Pediatric Annals

guest editorial 

THIS ISSUE: Obesity

Steven P Shelov, MD, MS

Abstract

What could be new as we read, once again, about the epidemic of obesity and new onset of type 2 diabetes in children? The facts are increasingly clear, as the accompanying articles detail, that this epidemic that is affecting our children is only accelerating over time. The increasing percentage of the United States (now almost every state) where a significant percent of the population has a body mass index at or above the 85% speak legions as to the widespread nature of this problem. The facts are so replicable, that they need not be repeated to any great extent. The reality surrounds us: all one has to do is keep one's eyes open when you are in public spaces. From recreational stadiums, to theme parks, to walks along the beach, the prevalence of obesity in all age groups is just in plain site.

In addition, the causes of this epidemic have also been widely debated, and will continue to be subject to accusations, counter-accusations, defensive posture by the fast-food industry, soft-drink industry, schools where soft drinks are too readily available, and any number of other involved parties. The sources of potential calorie excess are everywhere. Portion size, excessive transfats, and high-sugar soft drinks are all part of the nutritional environment in which our children are being raised.

Combine this negative nutritional environment with a paucity of exercise opportunities in schools and everyday activities for our children, the combination of excess calories with too little exercise is simply overwhelming to our homeostatic mechanisms to keep weight in reasonable balance. As the adults fare so poorly in this struggle, it is not a surprise that our children, with the combination of genetic predisposition added to environmental risk factors, create an optimum environment for an increasingly obese society in all age groups. With the Westernization of many other countries around the world, with increasing availability of all of the nutritional risk factors we have in this country combined with increasingly sedentary life styles, the prescription for an obese society is crossing all geographic boundaries around the world. All one has to do is visit the major cities of China, for example, as I have done recently, and it is readily apparent that their country is rapidly copying ours with a tendency toward an increasingly obese population.

We, as pediatricians, have a number of different arenas to focus our attention, and I would suggest that we use our influence and expertise in all of them:

1) In the office or clinic, we educate our patients and our staff on optimizing nutrition at every encounter. The American Academy of Pediatrics has recently published a superb manual "A Parent's Guide to Childhood Obesity," which can provide guidelines for such multitargeted educational efforts.

2) In the community setting, there are a number of opportunities. The schools can benefit from expertise in both nutritional and exercise programs. Pediatricians have always been looked to as experts in children's health, and schools provide a perfect series of opportunities to use that expertise and influence.

3) School policies regarding availability and type of school nutritional programs, exercise policies and programs, and after-school nutritional and exercise opportunities are all in need of expert advice. Pediatricians can further expand their influence across all areas where children are engaged. Parents, teachers, school administrators, local legislatures are all eager to do their role in pushing back against this rapidly accelerating epidemic.

4) Many local hospitals have the knowledge necessary, but local public health agencies are always in need of greater expertise. The pediatrician is the logical source of that information.

5) Local media access opportunities…

What could be new as we read, once again, about the epidemic of obesity and new onset of type 2 diabetes in children? The facts are increasingly clear, as the accompanying articles detail, that this epidemic that is affecting our children is only accelerating over time. The increasing percentage of the United States (now almost every state) where a significant percent of the population has a body mass index at or above the 85% speak legions as to the widespread nature of this problem. The facts are so replicable, that they need not be repeated to any great extent. The reality surrounds us: all one has to do is keep one's eyes open when you are in public spaces. From recreational stadiums, to theme parks, to walks along the beach, the prevalence of obesity in all age groups is just in plain site.

In addition, the causes of this epidemic have also been widely debated, and will continue to be subject to accusations, counter-accusations, defensive posture by the fast-food industry, soft-drink industry, schools where soft drinks are too readily available, and any number of other involved parties. The sources of potential calorie excess are everywhere. Portion size, excessive transfats, and high-sugar soft drinks are all part of the nutritional environment in which our children are being raised.

Combine this negative nutritional environment with a paucity of exercise opportunities in schools and everyday activities for our children, the combination of excess calories with too little exercise is simply overwhelming to our homeostatic mechanisms to keep weight in reasonable balance. As the adults fare so poorly in this struggle, it is not a surprise that our children, with the combination of genetic predisposition added to environmental risk factors, create an optimum environment for an increasingly obese society in all age groups. With the Westernization of many other countries around the world, with increasing availability of all of the nutritional risk factors we have in this country combined with increasingly sedentary life styles, the prescription for an obese society is crossing all geographic boundaries around the world. All one has to do is visit the major cities of China, for example, as I have done recently, and it is readily apparent that their country is rapidly copying ours with a tendency toward an increasingly obese population.

We, as pediatricians, have a number of different arenas to focus our attention, and I would suggest that we use our influence and expertise in all of them:

1) In the office or clinic, we educate our patients and our staff on optimizing nutrition at every encounter. The American Academy of Pediatrics has recently published a superb manual "A Parent's Guide to Childhood Obesity," which can provide guidelines for such multitargeted educational efforts.

2) In the community setting, there are a number of opportunities. The schools can benefit from expertise in both nutritional and exercise programs. Pediatricians have always been looked to as experts in children's health, and schools provide a perfect series of opportunities to use that expertise and influence.

3) School policies regarding availability and type of school nutritional programs, exercise policies and programs, and after-school nutritional and exercise opportunities are all in need of expert advice. Pediatricians can further expand their influence across all areas where children are engaged. Parents, teachers, school administrators, local legislatures are all eager to do their role in pushing back against this rapidly accelerating epidemic.

4) Many local hospitals have the knowledge necessary, but local public health agencies are always in need of greater expertise. The pediatrician is the logical source of that information.

5) Local media access opportunities are often in need of material for their daily programs. Pediatricians can speak on this important topic of obesity and type 2 diabetes and influence an even wider audience on the importance of changing our nutritional opportunities for children and encouraging exercise as a regular activity.

The articles in this issue are meant to provide the background data that pediatricians can use to craft their own messages, modified depending on the audience. The American Academy of Pediatrics remains another excellent source. Working with the communities we live and practice in, we can begin to shape a global response at all levels to begin to push back against this accelerating problem, which has the potential to affect our global civilization for decades to come.

10.3928/0090-4481-20070201-02

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