Like their mother, the children were exceedingly overweight.
The mother was in her 30s; I had all but given up hope for her long-term survival. And as I watched her children, I feared for their health.
Childhood obesity is a recent disease. During medical school in the late 1980s, I do not recall a single lecture or patient case presentation on the subject. But much has changed; in just the past two decades, obesity among children has more than doubled, from 7 percent to 18 percent, and among adolescents it has more than tripled, from 5 percent to 18 percent. These children are more likely to have pre-diabetes, bone and joint problems, sleep apnea, and risk factors for cardiovascular disease.
Certainly parents have responsibility here. But I often wonder: What is the responsibility of the medical establishment?
Three months ago, the American Medical Association recognized obesity as a disease. We doctors are now struggling to figure out our role in treating this newly declared illness — and how to approach children and their parents about healthy eating and exercise habits that will last a lifetime.
When I spoke about this with a pediatrician in my community near Memphis, she sounded discouraged. In a typical case of an overweight teenager, she said, “I show the mother the growth curve and point out that the child is way off the charts. Then I ask, ‘Have you thought about controlling the weight?’
“First there is denial,” she said. “And often there is the blame game — it’s the grandma or the dad” who overindulges the child. This isn’t a problem that is easily solved in a doctor’s office, she said.
One tool in her limited kit is something called “5210 Every Day.” Adapted from a program that originated in Maine and is spreading nationwide, 5210 promotes four “numbers to live by”: Kids should eat 5 or more servings of fruit and vegetables a day; spend 2 hours or less on recreational screen time; get 1 hour or more of physical activity; and consume 0 sugary drinks.
She explains the program to her patients and sends them home with a 5210 brochure.
A brochure? “How much can I do in 15 minutes?” the pediatrician said. That’s how long she has to tend to the problem that prompted the visit, plus provide other counseling: vaccinations, drinking, drugs, sexually transmitted diseases, bicycle helmets, and yes, diet and exercise. And it may be another year before she sees the youngster again.
I understand the pediatrician’s quandary. For one thing, how do you tell a mother to send her children outside to play if their street has boarded-up windows and drug dealers on the corner? How hard is it for her to buy and prepare fresh foods? In other situations, where families are fortunate enough to live in a safe neighborhood and have plenty of fruit and vegetables in the refrigerator, we see some parents who are too worried about their children’s self-esteem to talk to them about their weight.