Childhood Obesity

The Journal of the American Medical Association (JAMA) did something very unusual with its June 27, 2007 issue – the entire issue is devoted to children’s illnesses.

It’s no secret childhood obesity is epidemic in the United States. The number of children who are overweight has doubled in the last two to three decades; currently one child in five is overweight. The increase is in both children and adolescents, and in all age, race and gender groups.

How did this happen? If you look closely, the JAMA issue tells us. In the article, Improved Use of BMI Needed to Screen Children for Overweight, the author states that:

"…some physicians feel kind of hopeless about obesity. … They say, 'What can we do, we tell [patients] don’t eat so much and to exercise more. There isn’t a lot more to tell them to help them.'"¹

The article goes on to basically scold the medical profession for not making better use of the BMI, or Body Mass Index, a reliable gauge of body fatness:

"…new research shows that despite recommendations from prominent health groups, pediatricians have not widely adopted the practice. At best, roughly half of pediatricians use BMI percentile measurements to assess overweight, but the figure dips to as few as 6% in some areas. The result is missed diagnoses of overweight and lost opportunities to help pediatric patients maintain a healthful weight and prevent comorbidities."

If we look to "the experts" to keep us out of trouble, we are looking in the wrong place. The American medical profession is more geared to treating disease than preventing it. Thus, doctors get perhaps a mere 6 hours of nutrition in medical school, but entire semesters on drug therapies and surgical procedures. I think it is telling that the advertisement on the inside of the front cover of this issue of JAMA is for Levemir®, a long-acting insulin sold in a handy easy-to-use injection pen.

For the most part, doctors today work in an environment that allows them about 10 minutes for each patient appointment. You can write a prescription in that time, but you can’t do much to help overweight kids - and their parents - understand what is happening and change dietary habits.

The "health" insurance industry does not speak much about prevention either.

And then well meaning groups pile on, like former President William Clinton, who advocates diet sodas in schools. Diet foods often trigger cravings that simply cause you to eat more.

It doesn’t take a rocket scientist to figure out what caused the epidemic obesity in children:

• television and computer use; almost half of children aged 8-16 years watch three to five hours of television a day
• mass marketing of junk food through television ads and movies
• proliferation of fast-food restaurants with food high in trans fats, sugars and processed white flour
• processed food displayed at children's eye level in supermarkets
• the addition of sugar and its addictive chemical substitutes to all manner of food "products"
• school–sponsored sales of junk food and soda at the same time physical education classes and recess were cut
• working parents made home cooked meals a low priority
• fear of child kidnappings which kept children away from outdoor activities

Education alone will not stop this epidemic. There are too many factors at work. In nature, animals know what to eat and what to avoid. Mankind either never did or lost that basic instinct. What we do know is never before have we had such much affluence – the ability to have food – combined with such little need to do physical labor – the couch potato syndrome. Our genetic makeup is hardwired to protect us from starvation. In olden times, the king and the elite members of society may have had expanding waistlines, but not the rank and file citizen. Today, we are all at risk for that expanding waistline and the multitude of health problems that go with it.

Obese children now have diseases like type 2 diabetes that used to only occur in adults. And overweight kids tend to become overweight adults, continuing to put them at greater risk for heart disease, high blood pressure and stroke. Living with type 2 diabetes beginning around age fifty is one thing; living with it from age sixteen is quite another.

I like the way a group of experts writing for The Future of Our Children put it:

"Most agree that the nation has seen dramatic changes in the past thirty years in the ways Americans work, live, and eat. Broad societal and environmental trends have engineered routine physical activity out of everyday life for most Americans and made low-nutrition, energy-dense foods and beverages more accessible, affordable, and appealing than more healthful foods. Although reducing obesity requires changes in behaviors surrounding eating and physical activity, strategies that rely only on individual “self-control” are unlikely to be effective in environments that are conducive to poor eating habits and sedentary activity. This is especially true for children, who don't control the environments in which they live, learn, and play. In addition, children have a more limited capacity to make informed choices about what is healthful and what is not. For this reason, there is a clear rationale for modifying children's environments to make it easier for them to be physically active and to make healthful food choices, thus reducing their chances of becoming obese."²

Children can't change their exercise and eating habits by themselves. They need the help and support of their families. Same goes for adults.

At the Arizona Center for Advanced Medicine, we have such a program for change. It is called . We measure the BMI routinely on all our patients. During the course of the program we measure the BMI twice a month to determine whether muscle mass is being maintained while fat mass is lost. We take time to do lots of hand-holding and education. The program works for children, adolescents and adults. We show you how to choose nutrient-dense foods over calorie-dense foods. We help you plan a do-able nutritional program which will allow both children and adults to lose weight (fat), while maintaining muscle mass. And we hold your hand as you tackle that tough one, exercise – how much, what type, how to do it, and how often. We show you for example what you can do while sitting at your desk during a phone call. The 12-week program gives you the tools to enable you and your children to choose a healthy lifestyle for the rest of your lives.