Obesity in children may pave the way to an early grave, a new study in the New England Journal of Medicine finds.
The study, published Wednesday, followed nearly 5,000 American Indian children from childhood to middle age and found that those who were obese as children were more than twice as likely to die from disease before the age of 55.
This is the first large study to confirm that childhood obesity is a risk factor for long-term complications, though that is something experts have suspected for years.
Previously, research has only been able to show associations between early death and childhood obesity, said Dr. Nicholas Stettler, a pediatrician who specializes in nutrition and epidemiology at the Children's Hospital of Philadelphia. But this study is more powerful, he said, because it further confirms a direct relationship between childhood obesity and long-term health complications.
In the study, children were measured for body mass index (BMI), blood pressure, cholesterol and blood glucose from age 11 onward. High BMI and blood glucose levels were the strongest predictors of early death -- children with the highest BMI had double the risk of dying early when compared to those in the lower end of the BMI spectrum.
While the study was done in Pima Indians who were children 20 to 30 years ago, the rate of obesity for this population was similar to the high rate of obesity in American children today, a similarity that some doctors fear might mean an increased incidence of early death in the future.
"This population was ahead of the curve and allows us to look at risk factors in obesity during childhood because they've been carefully followed over time," Stettler said.
But there are aspects of the Pima population that may have exaggerated these results, said Dr. Lakshmi Atkuri, a pediatrician at Scott & White Hospital in Round Rock, Texas. As a group these children are shorter (and hence have a higher BMI) and tend to have higher rates of alcoholism as adults, she said.
"The study population had a death rate twice that of the U.S. population at large," she added, suggesting that they may not be representative of American children today.
However, study author Dr. Paul Franks said the Pima most likely are representative of populations at increased risk for obesity today, such as poor African Americans and Hispanics.
Several experts said they agree with this comparison, noting that given the high burden of obesity and cardiovascular disease in these populations, this study further emphasizes the need for community-wide initiatives to prevent childhood obesity in the first place.
Early Action May Save Kids from an Early Grave
As past attempts at fighting obesity have shown, tackling this problem is going to take a lot more than telling kids to eat right and exercise.
Most strategies to prevent childhood obesity have focused on individual behavior changes, said Dr. George Flores, senior program officer at the California Endowment, and these have had little success.
Children's habits are influenced by many factors, he says, including availability of fast food and soda, inadequate access to healthy food options in the neighborhood, and too few safe places, such as parks and recreational facilities, in which to play and exercise.
For these types of systemic issues, he said, public policy has to change. To fight the childhood obesity epidemic, such initiatives as removing soda and junk food from schools, requiring physical education in schools and afterschool programs, and redesigning neighborhoods to encourage walking, biking and playing are necessary.
Adults lay down the trajectory of their health in childhood, said Dr. Michael Rosenbaum, pediatrician and co-director of the Naomi Berrie Diabetes Center at Columbia University.
"The heart attack or stroke that one has at age 50 is in most cases somewhat of a reflection of every moment that one ate, slept, smoked, and exercised -- or didn't exercise -- before then," he said.
Some of the damage done early on, such as the buildup of plaque in the arteries, isn't reversible, Stettler said, so changing our eating and exercising culture needs to happen early.
"We shouldn't ignore things that we can influence today," Stettler said. "We should address them now, which is why Michelle Obama's new initiative is very important."
The first lady's "Let's Move" campaign to curb childhood obesity is an effort to address these endemic forces on a societal level.
"We want to eliminate this problem of childhood obesity in a generation," the first lady told "Good Morning America's" Robin Roberts Tuesday. "We want our kids to face a different and more optimistic future in terms of their lifespan."