Implications For Children And Society At Large

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Many of us consider our weight and height as personal statistics, primarily our own, and occasionally our physician's concern. Our weight is something we approximate on forms and applications requiring this information. Body size has been a cosmetic issue rather than a health issue throughout most of human history, but scientific study has changed this view. One's aesthetic preference for a lean versus a plump body type may be related to personal taste, cultural and social norms, and association of body type with wealth or well-being. However, the implications of a wholesale increase in BMIs are increasingly becoming a public health problem. Thus, we need to acknowledge the sensitive personal dimension of height and weight, while also viewing weight as a public health issue, especially as the weight levels of children, as a population, are proceeding on a harmful upward trajectory.

The as yet unabated epidemic of childhood obesity has significant ramifications for children's physical health, both in the immediate and long term, given that obesity is linked to several chronic disease risks. In a population-based sample, approximately 60 percent of obese children aged 5 to 10 years had at least one physiological cardiovascular disease (CVD) risk factor—such as elevated total cholesterol, triglycerides, insulin, or blood pressure—and 25 percent had two or more CVD risk factors (Freedman et al., 1999).

The increasing incidence of type 2 diabetes in young children (previously known as adult onset diabetes) is particularly startling. For individuals born in the United States in 2000, the lifetime risk of being diagnosed with diabetes at some point in their lives is estimated at 30 percent for boys and 40 percent for girls if obesity rates level off (Narayan et al., 2003).2 The estimated lifetime risk for developing diabetes is even higher among ethnic minority groups at birth and at all ages (Narayan et al., 2003). Type 2 diabetes is rapidly becoming a disease of children and adolescents. In case reports limited to the 1990s, type 2 diabetes accounted for 8 to 45 percent of all new childhood cases of diabetes—in contrast with fewer than 4 percent before the 1990s (Fagot-Campagna et al., 2000). Young people are also at risk of developing serious psychosocial burdens related to being obese in a society that stigmatizes this condition, often fostering shame, self-blame, and low self-esteem that may impair academic and social functioning and carry into adulthood (Schwartz and Puhl, 2003).

The growing obesity epidemic in children, and in adults, affects not only the individual's physical and mental health but carries substantial direct and indirect costs for the nation's economy as discrimination, economic disenfranchisement, lost productivity, disability, morbidity, and premature death take their tolls (Seidell, 1998). States and communities are obliged to divert resources to prevention and treatment, and the national health-care system is burdened with the co-morbidities of obesity such as type 2 diabetes, hypertension, CVD, osteoarthritis, and cancer (Ebbeling et al., 2002).

The obesity epidemic may reduce overall adult life expectancy (Fontaine et al., 2003) because it increases lifetime risk for type 2 diabetes and other serious chronic disease conditions (Narayan et al., 2003), thereby potentially reversing the positive trend achieved with the reduction of infectious diseases over the past century. The great advances of genetics and other biomedical discoveries could be more than offset by the burden of illness, disability, and death caused by too many people eating too much and moving too little over their lifetimes.

2These projections are based on data on the lifetime risk of diagnosed diabetes and do not account for undiagnosed cases. The data do not allow for differentiation between type 1 and type 2 diabetes. However, the major form of diabetes in the U.S. population is type 2, which accounts for an estimated 95 percent of diabetes cases (Narayan et al., 2003).

Aside from the statistics, we can see the evidence of childhood obesity in our community schoolyards, in shopping malls, and in doctors' offices. There are confirmatory journalistic reports of the epidemiologic trends in weight—from resizing of clothing to larger coffins to more spacious easy chairs to the increased need for seatbelt extenders. These would be of passing interest and minimal importance were it not for the considerable health implications of this weight gain for both adults and children. For example, compared with adults of normal weight, adults with a BMI of 40 or more have a seven-fold increased risk for diagnosed diabetes (Mokdad et al., 2003). Indeed, the obesity epidemic places at risk the long-term welfare and readiness of the U.S. military services by reducing the pool of individuals eligible for recruitment and decreasing the retention of new recruits. Nearly 80 percent of recruits who exceed the military accession weight-for-height standards at entry leave the military before they complete their first term of enlistment (IOM, 2003).

What might our population look like in the year 2025 if we continue on this course? In a land of excess calories ingested and insufficient energy expended, the inevitable scenario is a continued increase in average body size and an altered concept of what is "normal." Americans with a BMI below 30 will be considered small and obesity will no longer be newsworthy but accepted as the social norm.

While the existence and importance of the increase in the population-wide obesity problem are no longer debated, we are still mustering the determination to forge effective solutions. We must remind ourselves that social changes to transform public perceptions and behaviors regarding seatbelt use, smoking cessation, breastfeeding, and recycling would have sounded unreasonable just a few decades ago (Economos et al., 2001), yet we have acted vigorously and with impressive results. How to proceed similarly in meeting the formidable childhood obesity challenge is the focus of this Institute of Medicine (IOM) report.

The 19-member IOM committee was charged with developing a prevention-focused action plan to decrease the prevalence of obesity in children and youth in the United States. The primary emphasis of the committee's task was on examining the behavioral and cultural factors, social constructs, and other broad environmental factors involved in childhood obesity and identifying promising approaches for prevention efforts. This report presents the committee's recommendations for many different segments of society from federal, state, and local governments (Chapter 4), to industry and media (Chapter 5), local communities (Chapter 6), schools (Chapter 7), and parents and families (Chapter 8).

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