OBESITY IN CHILDHOOD

OBESITY IN CHILDHOOD D URING the past 35 years the North American culture has become increasingly preoccupied with the problems of obesity. \Vhile marked excesses of body fat have worried both patients and physicians for over half a century, the same mutual anxiety is often elicited today by mild or only moderate upward deviations from average body weight. Pediatricians vary greatly in their attitudes towards obesity in children under their care. This variation probably reflects, on one hand, the madequacy of available information on the implication of obesity in childhood and, on the other, the physical and emotional differences among physicians. This report attempts to place in perspective some of the available data concerning obesity in childhood. At the same time, it poses certain questions which may help the pediatrician to develop a realistic and practical philosophy for the assessment and, in some instances, treatment of obese children and adolescents. A review of current knowledge concerning obesity, rather than a treatment guide, may be of more immediate value to the physician, since many facts necessary for a comprehensive understanding of the pathogenesis of obesity are still lacking and the long-term results of all forms of treatment are often disappointing. In a review of this nature, the following questions must be considered. What is the basis of the current anxiety over obesity? Can obesity be defined with any degree of accuracy? Can obesity be regarded as an entity with a single etiology? What is the natural history of obesity in childhood and adolescence? What risks are directly attributable to obesity and can they be reduced by the induction of weight loss? How successful are therapeutic programs for weight reduction in obese children and adolescents and are there any undesirable side-effects or dangers in such treatments? \Iuch of our current concern for the obese individual originated in 1930 when Dublin and Marks documented an association between overweight and increased age-specific mortality rates in adults. In their study, death from certain types of diseases occurred with greater frequency in obese individuals; cardiovascular-renal disease was 1.62 times more frequent and diabetes was 2.57 times more frequent than in nonobese controls. These data alone indicated only an association, not necessarily a cause and effect relation. Conceivably both obesity and the increased mortalth rates could have been causes of or results from one or more underlying metabolic disturbances. The ultimate benefits of weight reduction in obese individuals could only be assessed with certainty if morbidity and mortality rates from the foregoing disease states fell significantly as a result. Dublin2 has published evidence bearing on this question in adults. He found that death rates among previously overweight adults who had lost sufficient weight to qualify for lower insurance rates were reduced by onefifth in men and by one-third in women. Physicians must recognize the enormous and often subtle social pressure to which they and their patients are subjected whereby thinness and weight reduction are promoted as the touchstones of good health and social acceptance. Ever increasing mulions are being spent on low-calorie foods and beverages and in slenderizing salons as well as in advertising designed to glamorize the slender figure. The statement that people are fat because they eat too much is as enlightening as a pronouncement that “individuals are alcoholic because they drink too much.” Therefore, an examination of the etiology and treatment of obesity must begin with an appraisal of the various factors which regulate food intake.