Dr. David S. Ludwig, a well-known and very highly-regarded child obesity specialist from the Children's Hospital in Boston, wrote a sobering editorial entitled "Childhood Obesity – The Shape of Things to Come" that was recently published in the prestigious scientific journal The New England Journal of Medicine. In his editorial, Dr. Ludwig projects that obesity in children may shorten average life expectancy by two to five years by midcentury (~2050). We stopped short when we read that - whew.
Dr Ludwig, just to push the point in case there were any misunderstandings, called this a health burden that is equal, he wrote, to all cancers combined! He compares the obesity epidemic to global warming, describing both as "looming crisis" – an excellent (and supremely daunting) analogy in our view.
While we very much appreciate the attention Dr. Ludwig brings to the childhood obesity epidemic, we did think one part of his editorial missed the mark a little bit. Dr. Ludwig describes the obesity epidemic in children as consisting of four overlapping "phases." He says we are currently in "phase 2."
• Phase 1 began around 1970, characterized by the
progressive increase in Body Mass Index – a more objective meausure to
help define overweight and underweight - among children. (You can
measure your BMI online at www.niddk.nih.gov/publications
• Phase 2 is marked by the emergence of serious weight-related problems in children such as type 2 diabetes and fatty liver disease (this is the accumulation of fat in liver cells - you can learn more by doing a search at www.mayoclinic.com).
• In phase 3, medical complications of obesity in children lead to life-threatening disease - coronary heart disease, hepatitis, cirrhosis, kidney disease requiring dialysis, and ultimately premature death.
• In phase 4, the childhood obesity epidemic will accelerate through non-genetic inheritance mechanisms. In other words, pregnant women who are obese will affect the developing fetus in such a way that the child's chances of becoming obese are increased. These mechanisms are just starting to be discovered, but if this does in fact occur, the obese adult population will give birth to a generation with even more obesity and related complications.
The problem with Dr. Ludwig's description of "phases," in our view, is that the so called "phases" of the epidemic are all happening right now, and each phase is getting worse! There are adolescents today who are obese and do not have complications (phase 1), and there are obese mothers today who raising their child's chance of becoming obese later in life through paranatal programming (phase 4). As we see it, Dr. Ludwig's "phases" are easier to think about as components of the obesity epidemic. Each component is a problem, and each component is getting worse. It's important that patients, healthcare providers, the government, educators and the general public fully recognize the extent of the obesity problem in this country - Dr Ludwig's editorial takes of further along that path and for this we are grateful.