Should 8-Year-Olds Be Popping Cholesterol Pills?

It's clear that heart disease starts early -- really early -- so we thought about applauding one of the new guidelines from the American Academy of Pediatrics (AAP). In July, the AAP recommended testing kids for high lousy LDL cholesterol, low healthy HDL cholesterol, and triglycerides starting at age 2 if they have a family history of heart disease or are overweight.

But we sat back in our seats when we read what came next: The AAP urged pediatricians to consider prescribing LDL-lowering and HDL-raising statin drugs for children as young as 8 who have high LDL (you want your LDL under 100 and your HDL over 50).

The AAP cares about kids and isn't in the hands of the pharma companies. But we wondered why it didn't just "prescribe" getting more exercise and changing diets. Relying on drugs to lower kids' LDL is likely to make people think that lifestyle changes -- which can accomplish exactly the same thing -- are irrelevant. Instead of playing tag, learning skateboard tricks, and savoring bowls of strawberries afterward, the AAP seems to be saying to kids that nutrition and exercise are optional; that it's okay to take pills and be a couch potato and eat foods that make you and your genes age faster.

That is just wrong, from a health standpoint. Statin drugs are good, but they are tremendously inadequate, compared with a healthy lifestyle. It's like saying that if there is a break in a levee, all you need is a rowboat. Yes, you'll survive for a while, but that rowboat doesn't deal with the cause of the levee break or what happens to your home or town. The lack of physical activity promotes cancer as well as aging of the arteries, and poor food choices inhibit sexual enjoyment later in life as well as a host of other things. So the pills may keep you alive for a while, but that boat won't make the levee stronger.

Then there's the safety issue. Although several statin drugs have been tested in children, and four are FDA-approved for them, none of these studies lasted longer than 4 years, and most were done on teenagers with a genetic predisposition to high cholesterol. While the drugs did the job, we don't know if there are long-term effects in children whose bodies are changing and growing.

To fight the childhood obesity epidemic and the twin epidemics of diabetes and heart disease it will spawn, we need to make a heart-healthy lifestyle as attractive to kids as cheeseburgers and Grand Theft Auto. It's not that hard, especially if YOU get involved. Here's how:

Start small. If you rampage through the kitchen cabinets, tossing everything that's not healthy, your kids will rebel and start sneaking treats elsewhere. Make small changes that morph into big ones over time. Switch from regular milk to 2%. When everyone's used to that, go to 1%, then to skim. (A squirt of fat-free chocolate syrup makes the transition smoother.) Cut back on the beef in your chili or pasta sauce, and substitute beans or soy crumbles. Serve kid-pleasing fruits and veggies: Most kids are happy to eat carrot sticks with dip (mash avocado with salsa, and teach them how to make it) or peanut butter. Or try orange slices with a drizzle of that nonfat chocolate syrup, parfaits of fruit and fat-free yogurt, or celery stalks filled with peanut butter and dotted with raisins.

Think short. Put healthy snacks at kid level -- keep a bowl of fruit on the counter -- so they can grab them when hunger strikes. Peanuts in the shell are good, too. Kids think they're fun, and the shells keep them (and you) eating healthy amounts (about 20 peanuts), not fistfuls.

Let kids serve themselves. In a Penn State study, children served themselves less and ate 25% less when they filled their own plates than they did when adults doled out the food.

Start a "walking school bus." If you live within about a mile of school, tell your kids you're all going to start hoofing it every morning (it's good for you, too).

Restock the toy chest. Remember balls, bats, Frisbees, hula hoops, jump ropes, skates, sleds, and kites? Active toys can still lure kids away from TVs and Game Boys, especially if you join in (though they may make fun of your batting skills). Spring for video games that exercise more than kids' thumbs. In one study, Dance Dance Revolution helped children burn up to six times more calories than other video games. The Wii sports programs burn calories (and hone skills) by requiring kids to mimic athletic moves: swinging a bat, racquet, or golf club. And when they yell "Next!" -- be in the lineup.