There is a lot of concern in the medical community about the epidemic of obesity in children. Fat kids usually grow up to be fat adults. Also, fat kids are increasingly being diagnosed with Type 2 diabetes, a disease that used to occur almost exclusively in middle-aged overweight adults. The concern is not only that these children will have to take diabetes medications to control their blood sugars, but also that they will develop all of the complications of diabetes (such as heart disease, stroke, amputations, renal failure, and blindness) while still quite young.

Childhood obesity occurs in both boys and girls. It impacts well-to-do and middle-class families as well as families living in poverty. Although certain ethnic groups are disproportionately affected, such as Hispanics, African Americans, and Native Americans, childhood obesity is being seen in all kinds of people. Our kids, like us adults, are suffering from too many calories consumed and not enough calories burned.

We are already starting to see the medical complications of obesity in children. About 60% of obese children, aged 5-10 years—let me repeat that, aged 5-10 years—have at least one cardiovascular disease risk factor, such as high cholesterol, high triglycerides, elevated blood pressure, or insulin resistance. Twenty-five percent (25%) of obese children have two or more risk factors. The short-term risk of developing overt cardiovascular disease increases as the number of risk factors pile on.

It is estimated that boys born in the U.S. in the year 2000 have a 30% chance of developing Type 2 diabetes during their lifetime; girls have a 40% chance. Think of that: One in 3 boys and close to half of girls who are now in kindergarten will become diabetic at some point in their lives.

Many experts are predicting that the epidemic of childhood obesity will wipe out all of the gains in life expectancy over the last century that occurred as a result of eliminating childhood infectious diseases, such as polio, whooping cough, and measles. Our kids and our grandkids could have shorter life expectancies than we do. In the year 2006, with all of the advances in medical knowledge and treatments, how heartbreaking it will be to lose ground because of too much food and too little physical activity.

Although the cause of childhood obesity can be glibly distilled down to an unfavorable energy balance, the reasons why kids are eating more and exercising less are actually quite complex and involve multiple factors. The Institute of Medicine has published a review of the topic called Preventing Childhood Obesity, Health in the Balance. The authors of this book describe multiple, often intersecting societal changes that contribute to variable degrees to the development of childhood obesity:

  • Changes in family life (more working mothers, fewer meals prepared from scratch, more meals eaten in restaurants)
  • Increased ethnic diversity (differences in susceptibility to obesity, Type 2 diabetes)
  • Unfavorable eating patterns (high calorie, low cost, highly palatable foods—think french fries) readily available all hours of the day, every day. Portion sizes have increased so that it is quite possible to ingest an entire day’s calorie requirement in a single sitting)
  • Limited physical activity (less PE at school, lower participation in physical activity after school, fewer kids walking to school—or anywhere else for that matter)
  • Ready availability of electronic media diversions (more time spent watching TV, playing video games, or surfing the internet)

The surgeon general of the United States, Richard Carmona, MD recently called the epidemic of obesity “the terror within”. He went on to say that “unless we do something about it, the magnitude of the dilemma will dwarf 9-11 or any other terrorist attempt.” He declined support for public policy reforms stating that “common-sense health decisions cannot be legislated.” I think he is wrong. Legislation and regulation can help.

Just as the cause of childhood obesity is multifactorial, the solutions will similarly involve multiple changes in both our private lives and in our public approaches to the problem. Successes in the realm of public health, such as the reduction of infectious diseases and cigarette smoking, required more than individuals being personally responsible. Public policies, such requiring vaccinations to attend school or banning smoking in public places, have created environments that support and enhance personal actions. Both types of interventions are necessary to change social norms.

Thirty years ago, the norm was smoke-filled restaurants. Today, in many states, restaurants, and even bars, are smoke-free. The norm today is easy to access high-calorie fast foods in our neighborhoods, our schools, and our workplaces. I suspect when we really get serious about the obesity epidemic, we will have to embrace public policy reform, and, yes, even some regulations that create fast food free zones for our kids. We may even have to require them to participate in some sort of vigorous daily exercise at school. It will not be fun. It will not be without a fight. The beauty of our American democracy is that we can have this public debate.

I firmly believe that if our kids and grandkids and their kids and grandkids are to enjoy long lives largely free of chronic illness, we will have to invoke both personal responsibility and institute public policy reforms to create a society that expects, indeed demands, a health-supporting environment. I am ready to engage in the effort…are you?