Dave of McRaven has taken exception to The Green Man scattering doom and gloom about willy nilly vis-a-vis obesity in the USA. Pointing out that weight gain may indicate increased health, not decreased, and this is a cogent argument. The reduction in smoking alone, which is a major killer in the USA, may have contributed to this.

Heart disease is often quoted as a major negative health outcome of obesity and yet, in spite of the rapid increase in obesity, there has been a dramatic reduction in deaths from heart disease over the same period, from 322 to 241 per 100,000. This reflects a reduction in heart disease generally with hospital figures showing discharge rates for patients for whom Ischemic Heart Disease was first-listed diagnosis have decrease from a high of 72 per 1,000 individuals in 1992 to 50.7 in 2002.

The fall is even more dramatic in the age group most at risk 65-74 year olds with rates falling from 100 to 57 per 1,000. What this dramatic fall masks in the overall statistics is the raise in heart disease in the age group 0-44. Over the lifetime of the statistics rates in this group have remained relatively stable at an average of 16.4. In 2002 the rate rose to 21.2 and one might hypothesise that this is correllated to the increase in childhood obesity.

This chart shows the growth in obesity over the period. Another very scary fact for children--Type II Diabetes, which used to be known as late onset diabetes, is now increasingly being diagnosed and adding to the cardiovascular risk profile of children. Many children now who are not only overweight, but they also have high blood pressure, lipid abnormalities, and diabetes--all of the factors that increase the risk among adults for cardiovascular disease and stroke.

Apart from these more clinical aspects, at a practical level, it is just not as much fun being a kid when you are fat.

Accordingly you would expect that it would be a big issue for pediatricians and so it is however research by Dr Eliana M. Perrin at the University of North Carolina has revealed that as few 12 percent of pediatricians surveyed felt effective in treating overweight children. You might think that ADHD would be a challenging complaint for pediatricians or that dealing with sexually transmitted diseases in children may confront a pediatrician's sensibilities but most surveyed were more comfortable dealing with these complaints than with obesity and the major reason appears to be their lack of comfort with their own body image. She says

pediatricians who thought they were thin had the toughest time counseling because they worried that patients would consider them unsympathetic ... Those who think themselves too heavy might have trouble counseling about weight for more obvious ‘pot-calling-the-kettle-black’ reasons.

Consequently, there is a culture of under-diagnosis of obesity problems in children despite the strong links to diabetes, high blood pressure and cardiovascular disease in later life.

The solution is relatively simple, a reduction in fast food and sugar rich carbonated drinks and a move to a less sedentary lifestyle. Implementing the solution on the other hand is a far from simple process.

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