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No Obese Child Is an Island

We can make health a family value under our own roof -- and unite the house.
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Mary Ann Liebert Publishing recently offered me the position of Editor-in-Chief for the journal, Childhood Obesity, an honor I accepted with great enthusiasm. The topic is timely, compelling, of urgent importance, ever more prominently in the public eye and a particular focus of my work. The journal is off to a great start, is in highly capable hands, and provides an exceptional forum for the combination of scholarly research articles, and pragmatic advocacy for needed changes in policies, practices, and programs. I consider the challenges of this new position a privilege.

But I do have one misgiving, related to the journal's title. For it is long established that no man is an island, and we may readily infer that no woman or child is an island, either. In my view, children and adults will control their weight and get to health together, or almost certainly will not do so at all.

That misgiving was compounded this past week by virtue of my role at the annual Art and Science of Health Promotion conference, held in Colorado Springs. I was asked to give the closing keynote address at the conference, and in doing so, to sum up the "lessons learned" at the conference. This, in turn, required that I attend as many of the conference sessions as I possibly could -- including catching enough of several concurrent sessions during any given block to discern the gist of each.

The conference was excellent overall, and the caliber of most sessions I attended was high. Many sessions -- even most -- addressed the obesity epidemic directly, and most of the rest made at least passing reference to it.

So it was clear enough that the obesity epidemic, and attendant chronic disease, were a major focus of the health promotion community -- as well they should be. It was also clear though, that the target of obesity control efforts was often children -- as often adults -- but rarely if ever ... both.

Experts in worksite wellness were an especially strong contingent at the conference -- no doubt testimony to the growing concern among employers that they are routinely spending more money on health care than on the materials needed to manufacture whatever their company makes. Many insights and innovations related to everything from architecture to incentives were presented, but the one message I never heard was: do something about the kids!

As a parent of five -- as someone who once was a kid -- and as an Internist who takes care of adults but routinely talks to them about what goes on in their homes -- I know something about the power the little devils exert on a family.

When kids have no interest in eating well, but instead want 'the one with Sponge Bob on it' it becomes virtually impossible for parents to make their home a safe nutritional environment. Conversely, when children are motivated to defend a health related issue, they become powerful agents of positive change. Kids were the major drivers of seat belt use, and fire safety nation-wide. They played a key role in reducing tobacco use as well. My own interest in nutrition as a child converted my whole family. For good, or for bad, kids are powerful change agents.

I attended some sessions and reviewed some posters at the conference that were dedicated to the issue of childhood obesity -- and these generally made no particular mention of the parents. In my own public speaking, I am usually invited to talk about adults, or children, but not both (although I do so anyway). Reviews of the obesity prevention and control literature suggest a similar fault line running through families, with children to one side, adults to the other.

To be sure, there are some obesity researchers focused preferentially on families; my friend and respected colleague, Dr. Len Epstein at SUNY Buffalo, springs immediately to mind. But this work is the exception rather than the rule, and still tends to be unidirectional in its intent. Dr. Epstein is best known as a childhood obesity researcher, who involves parents principally to facilitate weight control in the kids.

To some extent, a preferential focus on childhood obesity -- by researchers, and by my journal, is, of course, well justified.

As I have noted on many prior occasions, obesity and overweight are rampant among our children. The official definition of obesity in children (age -- and sex -- adjusted BMI at or above the 95th percentile) is willfully exclusive, rather than inclusive, to help minimize the numbers of children subject to the stigma of the term. By any reasonable definition, I think half of the children nationwide are already affected.

What was, a generation ago, "adult onset" diabetes, now routinely affects children under age 10 -- and is euphemistically called "type 2" diabetes, rather than what it really is: adult onset diabetes occurring in childhood due to massive societal irresponsibility and failure.

Studies show ever more cardiac risk factors in ever younger people. And, at the American Stroke Association's International Stroke Conference held in Los Angeles this year, a marked increase in the rate of stroke in children ages 5 to 14 was reported, and attributed to the obesity epidemic. QED!

My own work with school-based programming
has revealed to me that kids may be motivated to eat better, then go home to parents worried about -- and opposed to -- the potentially higher cost of more nutritious food (this worry is somewhat unfounded, by the way!). My work counseling adults has revealed again and again how challenging it can be to be active and eat well when the children at home vote no.

So there is danger in failing to see through the people to the family, as there is with the forest and its trees. What of opportunity?

Well, here is one simple idea that occurred to me. Among the many challenges schools face in efforts to adopt well-considered health promotion programming is lack of money. Worksites tend to have money, and more and more of them are spending some of it on wellness and weight control because they really have no choice. Just as companies adopt stretches of highway to demonstrate good corporate citizenship, and get some good PR by posting a sign that links a lack of litter to their company name -- they could adopt schools.

In fact, chambers of commerce could systematically help link companies to schools so that the schools get sponsored wellness programming; the companies get the recognition they deserve; and the health promotion efforts for kids in any given school or district are complementary to the programming for the parents of those very kids at a given worksite. And reciprocally, school-based health programming can be designed so it reaches into the home, and empowers parents too.

We all know what Lincoln told us about a house divided. I think it pertains no less well to the pursuit of health. Parents motivated to pursue the happiness of better health may be fully sabotaged by disengaged kids who don't want to play. Kids, inspired and enlightened by a school wellness program may hit an unyielding wall in parents opposed to change.

The basic functional unit of our society is ... the family. The household. No one of us is an island; and in our unity, there is potential strength.

Ideally, a whole array of programs and policies will help bridge the divide between kids and adults currently seeking health and weight control along separate tracks. But while waiting for this to be the norm rather than the exception, we can take matters into our own hands. We can make health a family value under our own roof -- and unite the house.

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