Celebrations for children in Bermuda almost always include cake, chips, soda and ice cream. I've never seen or heard a child bring a bag of apples for classmates to mark a birthday.

Celery and carrot sticks are not popular either, but parents should certainly take a crack at it.

Childhood obesity is a growing problem in the US and a major concern of Jaye Hefner, Associate Medical Director of Consult and Primary Care Services at Spaulding Rehabilitation Hospital in Massachusetts.

Dr. Hefner offered a lecture to Bermuda physicians last month on the prevalence of childhood obesity and what research studies have been done over the last 15 to 20 years.

In an interview with Body & Soul she said the entire family has to become involved if obese children are to be successfully treated.

"In childhood obesity it's important to treat the whole family. If you don't treat the whole family and you don't address the issue as a family, it's unlikely you will make any positive impact in the child," she said.

According to Dr. Hefner many parents don't realise their attitudes toward food in the home are damaging.

She added that something as simple as rewarding children with sweets is damaging not just because it promotes tooth decay and offers calories with no nutritional value, but also because it becomes a habit that can carry into adulthood.

"You can set up negative consequences with eating habits down the road," Dr. Hefner said. "If you set up an environment where you are disciplining the child with food 'If you do this then we'll go get ice- cream' then you are using food as a reward system.

"Or if the child begins to associate the food with adverse consequences, these are all eating patterns that will be set for life."

Children may also become obese through turning to food for emotional comfort.

"There may be family problems between the parents and the child may console themselves with food," Dr. Hefner said. "So as adults they eat when they are lonely or when they need to feel better. This is another way we develop unhealthy eating habits."

Although the food may comfort the emotions, if it results in the child being obese, it creates serious physical illnesses including hypertension, high blood pressure, diabetes and arthritis.

"We have a paediatric programme at Spaulding where we see children who have had strokes the youngest one we've had was 16," she said.

While the child stroke victims all had an underlying medical condition, like diabetes or hypertension, the common thread among them was morbid obesity, the doctor added.

The good news, she said, is that awareness is also rising although not across the board.

"We're not reaching the right populations of people so you find that weight is often determined by socioeconomic status," she said. "So if in a more affluent neighbourhood children's weights are coming down to normal that's all well and good, but did we really change people's life at the poverty level and those slightly above the poverty level?

"These kids continue to have weight issues."

She said the issue needs to be tackled on many fronts and that as a community we should be asking ourselves how we've failed and what we can do.

"Are we really giving them the right education and setting realistic goals for them?" she suggested.

And she noted that the reality of single parents may be that they cannot afford to make the types of lifestyle changes needed. The same can be true in a family with both parents.

"If a family of four has limited income and they cannot afford to buy all the fruits and vegetables, and they can only afford the more caloric dense food that tastes good, or they are getting by on the dollar menu, how can we make that cultural shift?

"That's not an easy shift to make because there's not just one aspect to it," she said.

The most important thing is to have everyone recognise the importance of maintaining a healthy weight, she said.

"If you are ten you may not think what your doctor says really matters," said Dr. Hefner." It's up to us the parents, the providers, people who have a vested interest in the health of the community to say it does matter to me that this person is overweight. What can I do now to prevent that?"