WASHINGTON — An epidemic of obesity is compromising the lives of millions of American children, with burgeoning problems that reveal how much more vulnerable young bodies are to the toxic effects of fat.
In ways only beginning to be understood, being overweight at a young age appears to be far more destructive to well-being than adding excess pounds later in life. Virtually every major organ is at risk. The greater damage is probably irreversible.
Doctors are seeing confirmation of this daily: boys and girls in elementary school suffering from high blood pressure, high cholesterol and painful joint conditions; a soaring incidence of type 2 diabetes, once a rarity in pediatricians' offices; even a spike in child gallstones, also once a singularly adult affliction. Minority youth are most severely affected, because so many are pushing the scales into the most dangerous territory.
With one in three children in this country overweight or worse, the future health and productivity of an entire generation — and a nation — could be in jeopardy.
"The sense of this as a national health priority just doesn't come through," said Jeffrey P. Koplan of Emory University, a former director of the Centers for Disease Control and Prevention and chairman of the Institute of Medicine's 2004 study of childhood obesity. The top recommendation of that seminal report was for the government to convene a high-level, interdepartmental task force to guide a coordinated response. No such body has been assembled.
There's no question that the U.S. epidemic won't be reversed by federal fiat alone; responsibility lies also with individuals, the health community, corporations, local governments and others. Still, health experts insist that strong leadership from the top is crucial, and see the Bush administration falling short of expectations and few real champions in Congress. They say the administration and lawmakers are not aggressively pressing for industry or food policy changes.
The trouble is a quarter-century of unprecedented growth in girth. Although the rest of the nation is much heavier, too, among those ages 6 to 19 the rate of obesity has not just doubled, as with their parents and grandparents, but has more than tripled.
Fears about future
Because studies indicate that many will never overcome their extra weight — up to 80 percent of obese teens become obese adults — experts fear an exponential increase in heart disease, strokes, cancer and other health problems as the children move into their 20s and beyond. The evidence suggests that these conditions could occur decades sooner and could greatly diminish the quality of their lives. Many could find themselves disabled in what otherwise would be their most productive years.
The cumulative effect could be the country's first generation destined to have a shorter life span than its predecessor. A 2005 analysis by a team of scientists forecast a two- to five-year drop in life expectancy unless aggressive action manages to reverse obesity rates. Since then, children have only gotten fatter.
The epidemic is expected to add billions of dollars to the U.S. health-care bill. Treating a child with obesity is three times more costly than treating the average child, according to a study by Thomson Reuters. The research company pegged the country's overall expense of care for overweight youth at $14-billion annually. A substantial portion is for hospital services, since those patients go more frequently to the emergency room and are two to three times more likely to be admitted.
Given the ominous trend lines, the study concluded, "demand for ER visits, inpatient hospitalizations and outpatient visits is expected to rise dramatically."
Ultimately, the economic calculations will climb higher. No one has yet looked ahead 30 years to project this group's long-term disability and lost earnings, but based on research on the current workforce, which has shown tens of millions of workdays missed annually, indirect costs will also be enormous.
Childhood obesity is nothing less than "a national catastrophe," acting U.S. Surgeon General Steven Galson has declared.
The individual toll is equally tragic. "Many of these kids may never escape the corrosive health, psychosocial and economic costs of their obesity," said Risa Lavizzo-Mourey, president of the Robert Wood Johnson Foundation, which has committed at least $500-million over five years to the problem.
The cycle of obesity and disease seems to begin before birth: Women who are overweight are more likely to give birth to bigger babies, who are more likely to become obese. "And so you build it up over generations," said Matthew Gillman, associate professor of ambulatory care and prevention at Harvard Medical School. "You get an intergenerational vicious cycle of obesity and disease."
The extra pounds appear to weigh more heavily on bodies that are still forming. Fat cells, researchers have found, pump out a host of hormones and other chemicals that might permanently rewire metabolism.
Risk of heart disease
"A child is not just a little adult. They are still developing and changing. Their systems are still in a process of maturing and being fine-tuned," said David S. Ludwig, an obesity expert at Children's Hospital in Boston. "Being excessively heavy could distort this natural process of growth and development in ways that irreversibly affect the biological pathways."
As many as 90 percent of overweight children have at least one of a half-dozen avoidable risk factors for heart disease. Even with the most modest increase in future adolescent obesity, a recent study said the United States will face more than 100,000 additional cases of coronary heart disease by 2035.
The internal damage does not always take medical testing to diagnose. It is visible as a child laboriously climbs a flight of stairs or tries to sit at a classroom desk, much less rise out of it. The emotional distress of these ailments, combined with the social stigma of being fat, makes overweight children prone to psychiatric and behavioral troubles. One analysis found that obese youth were seven times more likely to be depressed.
"Obese children are victimized and bullied," said Jeffrey B. Schwimmer, a pediatric gastroenterologist at the University of California at San Diego. "Not only do other children treat them differently, but teachers treat them differently. And if you look at obese adolescents, their acceptance into college differs. For obese girls, their socioeconomic status is lower. It cuts a broad swath."