*This post originally appeared on The PediaBlog on July 27, 2016.


Damage Starts Early



On Monday, we looked at data pointing to positive improvements in several areas of pediatric health in the United States over the past 20 years:

  • Teen pregnancies down.
  • Fewer kids binge drinking.
  • Fewer kids smoking (the lowest level ever recorded).
  • Fewer victims of violent crime among teens.
  • More children covered by health insurance (about 95% now).
  • More students completing high school continuing their education in college (68%).


But some things have not been getting better. Child poverty is a problem that not only persists in our country but is getting worse, even though Americans and their elected officials have been aware of it for decades. Yesterday, we looked at some proposals that should help solve this shameful situation.

Obesity/overweight in childhood and adolescence is also a major health problem that is not getting better. In fact, between 2011-14, obesity rates in the pediatric population increased. In the U.S., 19% of children ages 6-17 are obese (BMI greater than the 95th percentile); in 1980, 6% of children in this age range were obese. About the same percentage of children are not obese but are overweight. In all, nearly 40% of American children are overweight or obese.

Obesity and overweight have unmerciful health, social, and economic consequences for children, their families, and for society — consequences that can worsen over a (shorter) lifespan. For adults who are overweight (BMI 25-30), one year of life is lost on average. Moderately obese adults (BMI 30-35) lose three years of life and severely obese people (BMI >40) lose at least 8 years of their life expectancy on average. Being overweight is now the second leading cause of premature death in the U.S. behind smoking. It’s not just an American problem either: 1.6 billion people on the planet are either overweight or obese, according to the World Health Organization.

Most adults who weigh too much (defined by BMI) weighed too much as children and adolescents, which is why pediatricians are so intent on preventing obesity from occurring in the first place. A new study, which appeared last month in the New England Journal of Medicine, followed 2.3 million Israeli adolescents over 44 years and matched their BMI measurements as adolescents to their ultimate adult health outcomes. The study found, surprisingly, that even teenagers with BMI’s in the mid-to-upper normal range (50-75th percentile) had adverse outcomes compared to those with lower BMI’s (5-24th percentile):

BMI, including measurements in the currently accepted mid-normal range, was associated with a graded increase in the risk of death from cardiovascular causes. Obesity during adolescence was associated with a substantially increased risk of cardiovascular outcomes in middle age, particularly death from coronary heart disease. The associations, which were similarly evident in both sexes, persisted strongly for cardiovascular deaths occurring during four decades after the measurement of BMI in adolescence.


Molly Walker drills down:

After adjusting for multiple confounders, adults with an adolescent BMI in the obesity range (≥95th percentile) had an almost 5-fold risk of death from coronary heart disease, a more than threefold risk of death from total cardiovascular causes, and a more than twofold risk of death from stroke compared with adults with adolescent BMI in the 5th to 24th percentile, reported Gilad Twig, MD, of Sheba Medical Center in Ramat Gan, Israel, and colleagues.

But even those adults at the high range of normal BMI (50th to 74th percentile) as adolescents were more likely than their peers with lower BMIs (in the 5th to 24th percentile) to be at risk of death from coronary heart disease (CHD) than those adolescents on the lower end of normal BMI, they wrote in the New England Journal of Medicine.

Not surprisingly, those adults who were overweight as adolescents also had an increased risk of death from cardiovascular disease.


For most people, overweight and obesity are caused by an imbalance of calories eaten and calories burned, and it often begins in infancy. In developed lands-of-plenty like the United States, it’s not very hard for us to overshoot the mark of a normal weight (BMI) and become overweight or obese. What is very, very hard for us to do is to summon the nutritional and physical will, discipline, and patience necessary to equilibrate the caloric equation — and then reverse it — and achieve a normal body weight.

Pediatricians understand that it is usually easier to prevent a problem like overweight/obesity from happening than treating the problem once it presents itself. We’ll take a quick look tomorrow at one simple preventative measure.


(Google Images)