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Obesity: Big Laugh Or Big Problem?

If the principle we care about is protecting children from harm, the practice should pertain to all threats comparably. At present, it does not. We are feeding our children to death.
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A few years back, I gave a talk on the island of Maui. Ordinarily, that would be cause for envy, I admit. But in this case, I was there for all of two days to speak at a conference, and the two days happened to coincide with a visit from the remnants of a tropical storm. So no need to mutter about my good fortune under your breath.

What is relevant to my topic about being on Maui is the plane I took to get here. I happened to be sitting in first class (I know, you're muttering again; just pay attention!). In my row was a woman who moved to Maui a year ago, her sister, and her sister's 2-year-old daughter. They had only two seats for the three of them, as the purchase of a seat for a 2-year-old is not required. But holding a two-year-old on your lap for six hours is no picnic, so the Maui resident asked to take the empty seat next to me.

I am not ordinarily very sociable on a plane, as I tend to have a lot of work to do. But this very friendly woman engaged me in conversation I could not decline. I did not get to know her well, but enough to recognize that she was intelligent, kind and warm-hearted. She was thrilled to be bringing her sister and baby niece to visit her new island home for the first time. I liked her.

There was something else I got to know about her, which required no conversation at all. A glance was sufficient. Namely, she was a very large woman. Very, very large. I would guess she weighed more than 250 lbs. Her sister, just a couple of seats away, was at least as large.

At one point during the flight, my neighbor's sister returned from the airplane lavatory and told her sister, with a chuckle in her voice, "if I get any bigger I'm not going to fit in there!" The two of them had a good laugh and exchanged quips about the need to "extend" those little toilets. They clearly had some version of a supersized potty in mind, as they joked about their mutual plight.

Throughout the entire flight, my neighbor (and her sister) were eating and drinking. This is hard to resist in First Class, where you are constantly offered temptations. So my neighbor consumed several glasses of wine. She ate everything that was brought out. And she ate a box of some kind of glow-in-the-dark cheese puffs she had brought with her.

Now I, too, brought food with me. But I brought mine as an alternative to what might prove to be nutritionally questionable choices offered by the airline. So I ate what I brought: fresh and dried fruit, and some home made granola squares instead of the creamy entree, and myriad tidbits. My neighbor brought along junk food, and ate it in addition to everything the airline could serve up.

Now you may be thinking this is none of my business, and perhaps the fact that I'm sharing these observations is even a bit distasteful. I could almost agree with you. But I watched my very delightful neighbor and her probably equally delightful sister share their eminently destructive behaviors with the two-year-old in their company. I have essentially no doubt that this child -- still lean at age two -- is destined for even more extreme obesity than her mother and aunt, and destined for the chronic diseases that ensue. In other words, I was observing a pattern of familial behavior that would destroy an innocent child's health.

That is everyone's business. I am not suggesting we should tell friends and neighbors how to live their lives. I am not proposing we impose our opinions about nutrition on other families than our own. I am not advocating for policing the diets of fellow passengers on our planes. What I am proposing is much bigger.

I am proposing, imploring and insisting that we start taking obesity seriously as the health crisis it is.

It was not really funny that these women were busily feeding the propagation of their own obesity, not funny that they truly will find it difficult to fit through the door of an airplane lavatory should they expand any further. It was no funnier than the diabetes, heart disease, sleep apnea and cancer that might well result. It was not at all funny that they were cultivating this same fate in a child.

Imagine if two drug addicts joked in public about the health consequences of their drug use, even as they shared their drugs with a small child. Society would deem such behavior unacceptable, even if the drugs in question were legal. Children are removed from their parents for less than this.

Imagine if smokers joking about their worsening emphysema put their cigarettes into the mouths of their infants. Would anyone observing this feel inclined to mind their own business?

Don't get me wrong; I am not maligning these women. As I said, I found my airplane row-mate to be quite delightful. I really liked her. Nor am I am suggesting her harmful behavior was even her fault. Our society has yet to provide any clear guidelines on what is, and is not, acceptable when it comes to second-hand obesity.

That is what has to change. You don't get to decide for yourself if giving drugs or cigarettes or alcohol to small children is appropriate. Society has decided for you: it is not!

Why? Is there something unique about these substances? No. Rather, there is something unifying about them: they all have the potential to harm children. The principle that governs our societal standards in these cases is that responsible adults defend innocent children from harm.

That same standard calls out for guidance about the feeding of children. Data from the CDC indicate that children growing up in the United States today will suffer more chronic disease and premature death over their lifetimes from eating badly and lack of physical activity than from exposure to alcohol, tobacco and drugs combined. If the principle we care about is protecting children from harm, the practice should pertain to all threats comparably. At present, it does not. We are feeding our children to death.

And that's just not funny. I watched my neighbor's behavior in silent despair. It was not my place to impose my views on her. But it is society's place to establish behavioral guidelines that address our collective priorities. Surely the protection of children's welfare ranks high among them.

Obesity is not the fault of its many victims, but they should not be laughing about it either. And they certainly should not be propagating it and its harms among children. I like a good laugh as much as the next guy. But unless we start recognizing obesity for the serious threat that it is, the fate of our children will be cause for tears.

David L. Katz, MD, MPH, FACPM, FACP

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