Childhood obesity – what is the hype all about?

I’m not sure how, as a paediatric endocrinologist (child hormone doctor) whose main research interest was a rare condition called Congenital Hyperinsulinism, I ended up becoming a childhood obesity specialist. I think that journey began when my predecessor and mentor, Dr Catherine Hall, tragically and suddenly passed away, leaving the paediatric endocrine department with cohorts of children being seen for their weight issues who didn’t really have anyone to see them any more.

As I took on her clinics, it wasn’t long before I realised that the majority of the children with significant weight issues also had significant social issues too. It is well recognised, in research and the media, that unhealthy weight in UK children follows closely to patterns of social deprivation. Of course that doesn’t apply to everyone, but many of these children and their families needed help and assistance to stem the upward trend in weight.

Based on historical facts and figures, these children are destined to just become bigger. Despite this reality, government does little. Why is this? Well, it’s complex to say the least. I’m not going to pretend I know all the answers - because if I did, every single patient of mine would be reaching a healthy weight with no problems at all. But here’s a meagre offering to the ‘why’ question: diet, exercise (or rather lack of it), genes, parenting, early use of food as a reward, families’ inability to cook, ambivalence to the matter, general lack of perception due to the relative size of community members, the actual and perceived cost of healthy food – and its absence - the easy availability of high sugar and high fat foods, the sheer lack of clinicians who want to engage with patients because they don’t have a magic cure or bullet to sort the problem out and - for some - the fact that losing weight is just hard work requiring long-term lifestyle change that can seem painful to many.

But why is it important? Unhealthy weight in adults and children leads to a whole host of complications. In children, these might not seem so obvious at first, but they definitely do occur. The complications or comorbidities of obesity include lack of self-esteem, shame, victimisation by bullies, obstructive sleep apnoea which can affect daytime alertness and school learning, abnormal liver function (with obesity related fatty liver disease set to be the next biggest cause of liver cirrhosis and failure in the next generation), abnormal blood sugars and type 2 diabetes, increased risk of cancer and heart disease in the longer term, joint pains (particularly in the knees) and a general lacklustre feeling, to name a few.

I remember sitting at a political party conference session on health, gobsmacked to hear members at an invited roundtable saying things like ‘After all, people choose to be fat,’ or ‘They should just change the growth charts, since everybody is getting bigger.’ My rebuttal to the latter statement is the simple fact that we are not evolving at a rate that allows our bodies to adapt to a higher weight and fat content: changing the charts isn’t going to make the risk of diabetes and all the other complications go away. So we need to help people move toward healthier lifestyles and healthy weights now.

So how does all this relate to my Fellowship? Well, in the UK we definitely don’t have an overwhelming passion to see this issue dealt with in the paediatric world. So I visited Boston and Cincinnati Children’s Hospitals (which are two of the best children’s hospitals in the world dealing with childhood obesity) to see if they feel differently about the condition. And if so, what drives their passion for their expertise and efforts in this area? I plan to write about that, and I hope you’ll join me on this little journey of a lifetime.