Despite a belief that people of Vietnamese descent rarely become overweight, Vietnamese American children — mainly from low-income families — are bucking the trend and gaining weight in greater proportions than ever before, putting them at risk for health issues that once were found only in people decades older, experts said.

Type 2 diabetes, hypertension and high cholesterol are among the illnesses being diagnosed in these youngsters, whose weight also puts them at risk for having strokes as early as their 20s and 30s.

Reasons for these disturbing trends include the adoption of sedentary lifestyles and more Americanized eating habits that include meals filled with high-calorie fast foods and junk foods, said Tú-Uyên Nguyễn, a researcher who was involved in a 2004 study that showed this alarming increase in weight among low-income Asian American children. Those studied included Vietnamese American youngsters living in Southern California as well as Hmong American and Chinese American youths from other parts of the state.

“We found that with acculturation, the longer that they’re here, they adapt more and more to American eating habits, with more McDonald’s and Kentucky Fried Chicken,” Nguyễn said, referring to the findings, funded by the National Cancer Institute’s Asian American Network for Cancer Awareness, Research and Training (AANCART).

In addition to eating less healthfully, low activity levels are endemic among those studied, she said. “They get into PlayStation, gaming, computers. They don’t have as much physical activity as in their parents’ generation in their homeland, where they might be working in the fields all day,” said Nguyễn, an assistant research scientist with the Center of Community Alliance for Research and Education Division of Population Sciences at the City of Hope National Medical Center in Duarte, Calif.

Usually, low-income parents must work more than one job to make ends meet, often returning home exhausted and with little time or energy to cook healthful meals or take their children outside where they can get some exercise, she said. For dinner, many often simply microwave frozen dinners or get low-cost drive-thru meals.

While in Việt Nam, these same parents generally cooked nutritious dishes with rice, vegetables and fish sauce, but once in the U.S., their routines changed, agreed Linh Phaïm, a pediatrician who works primarily with indigent populations, including a large number of Vietnamese American children at a UCI Medical Center facility in Westminster, Calif.

Now, three years after the study, Phạm sees almost daily what Nguyễn and her counterparts learned in their research. “The typical Asian would be a thin Asian child, but now many are overweight if not obese,” she said.

With many fast foods, “you get more bang for your buck. I can get bigger French fries if I add 40 cents, and drinks are 42 ounces, 72 ounces. You put that amount, with all that sugar” and add that to little exercise and “it is just a recipe for weight gain. The overall mix of the foods they eat are high-fat and high-caloric,” she said.

While exercise would help compensate for the extra calories, Phạm said many of the children she sees are active only during physical education classes in school, and these in many cases are not offered daily.

Phạm’s patients tell her that when they return home from school they do their homework and then watch television rather than go outside to play, she said, adding that many of them live in apartments lacking yards. “I ask parents if they can go outside and play, and they say no, they have no place to go. The best they can do is ride a scooter in the house,” Phaïm said, shaking her head.

Another problem with overweight children is the cultural belief among the parents and grandparents of her young patients, she said, explaining that they think that healthy weight children are too thin, she said. “Mostly the older generation like their grandchildren chubby. In the old days, being chubby was a sign of prosperity,” she said.

“I get a lot of complaints that ‘my children are too little.’ They request medicines to have their children gain weight. Thin, healthy 5 or 6 year olds are lanky, all legs, and they think they’re too thin...”

“I also encounter situations where one child who is thin and one who is overweight are in the same family. Parents are still buying junk food and sodas for the thin child, but this sends mixed messages to the overweight child,” she said.

Changing a poor diet into one that is more healthful is a process of sorts, Phạm said. “I usually start with whole milk. I try to get them down gradually. If you don’t like less fat, try 2 percent fat milk, then 1 percent, then nonfat.” Also, they should limit sodas and juices, which are high in calories and sugars. Thirsty? Try giving your child plain old water.

The frightening aspect of being an overweight child is that their problems often go beyond physical issues, which include high cholesterol in youngsters who are still in elementary school, Phạm and other experts said.

An overweight child’s emotional well-being often is affected, as well, because those overweight often wind up with psychological damage from being teased by other youngsters. “They have low self-confidence and have a higher incidence of depression and anxiety,” as a result, Phạm said.

“These are self-esteem issues and body image issues,” agreed Dan Cooper, an exercise specialist who is part of a large National Institutes of Health-funded, school-based study to try to prevent obesity and type 2 diabetes in children. “They get depressed, so they eat more. This just compounds the problem.”

An important finding of the AANCART study was that changes need to be made at all levels of society if children are to maintain healthy weights, Nguyễn stressed.

In the report, parents said that they “wanted more resources in their neighborhoods, especially in low-income areas. They can do it at home, but need the environment to support the changes. Like (they need) parks that are safe, places where families feel safe. In low-income neighborhoods, there are lots of liquor stores, but (few if any) grocery stores that offer healthy alternatives” that the parents mentioned they would prefer, she said.

Transformations need to happen at all levels of society. “We need change within the family to change the behavior and we need this reinforced in schools. We need the schools with healthy lunches and no sodas and we need fast food places with healthy choices. It needs to start from the ground up,” she said, and from the top public policy level down.

What can I do as a parent or guardian to help prevent childhood overweight?

To help your child maintain a healthy weight, balance the calories your child consumes from foods and beverages with the calories your child uses through physical activity and normal growth.

Remember that the goal for overweight children and teens is to reduce the rate of weight gain while allowing normal growth and development. Children and teens should not be placed on a weight reduction diet without the consultation of a health care provider.

Encourage healthy eating habits

There’s no great secret to healthy eating. To help your children and family develop healthy eating habits:

* Provide plenty of vegetables, fruits and whole-grain products.
* Include low-fat or non-fat milk or dairy products.
* Choose lean meats, poultry, fish, lentils and beans for protein.
* Serve reasonably sized portions.
* Encourage your family to drink lots of water.
* Limit sugar-sweetened beverages.
* Limit consumption of sugar and saturated fat.

Look for ways to make favorite dishes healthier

The recipes that you may prepare regularly, and that your family enjoys, with just a few changes can be healthier and just as satisfying. For new ideas about how to add more fruits and vegetables to your daily diet, check out the recipe database from www.fruitsandveggiesmatter.gov. This database enables you to find tasty fruit and vegetable recipes that fit your needs.

Remove calorie-rich temptations

Although everything can be enjoyed in moderation, reducing the calorie-rich temptations of high-fat and high-sugar or salty snacks can also help your children develop healthy eating habits. Instead only allow your children to eat them sometimes, so that they truly will be treats.

Here are examples of easy-to-prepare, low-fat and low-sugar treats that are 100 calories or less:

* A medium-size apple
* A medium-size banana
* 1 cup blueberries
* 1 cup grapes
* 1 cup carrots, broccoli or bell peppers with 2 tablespoons of hummus

Help kids stay active

Children and teens should participate in at least 60 minutes of moderate intensity physical activity most days of the week, preferably daily. Remember that children imitate adults. Start adding physical activity to your own daily routine and encourage your child to join you.

Some examples of moderate intensity physical activity include:

* Brisk walking
* Playing tag
* Jumping rope
* Playing soccer
* Swimming
* Dancing

Reduce sedentary time

Although quiet time for reading and homework is fine, limit the time your children watch television, play video games or surf the web to no more than two hours per day. Additionally, the American Academy of Pediatrics does not recommend television viewing for children age 2 or younger. Instead, encourage your children to find fun activities to do with family members or on their own that simply involve more activity.

Sources: U.S. Department of Health and Human Services and the Centers for Disease Control and Prevention.