to tip the scales the wrong way."

An imbalance of 50 to 100 calories daily adds up to five or ten pounds over the course of a year, he added. The most direct solution is to get kids involved in active sports programs, to get them moving and keep them moving.

The other side of the equation, diet, can also be adjusted. Since parents set the stage for eating habits, it helps to enroll the entire family in creating a more healthy diet.

Parents should respect their child's appetite and not force them to eat. They should also avoid using food as a reward or a comfort. Adding higher fiber, less caloric foods is another step in the right direction. Prepared foods and sugared foods should be avoided altogether. Limiting screen time with TV, computer, or video games helps encourage exercise.

Asthma is the second most common medical problem for young athletes. Between 10% and 15% of high school and college athletes have exercise-induced asthma, Dr. Zlotnick said. Exercise is a trigger for virtually all chronic asthmatics. The key to treatment is to catch the mild persistent cases before they progress. Physicians should screen for asthma and coaches should be alert to the wheezing and coughing that can signal asthma. With adequate control and the appropriate use of rescue medication, most asthmatics can continue to participate in sports.

Diabetes is a growing problem for youngsters. Obesity appears to be driving an increase in the incidence of Type 2 diabetes. Insulin is the standard drug therapy, but insulin can cause significant weight gain, which exacerbates diabetes. Changes to diet and exercise are a better solution, but may not be effective for all patients.

Regardless of the type, all diabetics should avoid power lifting, which can induce bradycardia and syncope. Tolerance to heat and cold are also reduced. Insulin regimens will also need to be adjusted for strenuous or long-term exercise. And while most diabetics recognize the need for hydration, they may not realize that most sports drinks contain carbohydrates.