Spanish teenagers are significantly weaker today than two or four decades ago, pediatric specialist Dr Fernando Zárate has warned.
Zárate, director of the School Cardiovascular Health Program (Pesca) and specialist at Hospital Quirónsalud Sur and Hospital Quirónsalud Toledo, highlighted research showing that muscular strength and aerobic capacity among minors have fallen sharply across Spain.
In a national study published last year involving more than 3,000 children and adolescents, Zárate and his research team established updated national reference values for muscular strength using dynamometry. Comparing these measurements with Spanish data published 20 and 40 years ago confirmed a significant decline in adolescent physical strength.
Zárate stated that the primary enemy driving childhood obesity in Spain is an environment that promotes physical inactivity and a diet increasingly based on ultra-processed foods. He noted that young people are exercising much less and at a lower intensity than in previous decades.
Official figures show that 30 per cent of Spanish minors are overweight and eight per cent suffer from obesity. While recent data suggests childhood obesity rates may be stabilizing or slightly decreasing, Zárate cautioned that overall excess weight continues to climb, affecting more than 35 per cent of children.
Hospital Quirónsalud Sur and Hospital Quirónsalud Toledo are major medical facilities in central Spain providing specialized pediatric care. Excess weight in childhood conditions long-term health, significantly increasing the risk of developing obesity, type 2 diabetes, and cardiovascular disease in adult life.
Early organ damage and childhood health risks
Zárate expressed particular concern over seeing target organ damage at increasingly younger ages. He reported treating children aged eight or nine who already suffer from fatty liver disease or insulin resistance.
Fatty liver disease involves excess fat accumulation in liver cells, while insulin resistance impairs how cells respond to the hormone regulating blood sugar. Both conditions are major precursor markers for metabolic syndrome and early-onset cardiovascular complications.
Describing childhood obesity as an iceberg, Zárate explained that excess weight and body fat are merely the visible portion above the surface. Hidden beneath are early metabolic disruptions and potential deteriorations in mental health.
He added that the heart is fortunately among the last organs to suffer damage in children. Consequently, the medical challenge is to identify early warning signs and intervene before cardiovascular disease manifests.
Addressing the balance between calories and exercise, Zárate noted that both factors are highly damaging and reinforce one another. Inadequate calorie consumption often begins before two or three years of age, disrupting metabolism, while a sedentary lifestyle lowers basal metabolic rate, leading to visceral fat accumulation and physical deconditioning.
School health programs and canteen regulations
To tackle these risks, Zárate established the School Cardiovascular Health Program, known as Pesca, in 2018. The initiative brings early diagnosis, prevention, and overweight management directly into primary and secondary schools.
The Pesca framework integrates three diagnostic dimensions of cardiovascular health: anthropometric measurements such as body mass index, pathophysiological assessments of body composition, and functional testing of muscle strength. The program coordinates efforts among families, physical education teachers, school canteens, and pediatricians.
Zárate revealed that nearly 90 per cent of parents of overweight children view their child's weight as normal. Since 2018, Pesca has evaluated and provided individualized diagnoses for nearly 3,000 children, successfully reducing overweight prevalence, increasing physical activity, and proving that cardiovascular prevention can operate within school environments.
Zárate also addressed European Union regulations aimed at reducing meat consumption in school canteens. While substituting meat with fresh, high-quality plant proteins offers an excellent alternative, he warned against replacing meat with mass-produced ultra-processed plant products such as pre-packaged vegetarian meatballs.
European health guidelines encourage member states to promote sustainable diets in public institutions. However, food processing that relies on industrial additives, refined oils, and sodium can negate the nutritional benefits of plant-based meal plans.
Zárate emphasized that regulators must prioritize fresh, minimally processed foods with high nutritional value. He stressed that permitting ultra-processed items on school lunch menus contradicts the guidance pediatricians give families to avoid ultra-processed foods at home.
Parental guidance and healthy breakfasts
Offering guidance to parents dealing with children who express hunger after eating multiple snacks, such as two bananas, Zárate advised that healthy habits require education and learning to set firm boundaries by saying no.
Zárate recommended building healthy breakfasts around fresh ingredients such as fruit, plain natural yogurt, eggs, nuts, tomatoes, olive oil, and whole grain bread or cereals. He urged families to eliminate sugary cocoa powders, refined breakfast cereals, and industrial pastries from morning meals.
Zárate concluded that childhood health should hold equal priority with general education, emphasizing that early cardiovascular screening and habit building remain essential to protect children throughout their lives.
