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One of the fascinating aspects of medicine is that, even in the 21st century, our knowledge and understanding are continually evolving. Almost daily, new information overturns long-held concepts about medicine and health.
During the Vietnam conflict, autopsies on young soldiers killed in action revealed the stunning fact that subclinical atherosclerosis is evident in late adolescence and early adulthood.1 Coronary artery disease, previously considered primarily an illness of older adulthood, was well under way in young, apparently healthy men. The discovery marked a dramatic shift in our understanding and management of cardiovascular disease.
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The situation is similar with obesity. Until recently, a degree of pudginess in children was generally accepted as a benign sign of a healthy appetite or stocky parentage. It's becoming increasingly clear that overweight and obesity among our children are serious signs with profound implications for the individual and the medical community.
The true nature of obesity and its comorbidities are becoming more apparent. A new report in this issue of DOC News ("Metabolic Syndrome Center Stage at AHA Scientific Sessions," see page 1) has a troublingly familiar ring. Research indicates that young men with metabolic syndrome are 2.5 times more likely to develop early atherosclerosis than their normal counterparts, even when they have a low Framingham risk score. Once again, we are reminded that things may be much more serious than first appearances suggest.
MAGNITUDE IN FOCUS
A report released in September by the Institute of Medicine (IOM) of the National Academies, "Preventing Childhood Obesity: Health in the Balance," underscores the magnitude of the problems posed by overweight and obesity.2
According to the IOM, over the last three decades the rate of childhood obesity—defined as equal or greater than the 95th percentile on body mass index (BMI) charts—has more than doubled for children aged 2–5 years and adolescents 12–19 years, and has more than tripled for children aged 6–11 years.
The reasons for dramatic increase in childhood obesity are complex and multifactoral—a diet laden with fast food and sugary drinks; limited access to fresh fruits, vegetables and nutritious foods; reduced opportunities for physical activity during and after school hours; urban designs that discourage walking; leisure time spent watching television and playing video games.
Overweight and obesity pose a range of health risks to children in the near and long term. The IOM report notes that type 2 diabetes is rapidly becoming a disease of children and adolescents. Type 2 diabetes now accounts for 8%–45% of all new cases of diabetes, according to the panel. For those in ethnic minority groups, the outlook is even more grim.
Another story in this issue ("Study: Adolescents Aware of their Overweight and Obesity," see page 10) describes research suggesting that teens are fully aware of their physical appearance and report the intention to address their weight issues. In many cases, these children are motivated for change and only need somebody to guide them in the right direction.
A CALL TO ACTION
This news is deeply troubling. As clinicians—and concerned parents—we cannot stand idly by while our progeny face preventable morbidity and premature mortality.
At the front lines of public health, providers have historically risen to the challenge posed by health risks as they are identified, whether immunization or automobile safety belts or smoking. Our role is to talk with patients one-on-one to help them make healthful choices.
It's time to put overweight and obesity where they properly belong: a top priority as a public health risk. Physicians cannot solve the obesity epidemic alone. Reversing trends will take the involvement of schools, families, communities, industry, and government.
Physicians, nurses, and other health professionals should discuss weight issues with patients of all ages, and with the parents of pediatric patients. The IOM report recommends that pediatricians routinely track BMI in children and youth, regarding the index as another basic vital sign recorded during every visit.
Routinely tracking BMI is a reasonable, fairly simple step that is not performed often enough. A recent survey of North Carolina pediatricians shows that only 11% reported "always" charting BMI and 31% admitted that they never do.3 This just isn't good enough.
Beyond our clinical practices, physicians can play a role to improve the health of children in the community. Start with your children's school. Visit the school to see what sort of food choices are made available to students, and to determine whether kids are given time for physical recess during the day. Urge that soda machines be removed from schools and other healthful changes be adopted.
Doing otherwise—doing nothing—is a grave disservice to our
patients and our families. 
Footnotes
A pre-publication version of the Institute of Medicine report, "Preventing Childhood Obesity: Health in the Balance" is available in PDF format at www.nap.edu/books/0309091969/html.
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References
2. Committee on Prevention of Obesity in Children and Youth:Preventing Childhood Obesity: Health in the Balance . National Academies Press, Washington, D.C., 2005.
3. Perrin EM, Flower KB, Ammerman AS: Body mass index charts: useful yet underused. J Pediatr 144:455–460, 2004.[Medline]
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