Like global warning, that our youth (especially among minorities) are experiencing an epidemic of obesity, or overweight, cannot really be disputed. The diagnosis is not difficult, but the therapy is not simple and is resource intensive. When successful, the payoff from instituting a comprehensive treatment for this problem can be rewarding and beneficial for the long-term health of the individual child. The complications are well documented, the epidemiology quite clear, the pathophysiology complex but becoming more clear, but the therapeutic approaches that offer a reasonable chance of success have not been very obvious to me.
The details of Comprehensive Behavioral Treatment of overweight children are spelled out very well in the article by De Santis-Moniaci and Altshuler in this issue of Pediatric Annals. These authors review the literature concerning comprehensive therapy that combines diet, exercise, behavioral change strategies, and family participation. The last two components appear to be important for success, with behavioral change strategies that include the techniques of stimulus control and self-monitoring particularly important.
How to pull off these kinds of interventions in the context of the busy pediatrie office setting and current medical economic environment is not quite so clear, but understanding the kinds of interventions that can be effective, and the kind of assistance that psychologists or social workers can provide are important first steps to creating a model that can be effective and practical.
I have chosen a potpourri of stamps for this issue, as there really are not stamps that directly address the topic of this month's Pediatrie Annals. The horizontal stamp fromArgentina (see page 73) showing the knotted cigarette is in celebration of World Day without Tobacco 2006, certainly a noble goal. The blue French stamp of 2005 honors handicapped people. The yellow and brown Irish (Eire) stamp from 2006 depicts a seeingeye dog and even has some Braille letters imprinted at the top left The red and yellow 2005 stamp from Macedonia (see page 72) reminds us of tuberculosis. The blue and white Spanish stamp of 2005 is in honor of the effort to fingerprint newborns in that country, as well as the 76th anniversary of modern Spain.
Lastly is the 2003 Italian stamp (see page 72) that depicts an open book, which is of Bernardino Ramazzini (1633-1714) and entitled De Morbus Artißcum Diatribe. This was the first systematic work related to occupational diseases, published in 1700 in Modena. Dr. Ramazzini was a professor at Modena from 1682 to 1700 and at Padua from 1700 to 1714. He utilized the skills of the astute clinician and of the new field of epidemiology to observe that certain ailments were associated with certain occupations. He was the first to recognize the pneumoconioses, for example. He was against the use of phlebotomy, which was highly popular in his time, stating, "It seems as if the phlebotomist grasped the Delphic sword in his hand to exterminate the innocent victims rather than to destroy the disease." Relevant to the topic of this issue of Pediatrie Annals, he believed that it was the duty of the physician "to exhaust himself in infinite examinations, in continual experiments, to try to resolve the greatest as well as the most insignificant medical problems."