A Legacy of Harm: Childhood Obesity
For the first time in American history, our youngest generation of children will have a poorer life expectancy than that of their parents. As we have failed ourselves, we have failed our children. In 1960, then President-elect John F. Kennedy lamented about American’s fitness in an essay for the December 26th issue of Sports Illustrated entitled “The Soft American.” Kennedy’s proposed program included four parts:
1. A White House committee on health and fitness
2. Direct oversight by the Department of Health, Education and Welfare
3. An annual Youth Fitness Congress
4. The assertion that physical fitness was very much the business of the federal government
Then, about 32 percent of adults were overweight and 13 percent were obese. Four percent of children were obese between 6- to 17-years-old. In the 1970s, 6 percent of children were obese, and now it’s about 18 percent with currently about another 15 percent being overweight. The statistics vary from source to source, but all numbers are rising on a yearly basis.
Obese children have at least a three-fold higher risk of hypertension and their risks increase across the entire range of BMI values. A combination of factors, including insulin resistance and abnormalities of cardiovascular function, contribute to obesity-related hypertension. Research by the Bogalusa Heart Study indicated left ventricular mass is related to “ponderosity.” Fat mass and systolic blood pressure are significant predictors of left ventricular mass (LVM). A study of 115 children undergoing evaluation for hypertension had an increased LVM associated with higher BMI’s. Obesity in childhood and adolescents is associated with multiple cardiovascular risk factors with the highest risk occurring in overweight African-American girls.
“In the 1970s, 6 percent of children were obese, and now it’s about 18 percent with currently about another 15 percent being overweight”
Obese children are at risk for a number of adverse conditions including high cholesterol, earlier heart disease, type-2 diabetes, bone and joint problems, and skin conditions such as heat rash, fungal infections and acne. These problems, for some, pale compared to the affects obesity has on a child’s psyche, levels of depression, school absences, poorer earning capacity, feelings of inferiority, and a lower chance of dating or future marriage.
We physicians have not done enough to stop and reverse the ever-growing national and worldwide epidemics of obesity, type-2 diabetes, and related diseases and disabilities. There is hope however, if we look in the right direction.
Breast-fed children have a lower incidence of obesity even as they age into adulthood. Female infants that are breast-fed have a lower incidence of breast cancer as they grow into adult women. Why should we care? Obesity and all of its ramifications adversely affects and likely kills more humans collectively than any other causes of death in America.
The time has come to rethink what we physicians and researchers must do.
Preventing obesity during the weaning process and after breast-feeding may begin with introducing babies to natural foods while avoiding most processed foods. Providing fresh fruits several times per day along with fresh, cooked vegetables, limited whole grain food choices, and chicken, turkey, fish, lean meats, or eggs may be the path of the future for all children. Children must have their own diet. Never introducing a child to cookies, cakes, candies, sweets, ice cream, sugar-sweetened beverages, and other sugar-laden, processed confectionaries would likely prevent a “sweet tooth” from evolving. Parents create their child’s taste for sweets. It does not come to them naturally since in nature, with few exceptions, true sugar re-enforced foods do not exist. It is time to stop poor nutrition by restructuring the diet of babies upon weaning and young children who are too young to know the difference.
“On average, school-age children today use electronic media for 7.5 hours per day”
This precedent in changing diet patterns may spell the beginning of the end for obesity when coupled with daily exercises that are natural for all children who love to race around their homes, yards, and fields by themselves or with friends. We need to change our thinking to benefit the very young so they will not develop the same food tastes or sedentary lifestyle that we have grown used to. It may not save the rest of us, though it will become the foundation of a future of normal weight children for all generations to come. This may sound over the top, though feeding children high-sugar and high-fat diets may be akin to a form of parental negligence when we now realize how nutritionally dangerous these types of foods become over time to the development of obesity, diabetes and serious diseases.
Some believe that obesity and childhood obesity is primarily a genetic problem. After over 20 years of research in childhood and adult obesity, it is my opinion that genetics play a limited, if any, roll in obesity. Sure obese adults are more likely to have obese children because obese children tend to mirror their parents in levels of activity and eating patterns. Having said that, not all children of an “obese family” will be obese or even overweight. Obesity, based on my research and observations, for the majority of people is primarily a function of a sedentary lifestyle. Over the past 170 years, our calorie counts have consistently gone down as our BMI’s have increased. Women of the 1850s ate an estimated 3000 calories per day and had apparently normal BMI levels based on photographs of that era. Women today eat between 2000-2200 calories per day, and 70 percent are overweight or obese. Lumber Jacks of the 1890s cutting down trees with axes and handsaws ate about 8500 calories per day. They were normal in weight. Men today eat about 2400 calories per day and most are overweight or obese due primarily to a lack of physical labor or activity. Michael Phelps, the Olympic champion, swam laps in a pool for six hours per day. He estimated that his intake was about 12,000 calories per day.
On average, school-age children today use electronic media for 7.5 hours per day. They are consumed by computers, cell phones, TV, electronic games, and who knows what other future gizmos will surface to steal their bodies from exercise and fitness. Most children have no exercise regimens of any kind. They are drowning in a sea of electronic babysitters. Parents must ban the “tronics” for two or more hours each day insisting on outside or alternative activities associated with fitness and exercise. Our schools must do even more.
Obesity and weight problems for adults, adolescents, and teens are in my opinion due primarily to a sedentary lifestyle coupled with high-calorie, high-fat and high-sugar food choices. Our current diet is not a natural diet as was intended by nature and evolution. It appears that our life expectancy is being reduced by our daily poor “food” choices. Some may call this evolution though I would call it “inverse-olution.”
“In 1969, 40 percent of children walked to school. Now only 12 percent walk”
What can be done about reversing this trend? It begins with educating parents and asking all physicians at every level of our profession to promote healthy exercise and sound food choices. All physicians see obesity-related medical problems in their practice on a daily basis. It is not enough to say, “Eat a better diet and start exercising.” Those inadequate methods have not and will not work. We must do a great deal more. The epidemic of obesity at all ages, for all races, and for all nationalities continues to increase worldwide with no end in sight.
Let’s begin a major nationwide multi-pronged effort to stop obesity and related diseases in their tracks. It is not enough to have parents alone take action since much of our children’s lives are not spent at home but they are spent in school.
Our school systems have a broader responsibility in today’s society, and it is about local governments taking charge under the direction of school boards of education.
To begin with, let’s look at how children arrive at school. In 1969, 40 percent of children walked to school. Now only 12 percent walk. The rest are driven by someone or take a school bus. I walked two miles to school everyday and another two miles back. Those exact same routes are now frequented by school buses. Talk about losing an opportunity to help fix the problem of childhood obesity. Our schools and local governments must do more.
Schools and taxpayers must contribute major resources to solve these serious, life-threatening problems or all other efforts will fail. At the end of the day, taxpayer’s money will be recovered through improving their children’s lifestyle and decreasing their exposure to preventable diseases and higher medical bills.
School boards must overhaul the curriculum to mandate “class time” each day for physical exercise, physical education, and sports options to include all students K-12. In some cases, the school day will have to be lengthened to accommodate the need for physical fitness, gym classes, or other activities to reverse our sedentary lifestyles. But that is not enough. Children should also participate in after-school sports or intramural activities of some form. After-school sports and physical exercise must become a reality for all students.
“In 2001, the Surgeon General’s “Call to Action to Prevent and Decrease Overweight and Obesity” identified a key public health priority for the United States has gone unanswered as the rates of obesity among our children and adults continues to escalate beyond all reason”
Classes in nutrition, cooking, and healthy food choices must all become required for all students at least on a weekly basis from grades K-12. Good nutrition is not intuitive for most, though it is not as complicated as some would have you believe. It boils down to eating what “Adam and Eve” would have eaten. Has anyone seen in nature a bread tree, a cookie bush, an ice cream lake or a pudding pond? As time goes on, processed foods should become a thing of the past. Processed meats, such as bacon and sausage, are now believed by some to be linked to pancreatic cancer. School cafeteria menu’s must reflect natural choices and severely restrict high-fat and high-sugar options.
African-American children are more likely to become obese than are white children, and African-American women are more than 50 percent more likely to be obese than white women. Obesity rates are above average among Mexican American boys. Obesity rates among American Indians tend to be nearly twice the national average. Causation remains a mystery for some because few have looked at the big picture. For example, poorer neighborhoods have fewer supermarkets and more fast-food franchises per capita. Foods sold at convenience stores in the inner cities tend to be of poorer quality and involve more processed foods, rather than fresh fruits, vegetables and good quality meats. The big picture is not pretty.
In 2001, the Surgeon General’s “Call to Action to Prevent and Decrease Overweight and Obesity” identified a key public health priority for the United States has gone unanswered as the rates of obesity among our children and adults continues to escalate beyond all reason. The epidemics of obesity and related diseases must not be ignored. All of us must step up to the plate and deliver a message to our parents, school systems, councilmen, mayors, governors, representatives and senators to take action. We are drowning in preventable diseases, costs, medical insurance and other financial excesses that must be addressed.
It is time that we start looking at this healthcare crisis as we have looked at the challenge of defeating cancer and heart disease. The problems of obesity and related diseases are likely more troublesome in their costs in lives and disability, yet they are also more approachable as we look at the big picture and begin now to reverse the trend of ever-growing numbers of obese children and adults. We need to organize a major congress for “The Fitness of Youth” inviting those of us who will work together to develop effective answers to defeat the tenacious problem of childhood and adult obesity around the globe. Defeating obesity must begin with our newborns and youngest children who have not yet been tarnished. Healthy children with proper guidance will usually become healthy adults.
All of us who believe in the future of sound health and practical solutions will begin the journey to defeat obesity among the world’s youth, and of course, this will cross over into the management of adult obesity as well. Obesity is less frightening to most of us than are cancers and the suddenness of myocardial infarction. That is why obesity has been given a pass. The Cleveland Clinic has identified over 30 co-morbid conditions that may occur in the severely obese individual.
The time to pass on obesity is over.
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