An earlier version of this article incorrectly identified Nazrat M. Mirza as a pediatric endocrinologist. She is a general pediatrician whose research focus is obesity at Children's National Medical Center in Washington.
The Search for Solutions
Thursday, May 22, 2008
Marisol Quiroz watched in alarm as her overweight son ballooned 50 pounds in a year. She had taken him to doctors and nutritionists who told her to make him stop eating so much but never told her how.
David Quiroz, 12, weighed 215 pounds last fall. Half his body mass was fat. His cholesterol was elevated, his blood pressure was too high and the sugar in his blood was hitting dangerous levels. He was well on his way to diabetes and heart disease before reaching high school. His mother made an appointment to see David's pediatrician alone. In tears, she told him she had no idea what to do.
She found out that the medical community does not really know, either. Doctors are great once a child becomes so obese that he or she develops diabetes or heart disease, critics said. But they have yet to figure out how to keep children from becoming obese or how to help them lose weight.
"We pediatricians do a fantastic job talking about food during a child's first year of life. We know precisely how much formula a 6-month-old needs because we've been concerned about failure to thrive. But we're not terribly good about what happens after that," said Nazrat M. Mirza, a pediatric endocrinologist at Children's National Medical Center in the District. "We pediatricians don't even talk about obesity."
Most in the medical community said they did not begin to recognize childhood obesity was a problem until it had become an epidemic. Now, researchers are predicting that one of every two children will develop Type 2 diabetes because of excess weight, which raises the probability that they will die as much as 20 years younger than their parents. And doctors are scrambling to catch up. The American Academy of Pediatrics only recently issued guidelines about what to do for an overweight child.
"There's been a delayed response in the medical and health-care community because, in many ways, we weren't prepared for it," said Thomas N. Robinson, director of the Lucile Packard Children's Hospital at Stanford University's children's hospital. The conventional wisdom was that children would outgrow the excess weight.
With so many young lives at stake, about the only thing the medical community knows for sure is that traditional weight-loss programs do not work. A success rate of 1 percent is the best medical professionals have seen.
"We know how to change people's behavior, but we don't know how to sustain those changes," said Terry Huang, program director for pediatric obesity at the National Institute of Child Health and Human Development. It sounds so easy, he said. Eat less. Exercise more. If it were so easy, though, the majority of Americans would not be overweight.
Even when it comes to bariatric surgery, the most radical method of weight loss that physically shrinks the stomach, only 5 percent of patients return to what doctors consider a normal weight . In all weight-loss programs designed for adults and children, almost everyone initially loses, but within two years, patients have put the weight back on. "We have to change course," Huang said.
That change is complicated by money. Obesity is not classified as a medical disease, which means few insurance companies will pay for weight-loss treatment. What they will pay for, however, are all the illnesses that arise from obesity.
Researchers are finding genes that contribute to obesity, and they are studying how foods affect hormones that contribute to appetite. Some researchers have found that people metabolize food differently, so no one diet will work for all types of people.
They are finding that the body is, evolutionally, still programmed to hunt for food and survive famine. If the body is not moving, as most aren't in these sedentary times, the brain thinks the body is starving. So the body begins to cannibalize protein-rich muscle to feed the brain and conserve fat stores.