In recent years, childhood overweight and obesity statistics have received a good deal of media attention, but this has done little to slow their rise.  Data from the National Health and Nutrition Examination Survey shows that nearly 1 in 5 children aged 2-19 are obese.  Even more concerning, since 1980 obesity rates have tripled in the 6-11 and 12-19 age groups.

Our individualistic society has decided that obesity is a personal failure – something that’s completely the fault (and under the control) of the patient – but it’s not as simple a decision to smoke a cigarette, drive drunk, or get on a motorcycle without a helmet.  Obesity is multifactorial, and this fact is only highlighted when dealing with pediatric patients, but the advice we give is two-dimensional:  eat less, exercise more.

Unfortunately, we’ve been giving more or less this same advice for decades as the problem continues to worsen.  There is accumulating research that obesity causes potentially irreversible metabolic alterations that render our mantra of “diet and exercise” inadequate to reverse the problem.  Thus, some would argue that the best way to address the obesity epidemic in America is to prevent obesity in the first place – but in order to do this, we have to understand how we got here.

Contributing to the obesity issue is the fact that we’ve drastically changed the very notion of what it means to feed ourselves:  at the grocery store we buy meals, entrees, and side dishes – not ingredients.  Worse, the food & diet industries actively work to confuse consumers through marketing and product placement.  Sedentary entertainment has vastly expanded in the past several decades, and in many communities, such as the one I currently serve, children have even less opportunities to exercise because their schools have cut gym class or it’s just plain unsafe to go outside.  These variables result in obesity being practically inevitable – “the new default,” as one of the physicians I work with recently called it.

So what are doctors doing about it?  Research shows that we’re doing a poor job of talking to children and their parents about unhealthy weights – one study revealed that among parents of children with a BMI in the 85th percentile or higher (the numerical definition of overweight in children), only 22% report being told by a doctor or other health professional that their child was overweight.  Assuming we even decide to address the issue, we have to give children and their parents a clear message and help them set real goals – I cringe when I see doctors tell parents “Johnny just has to try to eat a little less, and get a bit more exercise.”

Two of the biggest offenders I’ve been able to detect when interviewing children and their parents are liquid calories and portion size, but it’s important not to overwhelm patients when asking them to make lifestyle changes.  Therefore, my strongest recommendation to parents is often to limit juices and eliminate sweetened drinks – especially sports drinks and sodas.  I’m not a fan of artificially sweetened drinks or “diet” beverages, but in medicine we often have to bargain with patients, and I’d rather see children drinking flavored water than Coke and Gatorade.  However, I’d caution parents to consider the impact that training their children to drink only that which is sweet will have on their health in the future.

But things like limiting sugar and teaching portion control are just the tip of the iceberg.  We won’t make substantial inroads in reigning in childhood obesity until we attack the problem on multiple fronts.  That means improving school lunches, eliminating food desserts, making neighborhoods more exercise-friendly, and plenty of other small changes that, when combined, alter the environment we expose our children to – and this can only happen when we decide as a society that these are the right things to do.  Until then, parents and doctors will continue to bear the burden of the uphill battle against childhood obesity.

James Haddad is a medical student who blogs at Abnormal Facies.

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