Pediatric Conference Examines The Fattening Of America

By Kaaren Valenta

Fifty percent of the adult population in the United States is overweight. Even more alarming, 30 percent of children under the age of 18 are obese, a 10-fold increase in less than three decades.

Two physicians, Dr Michael Rosenbaum, a pediatric medicine specialist from New York City, and Dr Nir Barzilai, a researcher at Albert Einstein College of Medicine, outlined the growing problem of obesity last week at the 15th annual Pediatric Update Conference at Danbury Hospital. The speakers were introduced by Dr Jack S.C. Fong, chairman of the Department of Pediatrics at the hospital.

“Along with the increase in obesity, there has been a 20-fold increase in Type 2 Diabetes,” Dr Barzilai said. “With obesity [also] comes a striking increase in cardiovascular disease and the risk of dying from heart attacks and cancer. There is a relationship between obesity and death and all kinds of cancer.”

Dr Barzilai, an associate professor of medicine who is doing research in geriatrics and endocrinology, explained that during evolution the human body developed a “thrifty” set of genes that helped prevent starvation and protect reproduction during times when food was not readily available. What has changed, in the years since the Industrial Revolution, is the environment.

“Today people – especially children – are sitting in front of the television set or at the computer. They are eating as much as they want to, something they’ve never been able to do before in mankind’s history,” Dr Barzilai explained.

Longevity, he said, is inversely related to fat mass. “Fat tissue is not inert – it is biologically active and it is reactive to nutrients. And when it is abdominal fat, the body develops insulin resistance that can lead to diabetes.

Dr Barzilai said a 1992 study in Sweden showed that fat distribution is very important. “There was a 20 percent incidence of diabetes, heart attacks, and stroke in those persons who had a high ratio of waist to hip. Those with the lowest ratio of waist to hip had the lowest incidence,” he said.

Dr Rosenbaum said that there is more than environment involved in the increasing problem of obesity.

“Children as young as kindergarten think that a fat person is someone who is lazy and eats too much,” he said. “In fact, it is a biological and psychological problem. The genetic influence on fatness is as powerful as its influence on height.”

Dr Rosenbaum estimated that 70 percent of body fat could be attributed to genetics, 30 percent to environment.  “Body fat is very much inherited,” he said. “Growth patterns are inherited.”

He produced some other statistics: The average American gains a pound a year while consuming about 900,000 calories.  Ninety to 95 percent of the people who lose weight will gain it back within two years. The prevalence of obesity is increasing by 30 to 40 percent per decade. Although humans are not born with a fixed number of fat cells, once the fat cells develop, “they are there forever.”

Liposuction isn’t an answer either. “Research suggests that the body makes new fat cells to replace those lost,” he said.

In recent years researchers hoped leptin, a hormone that seems to signal the brain that the body has eaten enough, could be used to control appetite and weight. But Drs Barzilai and Rosenbaum said studies so far have shown that it takes a huge amount of leptin to produce any weight loss in humans, and there are harmful side effects with those high doses.

The alternative, he said, is to change our lifestyles. What parents can do is substitute water for sweet drinks, eat out less at fast-food restaurants, and decrease the amount of fatty or fried foods in the diet. Eliminate high-fat, calorically dense foods from cupboards. Watch less television, exercise regularly – but don’t have treats as a reward afterwards, he said. “Never use food as reward or punishment.”

Dr Rosenbaum said parents should not worry about a chubby baby, nor should they put children on low-calorie diets. “There are serious health hazards and risk of death in these cases,” he warned. “Let children grow into their weight naturally. If weight loss is necessary, because of a family history of diabetes and heart disease, do it slowly – 1-2 pounds per week in teenagers.”

Dr Rosenbaum said the entire family’s diet must be similar to prevent the overweight members from feeling that they are being deprived. And once there is a weight loss, there must be a long period of maintenance.

“If a 200 pound person loses 25 pounds, that person can’t eat like the average 175-pound person,” he said. “The hardest thing to sell is that you have to maintain [the weight loss regime] to keep the weight off. “

Losing weight is very hard work, he admitted, pointing out that one hour of walking equals the calories in one tiny snack-size bag of potato chips. But intentional weight loss can reduce mortality rates.

“Anyone who sustains even a mild degree of weight loss is deserving of our admiration and respect. They are bucking many millennia of evolution,” he said.

Other speakers at the conference included Stephen P. Herman, MD, of Newtown, associate clinical professor of psychiatry at Mt Sinai Medical center; Lee Pachter, DO, head of the Division of General Pediatrics at the University of Connecticut School of Medicine; Henry M. Feder, Jr, MD, professor in the departments of family medicine and pediatrics at UConn; and Jane E. Corrarino, RN, assistant director of nursing with the Bureau of Public Health Nursing in Suffolk County.

Pediatricians Humberto Bauta, MD, of Newtown, and Ana Paula Machado were the program moderators.