A 267# patient and I were discussing weight loss options when the subject of bypass surgery came up. Normally this option is on the table and one that I usually encourage patients to think about. But this patient was 22 years old and gastric bypass is not often performed in this age group.

We really don’t have enough data on the possible long term complications of this radical surgery in such a young population but with her abnormal blood sugars and elevated cholesterol, she was facing, in the very near future, a life filled with multiple medications and frequent medical visits.

 How did she get this way? As she exeplained it, she had always been a “little” overweight since childhood and over the years (not so many in her case), she had continued to gain weight – 30#s in the last year alone. She felt miserable about herself.

 Interestingly but not surprisingly, the markers for adult onset diabetes (DMII) are actually present in childhood/adolescence. Using only blood pressure readings and body mass index (BMI), the National Growth and Health Study (NGHS) followed 1,067 ten year old girls and 822 boys and girls aged 6-18 years in the Princeton Follow-up Study.

 The results showed that children in the top fifth percentile for BMI were 4 times more likely to develop diabetes in adolescence or adulthood. Additionally, an elevated systolic blood pressure (the top number) in the top fifth percentile increased the risk of diabetes 5.78 times.

 Given that the cost of treating diabetes and its complications (heart attacks, heart failure and kidney disease) will only continue to rise, we need to be hypervigilant about treating childhood obesity aggressively. The problem is, how?

 A recent study reported on by the National Institutes of Health, linked childhood obesity to the rise in working mothers – yet another hit on the chin for mothers – stating that these children were 48% more likely to be overweight or obese. Those percentages increased if both parents were obese/overweight.

 But obesity doesn’t happen in a vacuum and we can’t simply single out mothers to blame for increasing obesity rates. School lunches are often pre-packaged food high in sugar and salt. With a decrease in school funding, physical education classes are often cut back. Schools have been seduced into providing soda machines in exchange for a percentage of the money to help boost their falling coffers. Students now have less activity and easy access to junk food.

Some local school councils are under increasing pressure however to remove vending machines, or stock them with healthy snacks and drinks. There are also states who are closely examining the quality of the food served in schools and movement is underway to radically improve the quality of school food offering seasonal fresh fruit and incorporating fresh produce from local farms. 

Leisure time activities are more often sedentary – video games and TV predominate. Limiting TV/computer time and encouraging your child to be outside playing will help him/her burn more calories.

 Super-sized drinks and junk food advertisements are promoted everywhere as well as all-you-can-eat buffets. How about posting calorie counts on all food sold in the grocery-store bakery and take-out restaurants so that we can make informed choices? (I recently found out that the cinnamon scone I so enjoyed eating from Whole Foods actually had more calories than a donut – and here I thought I was choosing my food carefully). Although unpopular, we could apply a higher tax on foods we know are unhealthy – you know, those chocolate cereals, sodas, candies etc. After all, higher taxes on cigarettes has helped to reduce smoking rates.

 Truth is, obesity has many causes and as much as no one wants to be nagged about their eating and exercise habits, behaviors can change if there is a national will to do so – just consider how far we’ve come as a nation in decreasing smoking rates. With the same concerted efforts by public health officials as well as parental, local, state and federal involvement, we can reduce the rates of obesity in this country.