Managing the Risk of Childhood Overweight and Obesity in Primary Care Practice

Abstract

Obesity is a complex, multifaceted chronic disorder that is the result of genetic, epigenetic, environmental, and behavioral factors. It can be helpful for clinicians to examine the graphic showing the onset of the pediatric obesity epidemic (Fig 1). Abruptly, beginning in the mid-1970s, rates of overweight and obesity started to rise and continued unabated into the early part of this century, first for older children and teens, and later for preschoolers and toddlers (www.cdc.gov). Why did obesity suddenly become a problem? Although the media frequently focuses attention on individual factors as major contributors to excess weight, such as fast food or high fructose corn syrup or video games, the fact is that a confluence of many factors seemed to arise abruptly in the late 1960s and early 1970s, associated with the sudden accumulation of excess body weight among both adults and children. Consider that soft drinks became the national drink, replacing water and milk. Processed snack foods proliferated along with niche advertising directed specifically toward the kids market. Cable television, home movies, and early computer games enticed children indoors. The information age was ushered in by computers. Suburban layouts fostered driving and drive-through business, eating in cars, and longer commutes. The list could be very long. Fundamentally, American life changed. Consider it another example of Malcolm Gladwell’s “tipping point” concept, in which several small contributors result in an seismic shift away from the norm. 1 For both children and adults, the diet has shifted from natural, whole foods toward a hybrid comprising high-calorie low-nutrient, highly processed foods, while at the same time, routine physical activity has given way to a rising number of sedentary hours per day.