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While I am sitting in restaurants or standing in grocery store lines, I observe the health behaviors of adult caretakers and the children with them.

Two weekends ago, my wife and I were at a restaurant sitting next to a heavyset couple with two heavyset children. The children may have been between the ages of 3 and 6.

The woman was conversing with the man and, at the same time, pouring sugar into one of the children’s tea. The conversation and the downpour of sugar went on and on and on until the brown tea turned white and my face turned red. I felt my heart race, and my instinct was to turn toward the adult caretakers to tell them that they were harming their children.

My wife caught my reflexes and with her eyes signaled me to calm down.

Last week, I was in a grocery store line, and in front of me was a lady with three young children. The children may have been between the ages of 4 and 8 and appeared obese. My eyes roved around the grocery cart and observed the following items: white bread, jelly, bacon, chips, donuts, sodas, eggs, sausage, M&M’s, ketchup, bologna and mayonnaise. No produce, whole grains or milk. I turned around to look at my wife and I widened my eyes to the largest level allowed anatomically. My wife pulled the back of my shirt to give me the signal to calm down.

But how can I calm down? I picture these obese kids losing limbs, going blind, ending up on hemodialysis or having their chests cracked open for coronary bypass surgery before they reach adulthood.

I also picture government institutions running out of money because of the increasing cost of treating obesity-related chronic illnesses such as hypertension, diabetes, arteriosclerosis, arthritis and their co-morbidities. The cost of treating obesity in the United States is estimated at $190 billion per year. This cost is about 7 percent of the total U.S. annual health care expenditure.

According to the Centers for Disease Control and Prevention, in 2012, more than one- third of children and adolescents were overweight or obese. This should not be! Parents are accountable for this new childhood disease. Yes, obesity has just been categorized as a disease by the American Medical Association.

What needs to be done to stave off this childhood disease?

To provide a solution, we must first understand the problem. Childhood obesity is not a disease children are born with. It is being developmentally programmed by parents, mostly, in children between the fetal stage and 12 years of age. Children’s fat cells are like rubber bands – they expand and contract at least four times that we know of between fetus and age 12.

The four known time intervals of physiologic fat cell size expansion and contraction are in the fetus between 15 and 30 weeks of gestation; between the newborn stage and age 2; between 3 and 5; and between 9 and 12.

These four intervals are sensitive periods of children’s fat cell growth and fat cell number proliferation. If parents do not provide children healthy food options and encourage an active lifestyle, fat cells will expand and not contract. The expansion of fat cells, without contraction, will cause an incessant proliferation in the number of fat cells. Fat cell size can be reversed; fat cell numbers cannot. The abnormal proliferation of fat cell numbers leads to refractory obesity.

Parents can cause irreparable damage to their children’s physiology.

A study by the Social and Health Research Center in San Antonio, published in the Journal of Obesity last year, showed that if childhood obesity is not corrected at an early age, obese children will suffer not only from the chronic illnesses mentioned above, but also from learning disabilities. Unless childhood obesity is forestalled, there will not be enough money in government buildings to treat the medical conditions or enough tutoring in schools to improve scores on state competency exams.

What is responsible for the physiologic expansion and contraction of children’s fat cell size? Parents’ unhealthy behaviors being spilled over to children! For example, studies have shown that fetus taste buds develop around 27 weeks of gestation. Pregnant moms who consume milk and asparagus are more likely to have newborns with taste buds that favor milk and asparagus. And pregnant moms who consume Cheetos and Big Red are more likely to have newborns with taste buds that favor Cheetos and Big Red.

The second phase is between newborn and 2 years. Studies have shown that newborns whose mothers provide them with powdered or cow milk are more likely to develop obesity than breast-fed newborns.

The third phase is called “adiposity rebound.” This phase occurs between the ages of 3 and 5. At this stage, television begins to take control of the child’s brain. What is TV? First, it is a sedentary lifestyle and, second, it is about commercials. What products do commercials usually promote? Sugar, fat and beer.

A study by investigators from Case Western University found that the Public Broadcasting Service, Nickelodeon and Disney channels averaged 1.4 food advertisements every half-hour, with the majority of these commercials for fast-food chains and sugar-added beverages. And these are the “decent,” well-regarded TV channels. Can you imagine the indecent ones?

The fourth phase is when children reach puberty. Puberty occurs between the ages of 9 and 12. In this age group, children will either be entering or are already in middle school. In the United States, many elementary schools offer daily physical education, but by middle school, most stop requiring daily physical education.

By now I hope parents get what the solution is to stave off childhood obesity – higher consumption of fruits, vegetables, whole grain and low-fat dairy products and living a more active lifestyle.

The Social and Health Research Center followed nearly 1,400 children over three years to study their dietary intake during breakfast. Obese children who consumed cereals and milk for breakfast were more likely to become lean over time compared to obese children who did not.

The center has 14 years of experience implementing the Bienestar/NEEMA coordinated school health program. Studies published in the New England Journal of Medicine and Archives of Pediatrics and Adolescent Medicine have shown that children participating in our health programs have increased dietary fiber intake and physical activity and have decreased obesity rates, waist circumference and blood glucose and insulin levels.

The Bienestar/NEEMA health program is evidence-based and recognized as a successful strategy by the federal Agency for Healthcare Research and Quality and as a research-tested intervention program by the National Cancer Institute.

We have good news for parents. The prescription to treat the growing problem of childhood obesity is not in medical centers, universities or government institutions. It is at home and it may be in your child’s school.

Roberto Treviño is a physician and director of the Social and Health Research Center in San Antonio.