Obese Children: Offspring of an Obese Nation

Last week's news story fired up a debate about whether or not obese kids should be taken from their "neglectful" parents and placed in foster care.  The ruckus was kicked up by an article that appeared recently in JAMA (Journal of the American Medical Association) addressing the present national obesity epidemic and suggesting that, in extreme cases, obese children should temporarily be placed in foster care, believing that this would be more ethical than obesity surgery.

Here's more from KVEO, an NBC affiliate in Brownsville, TX (emphasis added) --

Dr. Donald Schwarz, Philadelphia Health Commissioner, says "we're talking about children who have not only the health issues, but who have parents whose behavior is seen as neglectful."

Dr. Donald Schwarz, a Philadelphia deputy mayor and the city's health commissioner, explains extreme cases can be defined in three ways: a child who is overly obese, has medical complications and whose parents have been deemed intentionally neglectful. He says only then the issue of foster care may be raised. He adds, in Philadelphia, the Department of Human Services, for example, would only remove a child in danger.

Dr. Schwarz says "in a case where we believe a parent is being neglectful, we would always consider whether or not that parent is an appropriate caregiver for a child "

Pediatrician Dr. Denise Baker says "I'm seeing it every day more and more however what is the real issue here. The issue is education."

Pediatricians like Dr. Denise Baker, who has been practicing for nearly 20 years, wonders if parents are truly neglecting their children or simply uneducated.

Dr. Baker says "we have to really go back to basics, eating meals at the table having healthy snacks around- go back to basics and prevention."

 A few points in response to the news story:

1) Rather than take the kids from the home, the State should first send in counselors to help the family resolve the problem(s), not only providing information on diet and exercise, but including counseling to get to the root of the extreme eating.  If the kid is obese, what do you want to be that the parents are, too?;

2) "Education" is not the sole missing component in the problem.  Anyone who does not know the "do's & don'ts" of eating and exercise has no excuse.  The information is everywhere, easily accessible, and free.  It's taught in school, on TV, in magazines, available in libraries and workplaces, and is even a topic in most people's everyday conversations.  As stated above, there needs to be some psychotherapy with the individuals to discover and work on the cause(s) of the lifestyle habits the individuals have created, adopted and propagate.

3) I continue to believe that obesity is our nation's allowable bias.  I've heard some individuals use it to slam another person in just as ugly a fashion as using a racial epithet.  So, in this case of obese children, it appears to be another permissible attack on fat folks.  How many times have I wished the State would intervene on a child's behalf in cases of clear-cut abuse?  The State will act far more quickly in the case of a dog than for a child.  Why doesn't the State intervene in other cases of "neglect", such as cases where parents "contribute to the delinquency of a minor" by allowing their children to skip school, in giving them alcohol, or standing idly by as their kids reproduce irresponsibly?  Those behaviors impact a child's life as much, if not more, than obesity.  And, like an unhealthy lifestyle, those delinquency behaviors are also propagated to coming generations.

What is the impact of our unhealthy lifestyle?  Here are some sobering statistics from Psychology of Medicine (emphasis added):

F as in Fat: How Obesity Threatens America's Future 2011 - Trust for America's Health

Adult obesity rates increased in 16 states in the past year and did not decline in any state, according to F as in Fat: How Obesity Threatens America's Future 2011, a report from the Trust for America's Health (TFAH) and the Robert Wood Johnson Foundation (RWJF).  Twelve states now have obesity rates above 30 percent. Four years ago, only one state was above 30 percent.

The obesity epidemic continues to be most dramatic in the South, which includes nine of the 10 states with the highest adult obesity rates. States in the Northeast and West tend to have lower rates. Mississippi maintained the highest adult obesity rate for the seventh year in a row, and Colorado has the lowest obesity rate and is the only state with a rate under 20 percent.

This year, for the first time, the report examined how the obesity epidemic has grown over the past two decades. Twenty years ago, no state had an obesity rate above 15 percent.  Today, more than two out of three states, 38 total, have obesity rates over 25 percent, and just one has a rate lower than 20 percent. Since 1995, when data was available for every state, obesity rates have doubled in seven states and increased by at least 90 percent in 10 others. Obesity rates have grown fastest in Oklahoma, Alabama, and Tennessee, and slowest in Washington, D.C., Colorado, and Connecticut.

"Today, the state with the lowest obesity rate would have had the highest rate in 1995," said Jeff Levi, Ph.D., executive director of TFAH. "There was a clear tipping point in our national weight gain over the last twenty years, and we can't afford to ignore the impact obesity has on our health and corresponding health care spending."

Our obesity has been deemed a threat to our national security.  (Huh?!?  Here's why: "Since 1995, the proportion of potential recruits who failed their physical exams because of weight issues has increased nearly 70 percent ..."  Go here for that article.)

So, what are the causes of our nation's obesity epidemic?  Sure, there's the medical explanation of what leads to gaining weight; but, I'm asking from from a psychological perspective.  We very well know what causes weight gain and know what we should be doing; but, we obstinately refuse.  Why are we so food obsessed, existing in a perpetual state of denial about our habits?  Everyone complains about the huge portions of food offered in restaurants and the ongoing snacking we engage in.  We know supersizing is bad for us, and I, too, am soooooooo guilty of ongoing grazing throughout the day. 

Why do we do it?!?

I decided to do some fishing around for some possible answers ...
• Of course, there's the depression-eating link.  Besides being bombarded with all kinds of food commercials and print ads, we also see quite a few ads for pharmaceuticals, including anti-depressants.  (It makes you wonder if we are we depressed as a nation.)  Here's an excerpt from a Psychology Today article about childhood obesity and depression:

Depression in children is often linked with obesity. But it seems to be a case of chicken and egg. The two conditions often occur together, but it is unclear exactly which is cause and which is effect.

Obesity rates are soaring. One study, published in Pediatrics, found that the longer a child is overweight, the more he or she is at risk for depression and other mental health disorders.

The study followed nearly 1,000 white children in North Carolina, ages 9 to 16, over eight years. Young boys, but not girls, proved especially prone to the dual problem of obesity with depression.

 "The link could have to do with social factors or it could be neuroendocrine-related," says Sarah Mustillo, Ph.D., of Duke University Medical Center. "It could be that if you're only obese for six months, there's not as much of an effect as if you were obese for five years."

At the center of obesity-depression link is biology, notably the hormonal pathway known as the HPA axis. It is the route of communication between the hypothalamus, the peanut-sized part of the brain that governs parts of the nervous system, and the pituitary and adrenal glands, which secrete a variety of hormones.

These three points of the body work together to maintain chemical equilibrium when the body is under stress. The HPA axis is responsible for releasing cortisol, the so-called "stress hormone." It plays a critical role in energy metabolism as well as other functions. The problem is, cortisol prompts the body to deposit fat around the abdomen, a pattern that is especially hazardous to health. Chronic stress also begets depression.

"Obesity, depression and behavioral disorders have all been linked to abnormal functioning of the HPA axis," says Mustillo. While social factors such as teasing and isolation may contribute to depression in obese kids, Mustillo believes the problem is much more complex.

"It's probably a combination of social and biological factors," she says, noting, "There's an interaction between what's outside your body and what's inside." Obesity carries a large social stigma and may bring on depression if it negatively affects self-esteem, body image or social mobility. It may even disrupt the normal hormonal pathways. Then again, depression may also bring on obesity, if a child lacks the energy to exercise or is immobilized by stress.

...

The best thing parents can do is to treat obesity as a health issue, not a problem of appearance, and to accurately record their child's height and weight. He urges parents, physicians and psychologists to press insurance companies to cover behavioral therapy for obesity.

It's also important to recognize that obesity isn't necessarily caused by overeating. Says Elizabeth Goodman, M.D., of Brandeis University: "There are different types of depression and different types of obesity. It's easy to say that it's all behavioral. That makes it sound like there's a choice; I'm not sure that it is."

As with all cases of an individual being counseled, it's always a good idea for the entire family to involved.  I wonder how many parents browbeat their kids about their weight.  How many parents themselves have poor habits, not to mention self-esteem?  I think of a friend who continually berates herself because of her weight.  One evening after a huge meal at a restaurant followed by chowing down during a movie, she said to me "I just hate myself!"  That was just one instance of her mentally beating herself up.  How often has her teenage daughter witnessed this behavior?  I imagine the daughter herself has adopted the same "ritual" of an eating binge followed by a round of mental self-flagellation. 

• Personally, I think it's a bit of a retaliation against this "food police" mentality we've had for a generation or two.  It started with my mother's generation -- all the women wanting to look like Audrey Hepburn.  It kicked in full-bore with Twiggy in the 60's and this trend has continued ever since.  Women's magazines at the grocer story check-out scream guilt-inducing headlines at me: "Lose 20 Pounds in 5 Days!"  "How Celebrity-So-And-So Dropped Her Baby Weight In Time for the Oscars", "20 Foods That Make You Fat!", "20 Foods That Burn Fat!" ... and that always sickly include one headline that says something like "20 Scintillating Treats to Bake for Your Family."

• Another personal thought: marketing.  There is a boatload of money to be made off of diet and fitness products.  We are awash in a sea of commercials and ads for food -- fattening and diet, exercise programs and contraptions, and pharmaceuticals.  According to Bloomberg Business, Americans spend $40 billion a year on weight-loss programs and products.  $40 billion?!? 

Are our pudgy waistlines merely a symptom of a bigger problem?

Apparently, there's a fancy-shmancy professor of political science at the University of Chicago that agrees with me!  J. Eric Oliver, in his book "Fat Politics: The Real Story Behind America's Obesity Epidemic", writes about a sick culture drowning in the paradox of too much choice and the shame of too much consumption.  Here's a description of his book from Amazon.com (emphasis added):

It's not obesity, but the panic over obesity, that's the real health problem, argues this scintillating contrarian study of the evergreen subject of American gluttony and sloth. Political scientist Oliver condemns what he feels is a self-interested "public health establishment"-obesity researchers seeking federal funding, pharmaceutical and weight-loss companies peddling diet drugs and regimens, bariatric surgeons and other health-care providers angling for insurance reimbursement-for spuriously characterizing fatness as a disease. He debunks the dubious science and alarmist PR that fuels their campaign, taking on arbitrary Body-Mass Index standards that slot even Michael Jordan in the overweight category, state-by-state maps of obesity rates that make fatness look like a contagion spreading over the countryside, and flimsy research studies that vastly exaggerate the danger and costs of weight gain. Oliver also examines American attitudes towards obesity, probing the abhorrence of fatness implicit in the Protestant ethic and, less plausibly, tying our contemporary feminine ideal of the emaciated supermodel to a confluence of sociobiology and the economics of the urban sexual marketplace. Arguing that fatness is perfectly compatible with fitness, he contends that scapegoating obesity drives Americans to experiment with dangerous crash diets, appetite suppressants and weight-loss surgeries, while distracting us from underlying harmful changes in the American lifestyle-mainly our incessant snacking on junk food and shunning of exercise and physical activity, of which weight gain is perhaps merely a "benign symptom." Oliver provides a lucid, engaging critique of obesity research and a shrewd analysis of the socioeconomic and cultural forces behind it. The result is a compelling challenge to the conventional wisdom about our bulging waistlines.

I've promptly downloaded a free chapter to my iPad!  His theories sound exactly like what's been playing in the back of my mind as my colleagues pound the table in disgust at "fatties."  (Something tells me I'll soon be buying the entire book!)