Fat
Chance
Health Toll of Childhood Obesity Carries Lifelong Implications
Scientists by nature tend to take a calm, measured approach to new data. But
Dr. Catherine Davis, assistant professor of pediatrics at the Medical College of
Georgia, acknowledges that a recent medical development “knocked our socks off.”
The development was the sudden emergence of children showing up in doctor’s offices with type 2 diabetes.
That’s type 2. The adult version. Or so scientists thought, until a generation of overfed, under-active children caused them to rethink conventional wisdom about lifestyle-related diseases.
“Parents need to awaken to the fact that being overweight in childhood isn’t just an appearance issue,” says Dr. Davis. “It’s a health issue, and a big one.”
Results from a 1999-2002 National Health and Nutrition Examination Survey indicate that about 16 percent of U.S. children and teens are overweight -- a staggering increase in the space of a single generation. Widen the lens and the picture turns even gloomier.
“Up until around age 2 or 3, the best predictor of obesity is whether the parents are obese,” says Dr. Harold Snieder, associate professor of pediatrics, noting the grim implications considering that about 65 percent of U.S. adults are overweight.
By age 5, he says, a child’s body mass index becomes the best predictor of future obesity. In other words, baby fat is a misnomer for kindergartners. Barring significant lifestyle changes, an overweight
5-year-old is primed to become an overweight adult— a concept bolstered by the research of Dr. Miguel Zuniga, director of MCG’s new public health program in informatics, whose longitudinal study of migrant workers in Texas showed that overweight 16-year-olds tend to stay obese for the rest of their lives.
MCG’s Georgia Prevention Institute has been at the forefront of documenting the myriad health problems associated with childhood obesity -- including early stages of diseases once thought confined to adulthood, such as hypertension, heart disease and type 2 diabetes.
“Only in the last couple of years have we changed strategies in grant proposals,” says Dr. Gregory Harshfield, associate director of the GPI. “Before, we focused on obesity-related risk factors in children. Now, we know the diseases are already there. The prevalence of hypertension in children has risen as high as 7 percent in some communities. The more we look at the underlying physiology, the better we’re understanding how obesity affects the body even at a very young age.”
The
MCG researchers cite all the usual suspects in identifying causes of a childhood
obesity epidemic, chiefly sedentary lifestyles and high-fat, high-calorie diets.
“Studies indicate that some kids start drinking soda when they’re 7 months old,” says Dr. Snieder. “That’s astonishing.”
But they stress that pat explanations are overly simplistic. For instance, the best parenting in the world can’t silence the din of media messages that relentlessly lure children to junk food while simultaneously presenting extreme thinness as the body ideal.
Likewise, it’s easy to chide parents for feeding their children highly processed foods until considering that their finances might preclude healthier choices such as fresh fruits, fish and lean cuts of meat. Finances notwithstanding, a perpetual time crunch is the decisive factor for countless families when golden arches beckon.
Dr. Christian Lemmon, associate professor of psychiatry and health behavior, also bemoans nutrition charts and other information that is virtually indecipherable to many parents. “A lot of people don’t know how to read nutrition facts and make sense of them,” he says—a problem exacerbated by slick marketing.
“Walk down a grocery store aisle and you’ll see sugar-filled candy bars labeled low-fat,” Dr. Davis says, rolling her eyes in exasperation.
“And ‘sugar-free’ usually means the sugar is being replaced with fat,” notes Dr. Paule Barbeau, assistant professor of pediatrics.
Also, it’s easy to counsel parents to increase their child’s activity level -- until considering associated costs and safety concerns. If the family budget has no room for hockey equipment, and if violence permeates the neighborhood, parents often choose a couch-potato lifestyle as the lesser evil for their children. Dr. Lemmon notes other societal factors, such as latch-key childhoods, that prompt children to eat in response to factors other than hunger, including boredom, stress and loneliness.
With so many factors conspiring to make American children fat, “the best thing we can do is focus on prevention,” says Dr. Reda Bassali, associate professor of pediatrics. “I talk to parents about nutrition at every single visit.”
He adds, “We also know that cutting TV time helps. If parents do nothing else but limit television-viewing to two hours a day, we see positive results.”
Dr.
Barbeau emphasizes the importance of working with schools, a collaboration
heartily embraced by the GPI. A recent GPI study documented the benefits of an
after-school exercise program, an initiative now being expanded by training
teachers to take the lead.
Dr. Zuniga worked on an elementary school project providing teachers with pedometers and a walking trail to encourage exercise at school and model the behavior for children. (See related story "Parents' Example Sets Stage for Life of Service")
Dr. Davis has received National Institutes of Health funding to document the cognitive benefits of exercise, which should help educators recognize that academic success and physical fitness go hand in hand. Drs. Bassali and Lemmon also believe based on their clinical practices that higher activity levels will lower rates of childhood depression and other emotional problems.
Dr.
Harshfield lauds MCG’s efforts in playing a leading role to address the problem
of childhood obesity. “MCG makes great efforts to bring together different
specialists -- pediatricians, researchers, psychologists and others -- to
address the problem. Having worked at several other institutions, I know that
this is a very unique, exciting opportunity.”
Still, Dr. Lemmon cautions that the health care field at large needs to build more bridges to ensure comprehensive, multidisciplinary treatment for these children, whose obesity portends huge societal costs. The CDC estimates that medical expenses associated with obesity account for 9.1 percent of total U.S. health care costs, or upward of $100 billion. Factor individual suffering and disability into the mix and it is unconscionable -- and highly unwise -- or society to be indifferent or unaccommodating at a point when the trend can be reversed, Dr. Lemmon says.
But he and his colleagues sense the public is getting the message -- and
responding. “I think the tide is shifting,” Dr. Barbeau says. “We’re starting to
see legislators get involved, proposing legislation to address this huge
societal problem. It’s on people’s radar screens.”
Dr. Snieder agrees. “I think we’re seeing a change in mentality like the one we saw with smoking. It has to become much easier to exercise like it became much more difficult to smoke when society began to understand the health implications.”
“The issue of smoking became a cautionary tale, and we learned a lot from it,” Dr. Davis says. “I’m hopeful the lessons we learned will make us much faster and more efficient in responding to this health crisis. And that’s just what this is: a crisis.”
--Christine Hurley Deriso
What's a Parent to Do?MCG experts agree there are no easy
answers to curbing childhood obesity,
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