Desperately Seeking Slimness

Nov. 8, 2006 — -- A recent story about a 12-year-old turning to liposuction out of desperation to lose weight attracted nationwide attention. But the real story is about a society not nearly as desperate as it should be to confront the crisis, complications and origins of childhood obesity.

Obesity is epidemic in the United States among children and adults alike, and rates are rising ominously with each passing year.

I recently gave a talk in Missouri, after which a dietitian in the audience came to speak with me about a 17-year-old boy who has undergone a triple coronary bypass.

This boy had no unusual genetic predisposition to heart disease. Just obesity and type 2 diabetes at a very early age, and then the predictable consequences.

Coronary bypass surgery may be life saving, but it is a last resort in an adult, let alone an adolescent.

Similarly, gastric bypass may be life extending, but with the risk of surgical complications including death.

Liposuction may seem the only option, as in the case of the 12-year-old, to restore some vestige of self-esteem, but with considerable surgical risk and no improvement in the metabolic complications of obesity.

Once we begin sizing up the pros and cons of coronary bypass, bariatric surgery, or liposuction in teens, we have already failed dreadfully to protect our children from a clear and increasingly omnipresent danger.

Well documented trends from the Centers for Disease Control and Prevention tell us that for every desperately overweight 12-year-old who gets rid of the weight and makes headlines, there are dozens, hundreds and maybe thousands equally desperate who do not.

As compelling as the individual tale may be, this is really a story about an entire population.

When I went to medical school, I learned about two kinds of diabetes mellitus: juvenile onset and adult onset. Adult onset diabetes, less than a generation ago, was almost exclusively a condition of overweight, middle-aged adults.

Now, what was once adult-onset diabetes has been renamed "type 2" diabetes and is more and more commonly diagnosed in children under the age of 10. This rather grave development is courtesy of epidemic childhood obesity. But still worse lies ahead.

Historically, heart disease has been an adult concern, just as adult-onset diabetes once was. But I am not convinced it will remain an adult problem.

If one chronic disease of midlife -- diabetes -- can become a condition of childhood, others can certainly follow. Experts say that diabetes in adults can be assumed to signal the presence of heart disease. The same is likely to be just as true in children.

When 16-, 17-, and 18-year-olds have had adult-onset diabetes already for a decade or more, we can expect to start seeing them show up in emergency rooms with heart attacks.

So how can we protect our children and grandchildren from the complications of obesity, ranging from diabetes to desperate unhappiness?

By committing to healthful eating and activity patterns ourselves and acting as role models for our families. By insisting that schools find a way to build in physical activity, toss out junk food and make their cafeterias models of good nutrition.

The responsible answer to the native rambunctiousness of children is recess, not Ritalin. By demanding that clinicians be trained to provide thoughtful, compassionate guidance toward a health-promoting lifestyle.

We need "food labels for dummies" that enable consumers to know, at a glance, what choices are best and when to step away from the box so no one gets hurt.