Childhood Obesity Epidemic a Long-Term Challenge

THURSDAY Sept. 20, 2007 -- In the 1980s and '90s, Americans tried to control their weight by watching their cholesterol by cutting dietary fat and substituting carbohydrates. They paid little mind to total calories and physical activity. And guess what happened to their waistlines -- and their children's?

"It was just an end run around the issue of health maintenance," said Dr. Henry C. McGill Jr., senior scientist emeritus at the Southwest Foundation for Biomedical Research in San Antonio, Texas. "And, of course, it crept over into kids, especially kids subjected to all of the advertising and offerings of high-density caloric food -- opportunities to avoid physical activity, attractions to television viewing and net surfing."

Today, more than one in three children and adolescents in the United States -- some 25 million kids -- are overweight or obese, according to the Robert Wood Johnson Foundation, which recently announced an unprecedented effort to reverse the childhood obesity epidemic by 2015. The Princeton, N.J.-based philanthropy said it plans to spend at least $500 million over the next five years on public health efforts focusing on kids and families in underserved communities.

It's the foundation's largest commitment ever. While the foundation has spent roughly as much in the area of tobacco over the years, "we never made the scale of that commitment up-front and public like we have with this," said Dr. James S. Marks, senior vice president and director of the foundation's health group.

"If we don't deal with children," he added, "this could be the first generation that will live sicker and die younger than its parents."

Scientists, physicians and public health advocates know that efforts to prevent obesity must start in childhood, because the problem leads to increased risk of coronary heart disease and other health hazards in adulthood. In fact, there's substantial evidence that obesity and related diseases, including diabetes and hypertension, can begin to exact damage during the teenage years.

In one landmark study, a group of researchers from across the United States analyzed post-mortem blood samples and evaluated atherosclerosis in coronary artery and aorta specimens from roughly 3,000 15- to 34-year-old men and women who died from causes such as accidents, homicide or suicide. One of the surprising results of the study, according to McGill, was that an elevated blood sugar -- as measured by levels of "glycohemoglobin" -- was associated in the late 20s and early 30s with about an 8-fold increase in advanced lesions in the coronary arteries. "It was a whopper of an effect," he said.

In another study, published in the Journal of the American Medical Association, researchers documented a significant upward shift over the past 16 years in blood pressure levels of children and teens aged 8 to 18. Lead author Paul Muntner, an epidemiologist at Tulane University School of Medicine, and colleagues said the increase in blood pressure levels is partially due to the increased prevalence of overweight in the United States.

And British researchers recently reported that children who are overweight at age 11 continue to have weight problems through their teenage years. Rates of overweight and obesity were highest among girls and children from lower socioeconomic backgrounds. The authors said the study highlights the need to target efforts to prevent obesity in the early years.

But even as more money and manpower are devoted to obesity prevention, McGill said it may take many years to erase the epidemic. And, he added, it will take action on many different fronts, from educating children and physicians to improving the health-care financing system to include more preventive medicine.

"It was 1964 when the first U.S. Surgeon General's report came out, and just now, there's talk about the tide turning on cigarette smoking," he observed. "Obesity's perhaps going to take that long to get the tide turned."

More information

For more on childhood obesity, visit the U.S. Centers for Disease Control and Prevention.

Posted: September 2007


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