Desperately Seeking Slimness

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.

Obesity Epidemic Keeps Expanding

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.

Stopping the Epidemic From Spreading

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.

We need social engineering to give us back time to prepare food at home, or ways to eat out that offer good nutrition at low cost.

We need new-age tools, such as, to help us navigate the complicated modern nutritional landscape.

We need to make the use of stairs rather than elevators the social norm. We need to subsidize the sale of fresh fruits and vegetables, rather than high-fructose corn syrup.

We should regulate or ban the aggressive marketing of junk foods to children. We should find ways to reestablish time-honored behaviors related to better health, such as walking to school. We need more sidewalks and parks, fewer drive-through fast food restaurants.

The list is long, but not complicated. Everything we can do to make eating well and being physically active the path of least resistance everywhere we go deserves our support. Every policy at odds with these goals is a public enemy.

As for the desperation that compels a child to seek liposuction to fit in, to avoid mockery and cruelty: Shame on us all!

Let's admit that children get their notions about when it's OK to mock, and when it isn't, from their parents. We are the ones who have made it acceptable to tease the "fat" kid into a state of desperation.

For far too long, obesity has been the last bastion of socially acceptable prejudice. That has got to stop. We must attack obesity, without attacking those afflicted by it. We must confront the health toll of excess weight, without compounding the stigma excess weight imposes.

We must, as a society, take responsibility for reversing the current ominous trends, without blaming the victims of them.

A study in the Boston area published in the journal Obesity in July reported a steep rise in the rate of overweight infants less than a year old. This is the next generation of desperate 12-year-olds, unless we confront the threat before desperation sets in.

The dangers of obesity in children should be cut off at the roots at age 7, or 5, or 2 with a societal and family commitment to healthful eating and regular physical activity.

There is no right approach to treating a health crisis in a child that could have been prevented.

We should not be allowing our children to suffer obesity-induced desperation. We instead should desperately be doing all we can to fight both obesity, and its stigma, so that need never arises.