Tom has always been big for his age. When he was born, he weighed eleven pounds, three ounces. His mother, Alice, is also a large woman. She was only 17 when she accidentally got pregnant and decided to have Tom. Not long after he was born, Tom's father left for good, and it's been Tom and his mother ever since.
When Tom was still a toddler Alice started working double shifts to make ends meet, and since Tom was already a picky eater, fast food and prepackaged snacks soon became mainstays of his diet. On as many as five nights a week, Alice would come home exhausted, opting for two large bags of bacon cheeseburgers, French fries and bucket-size sodas over firing up the stove and cooking something fresh. But that's how it had always been, for as long as Tom could remember.
By the time he entered the third grade, Tom weighed 150 pounds, almost twice the normal weight for a boy his age. By then, the "fat" jokes on the playground had become a daily occurrence, but Tom did a pretty good job of hiding his feelings of embarrassment and isolation. Some days it was more than he could handle and, after school, he would drown his sorrow in Cherry Coke while watching hours of television. On those nights, Alice would take Tom to McDonald's, his favorite restaurant, to brighten his spirits.
Alice felt guilty that Tom had to spend so much time alone in the apartment, but there were no after-school or community programs in their neighborhood, and expensive daycare was not an option. She would rather have Tom sitting safely at home in front of the TV, she reasoned, than out on the streets.
As Tom continued to get heavier, he began to have trouble sleeping. He would drag himself to school each morning, tired and unable to concentrate. He began to fall hopelessly behind the rest of the class, which only gave his classmates more to tease him about. His health, both physical and psychological, continued to deteriorate until his mother could no longer deny he needed help and finally took him to see a doctor.
The pediatrician ran some simple tests and determined that Tom's sleeplessness was due to a condition known as obstructive sleep apnea, a disorder that afflicts many overweight people. What's worse, the doctors also discovered that Tom was suffering from Type 2 diabetes, a disease that, until recently, was only detected in adults of poor health, beginning in their late 50's or 60's.
Although they were devastated by the news, Tom and his mom found comfort in knowing there were professional programs in place to help them get on the right track to a healthful lifestyle. Alice agreed to be proactive by preparing more meals at home and taking Tom on bike rides and walks to the park, and she began monitoring his television and Internet intake.
Tom is fourteen now and, although he still weighs over 200 pounds, his weight gain has stabilized and his diabetes and sleep apnea are under control. He also has much more energy, especially at school, and his grades have steadily improved since he began a low fat, low sugar diet. He and his mom swim at the local YMCA three nights a week, and she, too, has benefited from their change of lifestyle by losing over thirty pounds. The sad part of this otherwise hopeful story is that Tom will fight the debilitating effects of diabetes the rest of his life and, because of his obesity, he faces a higher risk of developing heart disease, cirrhosis of the liver, high blood pressure and other life threatening illnesses.
Tom's saga is typical of millions of cases overflowing the file cabinets of pediatricians throughout the world. Adolescent obesity has become a global epidemic and the United States has seen its percentage of overweight children and teens more than double in the less than three decades. Unchecked, this preventable disease will continue to account for millions of premature deaths and will cost American tax payers billions of dollars in additional healthcare and lost productivity.
According to a cover story in the July 3, 2000 issue of Newsweek magazine, the government estimated then that there were nearly six million kid in the U.S. that are heavy enough to put their health at serious risk. Another five million were right on the edge and experts expected the problem to get much worse before it gets better. They were right. Today the Centers for Disease Control (CDC) reports that in 2012 nearly one-third of all children and adolescents in the US are overweight or obese. Morgan Downey, executive director of the American Obesity Association, called the disease "the most prevalent health problem of the 21st century." Obesity is responsible for 300,000 to 500,000 deaths annually, according to Downey, who thinks the government isn't doing enough to address this growing epidemic.
Until about thirty years ago kids still engaged in regularly scheduled family meals where they ate a balanced diet of meats, grains, and vegetables, and drank milk instead of soda or sweetened juice. Television was still in its infancy and posed no real threat, as kids preferred to play outdoors or at numerous open gymnasiums, parks and skating rinks. This resulted in much more physical activity among children, which is essential in burning fat calories and speeding up metabolism. Extended sedentary periods in front of the television or computer were still decades in the future, so even quiet time was healthier. Kids played board games, read books, and did arts and crafts, all of which have been found to increase the metabolic rate as much as 16% over sitting and watching television.
In the 1950's, aside from an occasional milkshake at the neighborhood soda shop, most snacking was done under the watchful eye of an adult, and snack food, in general, didn't contain nearly the amount of added fat, salt and sugar found in most fast food today.
Another factor that is more prevalent today is the number of single parents raising "latch-key" kids (like Tom) who are faced with making unsupervised food choices on a daily basis. They, like most kids, have a natural tendency to eat food that tastes good and is readily available and, too often, that includes greasy French fries and ultra-sweet soda.
All the data indicates that the American population is much fatter now than it was thirty years ago, but how much fatter? According to a U.S. government health and nutrition survey conducted in 2000, more than 39 percent of American adults and 15 percent, or 9 million children were obese that year. These and other survey results are based on the body mass index (BMI) which relates a person's height to their weight. For example, a six-foot man who weighs 220 pounds, and a 5' 5" woman weighing 180 pounds, both have a BMI of 30. Any individual with a BMI over 29 is considered obese.
Most of the extra pounds that plague American teens come from high-calorie fast food, according to a study conducted by Samara Nielson, a doctoral candidate in nutrition at the University of North Carolina's School of Public Health. She and her colleagues found that in 1977, 9.6 percent of all meals were from fast food, and by 1996 that number had skyrocketed to 23.5 percent. They also discovered that snacking had risen more than 50 percent, accounting for 17.7 percent of the average American's daily calorie intake.
Coinciding with the rise in calories consumed is an alarming drop in physical activity by teens. The Centers for Disease Control (CDC) recently reported that between 1991 and 1997, physical activity on a daily basis for most adolescents slid from 42 percent to a dismal 29 percent, and the numbers are sure to be worse now, with nationwide budget shortfalls causing further cutbacks in physical education programs at schools and community centers across the nation.
Ironically, one way that some school districts have found to bridge their budgetary gaps is to install lucrative vending machines in the cafeterias and hallways of both public and private schools. Kids are lured by bright logos and ads urging them to "Do the Dew," as most agreements involve exclusive contracts between the schools and major beverage companies like Coca-Cola and PepsiCo. Ultimately, it is the health of the children, America's future, that is being sacrificed to pay for teachers, desks and books.
William F. Jacobson, executive director for the Center for Science in the Public Interest, believes that society should be doing all it can to encourage kids to eat healthy diets. "Instead," he says, "we're bombarding them with junk food advertising. We're putting junk food wherever they go, even in schools."
To put things into perspective, the food industry spends a whopping $30-billion annually on advertising. Yale psychologist, Kelly Bromwell, who is a specialist in eating and weight disorders, points out that the entire federal budget for nutritional education is less than one-fifth the annual ad budget for Altoid Mints. She, along with many others in the medical field who deal with obese children everyday, endorse the concept of a "fat tax" - a tax on fast food and snacks based on their propensity to contribute to obesity. Activist Jacobson, writing in the American Journal of Public Health in early 2002, noted that a one-cent tax on soda alone would generate $1.5 billion a year to promote healthier alternatives to junk food.
Not everyone is standing idly by, however, while huge corporations infiltrate our schools and corrupt the eating habits of America's young people. Recently a group of obese teenagers, suffering from a wide range of illnesses including diabetes, high blood pressure, coronary heart disease, and asthma claimed in court that McDonald's used deceptive acts to promote to children and did not adequately warn them of the dangerous levels of fat and sugar they were consuming.
Democratic senator Patrick J. Leahy of Vermont is took matters one step further by backing legislation that would allow the federal government to more tightly restrict school soft drink sales. And senators Bill Frist, Christopher Dodd and Jeff Bingaman introduced the Improved Nutrition and Physical Activity Act on July 30, 2002, aimed at reducing obesity among children. The bill would appropriate $200 million next year for nutrition, physical activity and research programs.
Young victims of obesity can expect to bare the burden of other illnesses throughout their lives if they are unable to overcome their weight disorder. One of the most common and devastating diseases now facing obese children is Type 2 diabetes, once known as adult on-set dabetes. Twenty years ago it was extremely rare for a juvenile to be diagnosed with Type 2, but now doctors are seeing a ten-fold rise in the number of cases. It's not because doctors were misdiagnosing cases before, they simply weren't seeing the disease in many children, according to Dr. Phillip Lee, head of pediatric endocrinology at UCLA. Today referrals of Type 2 account for fifty percent or more of their diabetes cases. Many medical professionals believe they are looking at the tip of the proverbial iceberg and the only answer may be a refocusing of the fitness and eating habits of the entire society. "It's difficult to change what you have grown to accept as normal all your life," says Dr. Silva Aslanian, head of clinical research at Children's Hospital of Pittsburgh, PA. "[Kids] are surrounded by an environment that is not willing to change."
Another dangerous and potentially life-threatening illness that affects many obese individuals is obstructive sleep apnea, whereby excess flesh around the throat causes loud snoring and a chronic lack of oxygen that can damage the heart, lungs and brain. Researchers tested the mental abilities of overweight adolescents against those of normal weight and found that the ones with apnea performed significantly worse than those without the condition. "One of the reasons these children perform poorly is that there's actually a type of brain damage due to the repeated events throughout the night where oxygen to the brain is cut off," says Susan K. Rhodes, Ph.D., a clinical psychologist at the Medical University of South Carolina, Charleston. Dr. Rhodes also noted that she and her colleagues have seen apnea disappear with weight loss.
There is a separate but equal form of suffering associated with obesity that is not obvious or easily measurable, and it is entirely unique to the individual. It is the psychological pain endured by most, if not all obese adolescents and it can start very early in life. Psychiatrist Hilda Bruch conducted research with obese families in the 1940's and found that mothers of obese children often had ambivalence and were insecure about the child. They compensated with excessive feeding and over-protectiveness, and the child became clinging and dependent. This would then lead to an inhibited sense of risk-taking and reduced muscular activity.
As obese children continue to grow and mature their psychological stability is eroded by prolonged bouts of depression and self-loathing. Researchers have concluded that some obese children and teenagers actually have a quality of life that is as low or lower than that of a young cancer patient. "Severely obese children really are suffering in a way that is perhaps greater than people realize," said Dr. Jeffrey B. Schwimmer, author of the study.
It is now well documented that obese children likely have severely overweight parents, so any significant changes in lifestyle must be initiated and reinforced at home as part of a family-wide program aimed at healthier living for all family members. Dr. Emily Liu of Kaleida Health's Women's and Children's Hospital in Buffalo, New York believes an effective program for weight-loss should not be focused entirely on the child but should include the parents and the school system. She maintains that high-calorie lunches and snacks in schools most likely add to the problem.
Other countries are also fighting the battle of the bulge. Dr. Colin Bell of Deakin University in Australia suggests vending machines might be "a subtle form of biological warfare" and is calling for them to be removed from all schools, gyms, pools and sports venues in order to combat the continent's growing obesity epidemic. "[Vending machines] undermine the efforts of teachers and parents to teach nutrition," Dr. Bell says. "They're also out of place in recreation facilities, local pools, gyms - anywhere people go to exercise."
But some school districts have embraced the concept of partnering with soft drink companies. The Colorado Springs school district was one of the first to sign an exclusive contract with Coke, who agreed to pay the beleaguered district $8 million over ten years. The principle of Palmer High School in Colorado Springs, Jackie R. Provenzano is pleased with their relationship with the drink giant, sighting that without the additional funding provided by the contract students would be going without programs like music and physical education. Instead, because of the additional funding, they were able to purchase a brand new cello for the student orchestra.
High occurrences of obesity have been recorded across all socioeconomic boundaries, confirming that this is not just a chronic problem among the poor, uneducated or minority groups. The whole country faces extraordinary annual costs of nearly $117 billion in healthcare and lost wages, due to the increasing ill health of the nation's 60 million obese people. This is a national crisis that affects everyone and is especially threatening to the impressionable youth who count on their peers, parents and teachers for guidance.
Vending machines, soda companies and fast food restaurants are the bricks in a huge wall separating Americans from a healthy future but the wall can be brought down. Significant changes and education in lifestyle, eating habits and physical activity routines must begin at home, and begin early enough in a child's development to engrain healthy behavior and good nutrition as the "natural" way to live. Parents, school administrators and medical professionals need to continue to work together to ensure that this frightening epidemic is brought under control and eventually removed from its place at the top of the nation's list of health emergencies.
An epidemic of obese children today means unhealthy and under-productive adults tomorrow. And if the cycle is not broken, statistics show that these same bad habits are guaranteed to be past along to the next generation of innocent and unsuspecting children.