Killer at Large

I never thought the word "Killer" would be in a title of one of my posts, but it is befitting the content. There is a new film directed by Steven Greenstreet. In 2005, Greenstreet directed the award-winning documentary "This Divided State" which chronicled the furor over Utah Valley State College's decision to bring Michael Moore to speak on campus in the days before the divisive 2004 presidential election.

This film, exposes the details of the American obesity epidemic. And it looks specifically at childhood obesity.

It serves as a call to arms for concerned parents, school districts, and entire communities who have empowered themselves to take a stand and reverse this deadly trend which is set to cripple our entire nation's health care system and bankrupt our economy within the next twenty years.

An interesting thing about this film is that 3 twenty somethings produced this film out their 6x8 studio apartment. This interview, tells alot about the filmmakers and the project. Kudos to these young guys.

Hopefully, Killer at Large, will serve as a catalyst to bring the issue of childhood obesity into the forefront so there can be more dialogue and positive steps to attack this problem.

It is being submitted to 30 Film festivals and is supposed to be released in early 2008. I'll be keeping an eye out for it.

Childhood Obesity Revisited

The other day, my kids reminded me of the dessert policy I instituted when they were young. They could choose to either have: 2 small items, like two cookies, or 8 M&M’s. Don’t ask me how I came up with this crazy formula. But I do remember firmly adhering to it and except on special occasions they knew never to even ask for special dispensation.

When they were too young to know any differently, there were no sweets or junk food in our house, at least not for them. As they got old enough to know better, I declared that complete abstinence would create cookie monsters, so “that food” became permissible but only in a natural, controlled rhythm. I do admit to sometimes finding empty candy wrappers and chip bags under couch cushions and under beds, but I allowed these digressions to pass without confrontation. I attributed it to youthful spunkiness and small acts of rebellion - allowing the guilty parties to believe that they had gotten away with something. Instead, maybe it should have been my wake up call.

By the time my kids became adolescents, they could easily have been labeled “chunky”, or “full”, or dare I say, overweight? Although I knew they weren’t skinny, they were very active, avidly playing all kinds of sports and most importantly, they had great self esteem, lots of friends and definitely no body image issues. Today, when I look back at their pictures they were definitely “overweight”. Back then I grappled with how to deal with the problem. Or was it a problem? They were far from obese, lead busy, active lives and quite honestly were very happy. The last thing that I wanted for my kids to believe was that their size mattered. Who's problem was it really?

So we framed it with discussions about eating healthy and the importance of being fit. We always had healthy meals and rarely ate fast food. Removing the sweets and chips from our cupboards was not the answer. I believed that teaching my kids how to eat in moderation and to enjoy food - every type - was a life skill they needed to learn. Removing temptations, instead of learning how to manage them, is no way to enjoy life. Perhaps this approach was a leap of faith, and either it worked or they just grew out of it. As they passed through adolescence, they eventually shed their extra weight.

But how would have I felt if their pediatrician actually labeled them “fat” to their faces at their annual physicals? I am positive I would not have welcomed this harsh reality check. Not only would I have been insulted, I never would have condoned such callous and insensitive behavior from our pediatrician. The American Medical Association has recently proposed such a recommendation:

"We need to describe this in medical terms, which is 'obesity.' When we talk to an individual family, we can be a little more cognizant of their feelings and more gentle, but that doesn't mean we can't discuss it," Washington said. "The evidence is clear that we need to bring it up."

In our ambitious attempt to confront these important issues, physicians still need to be mindful of the power in which they are vested. All adults, for that matter, cannot underestimate the potential damage their words can cause. Stigmatization can do as much harm to children as their overweight bodies. All my kids are average weights now. But they each have gone through different weight phases in their short lives. Had there been intervention by a teacher, a physician or even the government it may very well have had a detrimental affect on them. Who is to say what the best practice is?

It is crucial that we act on the obesity epidemic in our country. However, this call for action needs to be balanced ever so carefully with our responsibility to protect our young people from living a lifetime of never feeling good enough unless they are a size 2 or flaunt a sculptured body of muscle and fine lines. It’s a balancing act on a tightrope that requires master skills to gently make the way unfailingly across that wire or we risk raising an entire population of unhealthy as well as unhappy adults.

Children deserve time to be kids and to not feel like failures because they are overweight - especially when it’s not their fault. Parents, media, schools, economics and social factors are what is responsible for who they are and who they will become. They deserve to be healthy and to have a chance at living happy, normal, productive and fulfilling lives. Fixing the obesity problem in America is far more challenging than we may even begin to imagine.

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.