Childhood Obesity - A Threat to our Public Health

About 33% of US children and adolescents between the age of 2 and 19 years old are overweight and 17.1% of those are obese

“If we don’t take steps to reverse course, the children of each successive generation seem destined to be fatter and sicker than their parents.” Dr. David Ludwig made this statement in an editorial he wrote in a recent issue of the New England Journal of Medicine, in response to the findings of two published studies of childhood obesity. Both studies looked at the effects that childhood obesity will have on the future health of overweight children. One study followed 277,000 Danish students for decades by evaluating detailed health records. The study found,

…the more overweight a child was between ages 7 and 13, the greater the risk of heart disease in adulthood. The older the children are, the higher the chance for later heart risk. So, for example, a boy who was heavier than his peers at age 7 had a 5 percent increased risk for later heart disease, but a boy who was heavier than his peers at age 13 had a 17 percent greater risk.

If these findings aren’t startling enough, there’s more. The most obese child in the Danish study was at a 33% greater risk for heart disease in adulthood. Yet, the fattest boys in the entire Danish sample are barely considered overweight by US standards. Barely considered overweight by US standards! Think about the implications of that finding. This means that the risk for adult heart disease for Americans is most definitely even greater than 33%.

Now combine this information with the findings out of UCSF which state that:

if the number of overweight children continues to increase at current rates, then by the year 2035, the rate of heart disease will rise to 16 percent or as many as 100,000 extra cases of heart disease attributable to childhood obesity.

Although it may not seem like it now, it won’t be long before we are standing on the threshold of a Public Health crisis. The economic costs of this strain on our health care system will be enormous. A surge in serious illness (and obesity also increases the risk for Type 2 diabetes, kidney failure, limb amputation and premature death) translates into lower worker productivity, job loss and in the end a dying economy.

Pretty bleak forecast and in the meantime, not a lot is being done to turn this crisis around. Our kids continue to lead more sedentary lives, snack on junk food, eat fast food for meals, be inundated with ad campaigns for these dangerous foods and then be served them in their school cafeterias.

I don’t mean to say that nothing is being done to attack this epidemic. The State of Arkansas began a health report card for all students in grades K -12. At the end of every year students are sent home with a report their weight, BMI etc. Apparently there have been some positive results. When the fact that their child is overweight is staring them in the face some parents and kids take action; however, the program is purely elective, so it is unclear which families are opting in and which families are not being counted.

School systems have instituted nutrition and exercise programs with some success. For example, a research group, The Healthier Options for Public Schools, followed 3700 students in a Florida county over 2 years. School districts instituted an intervention program in 4 schools and the results were measured against two schools that did not have a program. The intervention program included dietary changes, increased exercise and nutrition awareness. There were dramatic changes in the kids who had intervention, however, when those students returned from summer vacation, most had reverted back to their old habits.

The good news is, that with education, changes in lifestyle and healthful diets, this trend can be reversed. The broader and more daunting question, is how? When the cost of healthy eating is often too high for low-income families and fast food has become the norm because families are too busy to sit down for a meal, and our entire population has become sedentary, it appears that we are doomed to fail our children. The issues are economic, cultural and political. But if we do not create a comprehensive national strategy to attack this problem, it will soon be too late.

We have in our communities a perfect storm that will continue to feed the childhood obesity epidemic until we adopt policies that improve the health of our communities and our kids," Frank Chaloupka, an economics professor the University of Illinois at Chicago.

So what do we do? There are countless competing issues. On the one hand, we have a culture that is unhealthy and overweight and on the other hand we have a “body image” obsessed society. There are issues of self esteem, bullying, and stigmatization attached to obese kids yet we also want to teach our kids to like themselves for who they are and not for what they look like. The one thing is clear, however, we cannot stay on this trajectory and if we do we will be doing a terrible disservice to this future generation.