Childhood Obesity

Like most family physicians, I am sadly lacking in answers to the rising epidemic of obesity. The term epidemic is used, I am reasonably sure, because of the dramatic rise in obesity over the last two decades, and the corresponding pathologies that are a result, such as heart disease, diabetes, etc. More appropriately, I think, obesity should be categorized as a chronic disease state (if an adaptive state, it is a pathological adaptive state). Like hypertension and elevated lipid levels, these chronic diseases are asymptomatic until the late stages of the disease. More and more diseases are found to follow a similar pattern (including Alzheimer’s disease).
Recently, I contacted the “would be” premiers of Alberta for their suggestions on how to control spiraling health care costs. So far, I have received one automated “thank you” and one response stressing “preventative medicine”. Total silence from the majority; although in all fairness, most of them sing the praises of preventative medicine in their party platforms on health care.
The problem is when I graduated in 1962, we had a full course on Preventative Medicine with a corresponding huge text book, and in spite of everyone’s best efforts since, we are failing the course in the public forum. This is most evident with the problem of obesity.
Let us briefly look at what we think we know about obesity and in particular, childhood obesity.
At a recent conference on migraine headache and pain control, the researchers suggested that some people genetically have a “pain monitoring and modulating” center that can be moved “upwards” with opioids and other pain medications, which results in addictions. In other words, more and more drug is required to produce the same therapeutic pain relieve, because “sensors” simply “adjust”. Research articles suggest that this type of genetic predisposition can exist in at least 60% of obese patients as well, but of course, controlled by a different neural system. It is suggested that we all have a “set point” for metabolism that is largely controlled by metabolic “sensing” neurons in our brains. This is supposed to tell us when to eat, so as to keep our energy level and our total body fat level, at a constant. Confusing stuff ; but basically, there should not be the problem of increasing weight with age----unless of course, something goes wrong----and therein is the “chronic disease” aspect. As mentioned previously, some 60% or more of the population have metabolic “regulators” that have the capacity to change during early life (and to some extent, throughout life), so that with increased food and a sedentary life style, metabolic rates may actually go down, but the regulators tell you that you need more food! What a mess!!! In effect, you become kind of a food addict!
Now, from what I can gather, our regulating system is most vulnerable to this change during pregnancy (inside of our mother’s womb), the post natal, neonatal (the first year of life), and during childhood. Once our system has been upgraded to do the wrong things and lie to us, this basically becomes a permanent thing (for many people, it continues throughout their lifetime). This explains why people “struggle with their weight all their lives”. Obesity, once established in the adult, has basically become a permanent and chronic condition.
One of the articles I read said (because of the above fact), that obesity prevention, therefore, is probably the best treatment. Which gets me to the gist of this entry. Let’s see how we are doing in the prevention of obesity in children, and therefore in the entire population.
Apparently, the city of Toronto, in the summer of 2000, abolished half the playgrounds at city schools, supposedly because they feared injury to the children. Now, I always thought that running and walking was good exercise, and that falling down from ones own height was a fairly benign event. The research suggests exercise helps prevent the “deregulation” pathological process responsible for obesity, so why get rid of playgrounds? Could this have something to do with real estate values and not injuries? I’m sure they put in lots of swings, slides, etc. for the kids (how many calories do you burn doing that)? Or maybe some great “monkey bars” that are ten feet high (it gives me creeps to see kids climbing on the top bars), but take up very little real estate. And of course, computers in our schools are a must (probably replaced Gym class in many schools). I understand that in some U.S schools, the “virtuous” school administrators prohibited playing “tag” and other similar activities on the school grounds. “Hey, you kids, stop running. You’re going to hurt yourselves! Get in here and sit in front of a computer, or get up on those monkey bars”! And what is with all this junk food in our schools? One of the researchers stated that “intake of highly palatable diets override the basic static controls of ingestion because it is regulated by neural systems mediating reward and motivation”. I think he was saying that by allowing junk foods, as parents and as a society, we are CREATING obese kids. I’m not suggesting we prohibit the manufacturing of these products, but perhaps as parents we should exercise some authority. Parents seem to be able to get peanut butter out of the schools, why not junk food? Yes, it too is killing our kids!
So how are our governmental leaders doing? Yes, the ones that say preventative medicine is going to save our health care system. They could penalize the schools that have junk food by decreasing funding to the perpetrators, and increasing funding to those that have healthy alternatives. They could also tax the h-ll out of junk food. Maybe take that tax money and give it to the schools? Apparently one of the main reasons we have junk food in the schools is to increase revenue. Now that’s a good one! We negotiate a financial deal that puts money into the education system, creates food addicts that are going to drain the health care pot in the future, and will usurp money out of the education system! Harper tried to take a baby step in the right direction by giving tax deductions to kids that sweat, but ran into criticism from parents whose kids were taking “archery lessons”. Good grief!
And how is the medical profession doing in addressing this problem. We used to restrict weight gain during pregnancy to 20 pounds. Now we say “eat as much as you want, as long it is healthy food”(good luck!). Some women gain forty or fifty pounds with no information to the contrary. The breast feeding mother is told that she is eating for two, so don’t be concerned. Still, as previously mentioned, this is an extremely important time for programming the infant to be obese. Restraint in any form seems to be a “bad” word these days. The toddler’s mothers are told that they will “wear it off” when they start playing soccer and become more active. But they don’t become more active. They discover T.V.s and computers, and these serve as super “baby sitters”. And if they cry---feed them, and if they don’t like what you feed them, keep offering them “stuff” until you hit upon something they like. As parents, why do we harbor so much guilt that we can’t say “NO”. Or are we so self involved that we can’t be bothered to be a parent to our child/children? Or is it that we don’t want to harm their self image by saying “NO”?
Well, here is a news flash, most obese people struggle with their self image.
We are indeed a weird society. We talk “ad nauseum” about prevention, but think about bumps and bruises. Some efforts of pediatric prevention have been laudable (seat belts, helmets, car chairs, etc), but how can we sit back and do nothing about behavior that will sentence a large number of our children to diabetes, heart attacks, and strokes? Talk about child abuse! I firmly believe that there is therapy in restraint and the word “NO”.