Abstract
We learned that things might be getting better. The Robert Wood Johnson Foundation published a report in September of 2012, 1 with subsequent coverage as a lead story in The New York Times, 2 indicating that rates of childhood obesity are declining slightly in those several locations around the country where the most is being done to make it so. For those of us who have struggled with relentlessly worsening obesity trends over decades, such findings are a welcome indication that success is possible.
The declines are modest, but as measured against the perennial increases to which we have grown accustomed, they qualify as a minor triumph just the same. The big news is that the curves are, at last, changing direction. When we do the right things, we can bend them.
But then again, things might be getting worse. The CDC has told us of dramatic increases in the prevalence of diabetes. 3 A recent report in The Lancet on the global burden of disease indicates more life, but less health around the globe with obesity a major driver of the decline. 4 We are living longer, but with ever more chronic disease. 5 While this report is about adults, it portends the future that awaits today's children. In the United States, life expectancy is rising less, especially for women, than it is in other developed countries, causing America's place in the world rankings to decline. 6 Again, this portends a less promising future than our children deserve, and perhaps even hints at the long feared possibility of life expectancies falling rather than rising. 7
While I am certainly gratified to see some early indications that the tide of childhood obesity may at last be turning, weight, per se, was never what mattered. What has mattered all along is health. Health is the prize because healthy people have more fun and lead better lives.
As Editor-in-Chief of the journal Childhood Obesity, one of the issues my editorial colleagues and I have wrestled with is our name. It makes sense, because obesity is on the causal pathway to every major chronic disease that plagues modern societies. Obesity is the major driver of diabetes trends around the globe, and the reason that what was once adult-onset diabetes was transformed into type 2 diabetes, a condition afflicting children now all too routinely.
But the name is a potential distraction, too. It implies that size and shape are what matter, when they are not. Any size or shape is fine for someone who is healthy and content there. What makes shape and size problematic is they are often harbingers of ill health and discontent. Ill health and discontent—loss of years from life, and loss of life from years—are the real enemies.
Therefore, that muddled message bedevils our efforts as they extend into the New Year. Obesity rates may be leveling off or even declining in some places. But related health measures seem to be worsening, not improving. Is this even plausible? It is, and in several ways. One, and perhaps the most obvious, is that there will be a delay before any changes in weight translate into health improvements. We could, in fact, not reasonably expect it to be otherwise. Stabilization in childhood obesity rates now means a comparable stabilization, and decline, in type 2 diabetes some years from now. Perhaps we just need to be patient.
But another route to plausibility is less hopeful. We heard news not long ago that while overall obesity rates may have leveled off, the rate of severe obesity is ‘skyrocketing.’ 8 If that news is juxtaposed with the good news about childhood obesity rates, we wind up with the possibility of a pale silver lining, shrouded by rather dense storm clouds.
What if, for instance, we are lowering rates of childhood obesity by helping those prone to only mild weight excesses to stay in the ‘normal’ weight range? What if we are not yet managing to help those prone to the more severe degrees of obesity most likely to undermine health, because they in fact need more intensive approaches than we routinely make available? 9
Obesity rates were, inevitably, going to level off, if not reverse, at some point. The worst-case scenario, which some still deem a possibility, is that virtually every one of us would wind up overweight or obese. 10 So, 100% obesity was always a ceiling.
At some point, we were going to have to ask a different question. It would no longer help to ask: How many of us are overweight or obese? The new question would need to be: How overweight or obese are the many of us? And that question would imply the corollary: And how, exactly, is our weight affecting our health?
What matters here is health. Everything else is just fashion. When a preoccupation with weight diverts our focus from health to fashion, dangerous mischief ensues, such as the impulses that lead young women and men alike toward eating disorders. 11
Obesity was always a proxy measure and, for that matter, health is a proxy measure, too. 12 Health only matters because it changes the quality of our lives. It is really living that matters. Healthy people live better. Healthy people have more fun!
So childhood obesity is a worthy topic, a deserving dedication, and a reasonable rubric. Not because of what children weigh, but because of what obesity does to the way they live their lives.
Tracking obesity trends has been constructive until now, because obesity trends have reliably indicated trends in morbidity, and because more obesity has meant less health, less living, and less fun for our children. A focus on obesity has been safe until now. Messages about obesity trends have reliably translated into messages about health.
But as 2013 gets under way, so does a new era in the effort to turn the tide of childhood obesity. It is not just a New Year; it is, apparently, also a new day. An era in which a mix of good news and bad may muddle the messages about how best to apply our minds to what truly matters is under way.
We need to be more careful than ever to see past weight to what really matters. Are we making kids healthier? Are we helping those who need help the most? Is our progress generalizable? Is it sustainable? Do the benefits travel home with the kids we reach through schools, to advance the health of other family members? We will only get the answers we need if we pose the right questions.
We close out a year with a drought of good news, and bad. We begin a year with cause for cautious good cheer, and careful vigilance.
Our cup may be half full, or half empty depending on the data we imbibe on any given day. But either way, it is not yet time to raise that glass and toast our early successes. There is clearly much work left to be done, and to do it we will need to keep our wits about us. For we may find it more challenging than ever to sort through mixed messages about the status of our mission, and mind what truly matters.