by Eric A. Finkelstein and Laurie Zuckerman

Chapter 1: Craze or Crisis?

What does Uncle Al, a rich American attorney, have in common with the women of Mauritania, a barren West African country?

The answer is this: Mauritanian women are getting thin for the very same reason that Uncle Al is getting fat -- as a result of a changing economy.

You see, in Mauritania, a girl can possess no greater currency than rolls upon rolls of fat. In this vast nomadic nation, thin women are a sign of poverty. In contrast, voluptuous wives and daughters are visible displays of a man's wealth and power. So in a society where obesity is seen as a conduit to a rich husband, it became traditional for well-intentioned mothers and grandmothers to force-feed their daughters and granddaughters.

In recent years, however, force-feeding is fast disappearing. Why? Well, it's not because of the government's efforts to warn women of the dangers of obesity. These radio blasts were largely ignored in a society where fat is revered.* No, it's because years of drought have put the country in crisis. With food increasingly scarce and food prices escalating rapidly, Mauritanians can barely afford to feed themselves -- let alone overfeed their daughters.

So what about Uncle Al? He's certainly not in a famine. In fact, his weight has been changing for the opposite reason -- he's in a land of feast. In America, for reasons we'll detail in the next two chapters, food prices are falling, not rising, especially for high-fat and high-calorie foods, and the costs, in terms of what Uncle Al would be missing out on, of being physically active continue to increase. As a result, so does Uncle Al's waistline.

So even though Uncle Al and Mauritanian women are on a divergent path, their changing weight is still a by-product of a changing economy. But that's where the comparison ends. Because while big might be beautiful in Mauritania, in America, "thin" is the revered cultural norm for most, especially Caucasians. So while the Mauritanians struggle to feed their families, here, for at least the past 20 years, books on how to lose weight -- whether by dieting, exercising, or by using some magical machine or dietary supplement -- have often topped best-seller lists. In fact, the New York Times began separating them (along with other self-help books) into a separate category from other nonfiction (though for many of these books, the fiction aisle may be a more appropriate location).

So Why Now?

Why, after decades of obsession with dieting and weight loss, has the obesity "crisis" become the subject of countless news articles, TV reports, and magazine covers? And, more to the point, why has what was once assumed to be a personal problem -- whether of medical, genetic, or behavioral origin -- suddenly become an issue for private foundations; school boards; lawmakers; and federal, state, and local government agencies (including child protective services in the case of at least one extremely overweight child)?

Is it simply the latest media craze? Is it griping from the many thousands of businesses who are upset about rising health care costs or their inability to compete in the global economy? Or is it hype from the many purveyors of weight-loss products and services whose profits escalate with each additional news story? We know Uncle Al has been gaining weight at a steady pace for decades, but is obesity really on the rise for the rest of the population?

Moreover, why should Dad care even if obesity is on the rise? Why should you? Are there broader implications for the economy, for policy makers, and for all Americans? If so, what should be done about it? Before we begin taking a hard look at these issues, let's take a step back and take a brief look at obesity trends across the nation -- and the world.

My Soccer Team Eats Oranges

I have to admit that few things bother me more than seeing overweight kids. So when it comes to my own kids, as my wife repeatedly tells me, I'm a pain in the ass. I'm obsessed with what my five-year-old daughter and seven-year-old son eat. (My infant daughter is still strictly under her mother's domain, but she won't be for long.) The occasional treat is fine, but you will almost never find soda in our fridge, and there are strict limits on the few sugary snacks in our pantry. I can probably count our trips to fast-food venues (that I know of) on one hand. And if this isn't enough, I also make sure that my children get plenty of exercise. As most parents will tell you, this is no easy task these days. It's also a constant source of friction between my wife and me, as she is the one left to implement these draconian policies while I am at work or off writing this book.

And it's not just my own family who finds me so irritating. I coach my son's soccer team (largely because he wouldn't play if I did not). Although many teams drink Gatorade and eat Popsicles after practice and games, I limit our team's consumption to water and oranges. This, too, is a real challenge, as I have to constantly remind parents not to bring "rewards" for the team after practice and games. I once had to tell a mom to put the powdered donuts and Juicy Juice® back into her car. I told her what I tell the rest of the parents over and over -- water turns out to be a pretty good way to hydrate your kids. Looking at what transpires on some of the other fields, I would not be surprised if many kids actually gain weight as a result of being in the league. By the way, although we are not supposed to keep score, it did not go unnoticed (by me) that our team of six year olds went undefeated; the lack of Gatorade was not an obstacle to the team's on-field success. Of course, maybe it was my great coaching . . .

I make no excuses for my sometimes off-putting behavior -- I'm a killjoy for a reason. As an obesity researcher, I see statistics on a daily basis that paint an increasingly depressing picture for our children's future -- a picture that, as a father and as a coach, I would like to change.

So what kind of picture are we talking about? Currently, about 17 percent of U.S. children are overweight, and many more are at-risk of becoming overweight based on the government's definition of excess weight among youth.* Overweight is the government's polite term for obese kids, and at-risk is their terminology for overweight kids.

As an aside, if you find these terms misleading, you are not alone. Recently, an expert panel made up of members of the American Medical Association and the Centers for Disease Control and Prevention (CDC) met to discuss a change in terminology. They claimed that these terms did not adequately represent the weight problem facing America's youth.* I'm sure my dad would agree.

Regardless of terminology, even more alarming than the high prevalence is the rate at which excess weight is rising among America's youth. Government data reveals that the rate of overweight 6 to 11 year olds tripled from 4 percent to almost 19 percent during the past 30 years. The rate for 12 to 19 year olds mirrored that jump, with an increase in prevalence from 6 percent to over 17 percent.* Even preschoolers are putting on the pounds. Since 1990, twice as many children between the ages of 2 and 5 are overweight (13.9 percent compared to 7.2 percent).*

Though children of all ethnic groups have gained weight, certain racial, ethnic, and socioeconomic groups have put on the most. As was the case 30 years ago, excess weight remains more common among African-American and Hispanic children than among whites. Whereas the gap between ethnic groups is shrinking for adults, it is growing for kids. According to a national study, from 1986 to 1998, overweight prevalence rose by more than 120 percent among African-American and Hispanic children compared with 50 percent among Caucasians.*

So what are the consequences for these kids? Sadly, given societal norms that reward thinness, these kids are likely to face significant discrimination throughout their lives. Moreover, discrimination and prejudice can begin at a very young age. Studies on children as young as five years old show that they have already absorbed our cultural bias against fat.*

Being the target of prejudice can be devastating for overweight children. They are more likely to be sad, lonely, and nervous. One study shocked even a jaded obesity researcher like me: The study found that children who were overweight rated their quality of life as being similar to children who were being treated for cancer.* Talk about a sobering comparison!

And the effects can stick around. Being overweight during childhood can have lasting effects on self-esteem, body image, and economic mobility.* Overweight children sometimes perceive themselves as unattractive, which may lead to depression, disordered eating, and risky behaviors such as tobacco and alcohol abuse.*

Even parents have been known to discriminate against their own overweight children. One study showed that parents of overweight daughters will not spend as much money on their daughters' college education as parents of normal-weight daughters.* 

If the social impact is heartbreaking, the health prognosis for these children is equally disturbing.

I'll bet if we asked Uncle Al, he would say that, due to advancements in medical technology, my Cousin Carl (his son) will have a longer life span than he will have, and that his new grandbaby will live even longer.

Well, researchers at the University of Illinois at Chicago have made a surprising new prediction: Due to increases in the prevalence of childhood obesity, today's children may not live as long as their parents.* The study suggests that weight problems could cancel out life-extending benefits of medical advances in the coming decades. As a direct result, the United States could be facing its first sustained drop in life expectancy in the modern era.

"It's one thing for an adult of 45 or 55 to develop type 2 diabetes and then experience the life-threatening complications of that -- kidney failure, heart attack, stroke -- in their late 50s or 60s," said Dr. David Ludwig. "But for a 4-year-old or 6-year-old who's obese to develop type 2 diabetes at 14 or 16 raises the possibility of devastating complications before reaching age 30. It's really a staggering prospect."*

Indeed, children are increasingly showing up in pediatricians' offices with type 2 diabetes and other conditions once known only to adults (type 2 diabetes was once synonymous with adult-onset diabetes, but thanks to the rise in childhood obesity and the prevalence of this condition in overweight kids, that is no longer the case). The American Diabetes Association now estimates that as many as 45 percent of new cases of pediatric diabetes may be type 2 (not the more common type I, or juvenile diabetes).* In fact, one study found that the number of type 2 diabetes prescriptions among children doubled from 2002 to 2005.*

Excess weight during childhood can also significantly increase the risk of disease and obesity in adulthood. Cardiovascular risk factors, for example, can be carried from childhood into adulthood, which predispose adults to severe chronic conditions such as heart failure.*

A recent study reported that increasing rates of childhood obesity also appear to be causing girls to reach puberty at an earlier age.* Results showed that the mean age of onset of breast development, which had been close to 11 years in earlier studies, is now approximately 10 years in Caucasian girls and just under nine years in African-American girls. The study's author reported: "Earlier onset of puberty in girls has been associated with a number of adverse outcomes, including psychiatric disorders and deficits in psychosocial functioning, earlier initiation of alcohol use, sexual intercourse and teenage pregnancy and increased rates of adult obesity and reproductive cancers."

So this is the kind of bleak information I encounter every day. And, yes, it bothers me. As we'll discuss in subsequent chapters, while adults have the ability to make informed choices related to diet, exercise, and weight, children do not. Most of their food consumption and physical activity decisions are made for them by parents or school administrators. So when I see a kid who is overweight, knowing that his or her excess weight will be very difficult to reverse later in life and could lead to lifelong health problems and a shorter life expectancy, I feel that parents and society are not doing their job.

As a result, I am willing to be the unpopular father and coach who deprives kids of their "reward" at the end of a hard practice. And if I think our friends are not feeding their kids a healthy diet, I let them know that, too. As I said, I'm obsessed. But, hopefully, the soccer moms will read this book and understand why Coach Eric is so annoying. If not, they can always switch their kids to a different team (although they may no longer go undefeated if they do).

Copyright © 2008 Eric A. Finkelstein and Laurie Zukerman. All rights reserved.

Published by John Wiley & Sons
January 2008
hardcover: 288 pages
ISBN-10: 0470124660
ISBN-13: 978-0470124666