I was at a White House meeting on April 9, one of a handful of physicians among 100 people from all walks of life. The topic was childhood obesity. Michelle Obama has made this her cause, and the President has created a multi-Departmental Federal Task Force to develop and implement solutions. The meeting included brief presentations by Mrs. Obama, the Secretaries of Education and Interior, the Surgeon General, and leaders in the Department of Agriculture and the White House office that led the health reform effort. They promised a May delivery of a draft plan to combat childhood obesity, and asked those assembled to help guide it.
This is why they—and we—were all there.
The last quarter of the 20th century gradually fattened us. As a result, obesity is the epidemic of the 21st century. Obesity in adults contributes to diabetes, cardiovascular disease, and some cancers; it contributes to early death. Obesity and its complications reduce productivity at work and consume huge amounts of medical care resources.
As in every epidemic, children are not spared. In the United States, about one third of children are overweight or obese (as defined by BMI percentiles). Every age group of children is affected, from infants to teens. The earlier the onset of excess weight and the longer it persists, the more likely it is that it will endure into adult life. During childhood, obesity is linked to medical problems that include sleep apnea, skin disorders, orthopedic disorders, insulin resistance and type 2 diabetes, hypertension, and depression. Obese girls go on to become obese mothers, whose children are at increased risk for obesity.
Because obesity is so prevalent, pediatric primary healthcare providers now routinely see many obese children. Because it contributes to so many co-morbidities, specialists are dealing with it every day as well. Obesity is now a common issue in routine pediatric surgeries.
This epidemic will be with us for a long time. Though rates of childhood obesity are leveling off, this is happening at historically high levels. At best, the healthcare system will be taking care of a generation of people who acquired obesity in childhood and suffer the consequences for life. At worst, a third of pediatric patients will keep going down this same road (or more, if the leveling off stops).
Over the last decade, some pediatricians across the country have been working to find ways to deal with this epidemic. Research has identified risk factors for obesity at every stage of child development, including prenatal ones (e.g., maternal pre-pregnancy weight and pregnancy weight gain, maternal gestational diabetes, low birth weight), early infancy ones (e.g., rapid weight gain in the first months of life), and on through adolescence. We have also learned how important social context is in fostering obesity: healthy lifestyles are hard to achieve in communities with no available fresh food and no safe places for activity; schools without PE and that serve unhealthy food make matters worse; many families are now led by second or third generation non-cookers; poverty encourages consumption of high-caloric-density junk food.
Thus obesity is not only prevalent, it is complicated. To reduce its toll, changes will be needed in every sector of society. The food distribution system will need to deliver more healthy products and get them out to more places and at affordable prices. Safe and affordable access will need to be provided to physical activity in schools and in the community, in ways that are engaging and fun. Schools will need to build in health promotion in varied ways. Parents need to be supported to help their children grow in a healthy fashion and learn healthy habits. These four realms are the ones that the government is focusing on.
The White House meeting was full of enthusiasm, which grew over the afternoon. There was a clear commitment from the current administration to undertaking, at a minimum, regulatory action to implement a plan of action. The networking among the attendees was energetic. The organizers indicated that the plan is to keep in touch with us.
As a pediatric community, we can take heart that this national effort is going on. It will provide an opportunity for our ongoing input, and can support the work we do. And work we must: despite many obstacles and also to overcome the obstacles.
The current funding environment and long-established practice make it very hard to care for obese children in 2010. Reimbursement is poor, and services—like the intensive nutrition and physical activity programs recommended by the US Preventive Services Task Force—are generally unavailable and not reimbursable. The care of obese children with multiple co-morbidities is not well coordinated. Clinical practice settings are not effectively linked to community based services (e.g., nutrition education, park district programming). There are not yet well proven primary care-based interventions to slow and reverse excessive weight gain.
NACHRI and its members can be leaders in this work. I jumped at the chance to represent children’s hospitals and be a pediatric voice at the 4/9 White House event. I also welcomed the chance to join with other pediatricians and government relations colleagues in providing guidance to N.A.C.H. on comments and recommendations related to proposed anti-obesity policy . I’ll continue to look for opportunities to be involved in this important work and encourage my colleagues, growing numbers of whom are doing so too.