In a given year in the U.S., 1/4^th of US men and 2/5^ths of US women attempt to lose weight or keep it off.

These are sobering statistics that we see all around us, particularly poignant in my office as a pediatrician. 

The impact is far reaching and burdensome. Indeed, "the prevalence of several categories of chronic illness in childhood is increasing and that these conditions arise, continue, or resolve in a highly dynamic fashion. Both findings have important implications and raise a number of significant questions."

We are seeing a scary shift in the 'epidemiology of child health'--from acute to chronic illnesses

In the study mentioned in a recent JAMA piece,"Dynamics of Obesity and Chronic Health Conditions among Children and Youth," 51.5% had reported they suffered from some chronic condition during the 6-year study period and the rate went from 12.8% in 1994 to 26.6% in 2006.  Health conditions in kids are, by definition, "unstable" This means, in effect, that kids exist in a more dynamic state, which explains the observation that of those who had a chronic condition at the start of the study, only 7.4 % had that same condition at its conclusion.

Along with obesity and the metabolic syndrome (Note: the child's version is different from the adult as the child is, by definition, more resilient), we also see, in this population, more:

• Reactive airway disease/asthma
• Learning disabilities including attention deficit hyperactivity disorder (ADHD)
• Hospitalizations
• Accidents/injuries/trauma causing more disability days such as school absenteeism
• Deaths

While we wait for more longitudinal data, I can say, yes, we are stressing our kids!

Source:  Halfon N, Newachek PW. "Evolving Notions of Childhood Chronic Illness." JAMA. 2010;303(7):665-666.  [Editorial's Abstract]

Which, in turn, is referencing, mainly, the following:

Van Cleave J, Gortmaker SL, Perrin JM. "Dynamics of obesity and chronic health conditions among children and youth." JAMA.Free full text] Feb. 17, 2010;303(7):623-630. [

Clearly a multifaceted approach is required, but the most important ingredient is caring, follow-up and follow-through.  All of the following modalities are necessary to prevent reversion: dietary counseling for the whole family (i.e., even those not overweight), behavioral modification that includes increasing physical activity, avoiding nibbling, food indulgences when stressed, and empty calories (e.g., junk food).  It is vital to include psychosocial support, the kind that "promotes long-term changes rather than fad diets that offer short-term weight reduction, only to return the individuals to their previous habits after the short-term goal is achieved." 

Flegal et al³ and Ogden et al⁴ write in the January 20, 2010 issue of JAMA;  based upon analysis of NHANES,* they "offer a glimmer of hope that in the United States at least, the steady, decades-long increases in overweight and obesity may have slowed or perhaps reached a plateau. But even if these trends can be maintained, 68% of US adults are overweight or obese, and almost 32% of school-aged US children and adolescents are at or above the 85th percentile of BMI for age."

The authors augur for a massive public health campaign that raises awareness about the "effects of overweight and obesity....Such campaigns have been successful in communicating the dangers of smoking, hypertension, and dyslipidemia; educating physicians, other clinicians, and the public has yielded significant returns. Major research initiatives are needed to identify better management and treatment options."

Tempest fugit:  "The longer the delay in taking aggressive action, the higher the likelihood that the significant progress achieved in decreasing chronic disease rates during the last 40 years will be negated, possibly even with a decrease in life expectancy." -- -- See Pediatrics (the Official Journal of the American Academy of Pediatrics) for the U.S. Preventive Services Task Force's meta-analyses of 20 studies published since 2005 and involving more than 5,000 children, attesting to benefits from pediatric obesity programs.

References

J. Michael Gaziano, MD, MPH.  "Fifth Phase of the Epidemiologic Transition: The Age of Obesity and Inactivity."   JAMA. 2010;303(3):275-276. Published online Jan. 13, 2010 (doi:10.1001/jama.2009.2025). 

1. Omran AR. The epidemiologic transition: a theory of the epidemiology of population change. Milbank Mem Fund Q. 1971;49(4):509-538. FULL TEXT | WEB OF SCIENCE | PUBMED

2. Olshansky SJ, Ault AB. The fourth stage of the epidemiologic transition: the age of delayed degenerative diseases. Milbank Q.1986;64(3):355-391. FULL TEXT | WEB OF SCIENCE | PUBMED

3. Flegal KM, Carroll MD, Ogden CL, Curtin LR. Prevalence and trends in obesity among US adults, 1999-2008 [published online Jan. 13, 2010]. JAMA. 2010;303(3):235-241. FREE FULL TEXT

4. Ogden CL, Carroll MD, Curtin LR, Lamb MM, Flegal KM. Prevalence of high body mass index in US children and adolescents, 2007-2008 [published online January 13, 2010]. JAMA. 2010;303(3):242-249. FREE FULL TEXT

See "Obese/Overweight Management"

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NY Times' Resources as referenced in "The Care and Feeding of Kids: Finding Information on Nutrition and Fitness" by Catherine Hutchings and Holly Epstein Ojalvo; February 17, 2010

• The Health Section, including the sub-section on Fitness and Nutrition
• Times Health Guide, including the sections on Obesity, Weight Management and Weight Problems and Children
• Times Topics pages on Obesity, Children’s Health, Weight, Diet and Nutrition and Physical Activity
• The Well blog, including the feature PhysEd
• The special Health section on children’s health, “Small Steps: A Good Health Guide”
• Recipes for Health, plus the Kids’ Edition and The Lunchbox

* The National Health and Nutrition Examination Survey (NHANES) is a program of studies designed to assess the health and nutritional status of adults and children in the United States. The survey is unique in that it combines interviews and physical examinations. The economic costs related to obesity/overweight (O/O) (BMI >25) in 2002 dollars are estimated to be as much as $92.6 billion in 2002 dollars—9.1% of U.S. health expenditures. The estimated opportunity cost of lost productivity related to O/O in 1994 dollars among Americans age 17 to 64 is $3.9 billion.

Finkelstein EA, Fiebelkorn IC, Wang G. National medical spending attributable to overweight and obesity: How much, and who's paying? Health Affairs Web Exclusive. 2003; W3:219-226.