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Pediatric Preventive Cardiovascular Risk Program at Stony Brook:
Jan 10, 2007

Dealing with Childhood Obesity-A Growing Problem, Larger by the Day

Peter Morelli, MD
Denise Dixon, PhD

America is under siege. Not by fundamental fanatical terrorist groups, but instead, by a slow moving, subtle, pervasive entity affecting one out of five children and one out of two adults. The offender is obesity. Where does it live? Who is most at risk? When does it begin to take form? How do we detect it? How do we abolish it?

Many epidemiologists and preventive health specialists are finding the above questions crucial to answer, as our societal health is ever more being affected by obesity-related illnesses.

Indeed, having a BMI greater than 2 standard deviations above normal may result in chronic disease closely approaching the health risks associated with long term cigarette smoking.

Why the sudden outburst of obesity? Ironically, it is a reflection of our wealth and overall success as a society. Our abundance of ample and calorie dense foods complement our comfortable, technology driven lives. The problem lies in the interface of our 21^st century lifestyle with our primitive 8000 B.C. genome. Those once protective genes that enabled us to store away needed calories and conserve energy expenditure during lean times/ and famine are still working – even when we down two big Macs in the dead of winter. Our genes and environment are not in sync---they’re battling, and the environment is “winning out”- and excess calories are stored away as unneeded fat.

What do we do about it? One is to just accept it. It may just be a part of the greater picture of evolution. Generations to come will be more sedentary, heavier and unfortunately sicker. Some estimate that life expectancy will actually begin to decline in each successive generation. Obesity related morbidities, such as diabetes, obstructive sleep apnea, heart failure, stroke, gall bladder disease and much more will markedly reduce the quality of life; but we don’t have to accept this proposition. While we can’t yet alter our genes, some would say we shouldn’t even if we could, we can still manipulate the caloric environment in which we live. This means paying attention to the calories we take in and those that we expend.

At University Hospital at Stony Brook, we have been attempting to address this societal health issue with a proactive interventional 10 week, program that introduces healthy lifestyle modification to children ages 8 to 18 years . Through a comprehensive semi-weekly nutritional, exercise and behavioral curriculum, children with elevated body mass index greater than the 95^th percentile, referred by their primary care provider, are enrolled in this intervention program. The children have anthropometric, nutritional, behavioral and exercise assessments pre- and post- program. Many children are beginning to demonstrate positive behavioral changes which are reflected in a lowering of BMI, body fat and systolic blood pressure.

Our challenge is multi-fold. We must be able to affect more children for longer periods of time. We need to invoke change that is life long. This will undoubtedly require societal involvement at a larger level. Public policy must be established to facilitate healthier eating habits and highly encourage active life styles. As part of this program, we hope to gives children and their families the skills needed to resist the subtle and often not subtle “call of the calorie”. We want them to learn that exercise and healthy diets will not only benefit them as children but also as adults. The behavioral aspects of the program are designed to accomplish just such a goal and change the current societal paradigm.

Let us get our arms around the growing epidemic of obesity.

It fits like a tight waistband after Thanksgiving dinner.