Obesity in children, adolescents the focus of new IOM report
■ The study recommends a multipronged effort by communities, government, schools, families, industry and health care to halt the ongoing march to obesity.
Washington -- A laundry list of diseases that generally don't appear until adulthood are starting to be seen in young children who are overweight. Primary care physicians fear that they might not be equipped to handle this new onslaught.
"Many of us are scared about what will happen to children's health, because obesity affects almost every organ in the body," said Thomas N. Robinson, MD, MPH, associate professor of pediatrics and medicine at Stanford University School of Medicine in Palo Alto, Calif.
"We are looking at adult chronic diseases starting to enter into the teen years and even childhood," he said.
Dr. Robinson spoke at a Sept. 30 briefing on a new Institute of Medicine report, "Preventing Childhood Obesity: Health in the Balance." He served on the panel that produced the report in response to a request from Congress.
Obesity among children and adults is causing concern worldwide because of its drastic health consequences. During the past 30 years, the obesity rate in the United States has more than doubled for preschool children and adolescents and more than tripled for children ages 6 to 11. Approximately 9 million American children older than age 6 are now considered obese.
"The great health advances made possible by genetics and other biomedical discoveries could be offset by the burden of illness, disability and death caused by too many people eating too much and moving too little over their lifetimes," said panel Chair Jeffrey Koplan, MD, MPH, vice president for Academic Health Affairs at Emory University in Atlanta, and former director of the Centers for Disease Control and Prevention.
"Preventing obesity from happening in the first place will be much better for everyone in the long run because healthy children become healthy adults," said Carden Johnston, MD, president of the American Academy of Pediatrics, which considers obesity a top priority.
The chronic conditions now being seen in children as young as five include obstructive sleep apnea; severe orthopedic problems; and menstrual, kidney and liver problems, Dr. Robinson said. "Certainly young children already develop arthrosclerotic lesions in their aortas and coronary arteries because they are overweight, and we commonly see hyperlipodemia and hypertension." The increase in type 2 diabetes among younger and younger people also has been widely noted.
The need for additional education and certification for physicians is apparent, he added. "This is a new morbidity, and physicians are not trained for it."
The cost of training to help health professionals understand how to counsel families is liable to be substantial, he added. "And in addition to not having the skills, there is no reimbursement for weight counseling."
Jobs for everyone
The IOM report suggests a wide range of activities for parents, schools, the food industry, communities and physicians. "No single factor or sector of society bears all the blame for the problem, and no single group or sector acting alone can solve it," Dr. Koplan said.
All have a role to play in reversing the epidemic, according to the report. For example, physicians' access to young patients and their influence with families enables them to make credible recommendations on diet and physical activity, he added.
The report urges pediatricians, family physicians, nurses and other health care professionals to discuss children's weight with parents and with children and to routinely calculate body mass index along with height and weight. Including BMI will communicate that this is an important matter, just as important as routine immunizations in protecting children's health.
In addition, regularly recording BMI measures will allow better assessment of a child's growth trajectory than would height and weight measurements alone, the report said.
The report calls on professional groups to develop information on topics relevant to obesity prevention. It suggests that the American Medical Association develop materials on assessing and treating children's obesity similar to its 10-part monograph on adult obesity. The AMA has scheduled a National Summit on Obesity Oct. 19-20 to discuss medicine's response to the obesity epidemic. The summit will cover medical practice, school, workplace and community issues.
The report also asks the food, beverage and entertainment industries to voluntarily develop and implement guidelines for advertising and marketing directed at children. Congress is asked to provide the Federal Trade Commission the authority to monitor compliance with the guidelines.
Schools are urged to implement nutrition standards for all foods and beverages served on school grounds and to expand opportunities for all students to engage in at least 30 minutes of physical activity each day.
Although reversing trends that contributed to the obesity problem during a period of 30 or 40 years won't be easy and will require effort and resources, Dr. Koplan said, the resources called for now will be a pittance compared with the estimated $98 billion to $129 billion that will be required to pay the direct and indirect costs of health care for future obesity-related conditions.