So. My goal for this blog was to be both accurate and comprehensive; the result was that it was very long. We need to have a thorough understanding of both the why’s and the how to’s if we want to make a difference in childhood obesity. This week covers just the first half, so you won’t nod off before the end. Today is all about the what and why; next week is about how we fix the problem.

Obesity is defined as weight more than 20% above a person’s ideal weight for their height. Morbid obesity is weight in enough excess that it affects a person’s health, or “causes morbidity.” In 2010, more than 1 in 3 children were overweight or obese. At a time in their lives when children should be running free and unencumbered, they are instead carrying the baggage of a society that has lost its way. Although issues like hypothyroidism and low levels of Leptin (a hormone that makes us feel full) can cause weight gain, medical causes account for less than 1% of the overweight kids.

Obesity has more than doubled in children and tripled in adolescents in the past 30 years. Rather than 5 or 7% of children being morbidly obese, as they were in the 80’s, now 18% are. Three quarters of these obese teens will become obese adults.

Why do we care? There are, of course, the physical health risks, including:

• heart disease
• stroke
• high blood pressure
• type 2 diabetes
• degenerative arthritis
• chronic back and knee pain
• slipped capitofemoral epiphysis (a crippling hip injury)
• ankle fractures
• several forms of cancer (colon, thyroid, prostate, and breast, among others)
• pseudogynecomastia (breast development in boys)
• gallstones
• obstructive sleep apnea
• pancreatitis
• skin infections
• deficiencies of zinc, calcium, iron, magnesium, and folic acid from a junk food diet

There are also serious mental health risks, including low self-esteem, body image issues by as young as 5 years, anxiety, and depression. Overweight children are frequently the victims of exclusionism, taunts, and ridicule. Bullying overweight people is one of the last socially acceptable forms of bigotry.

Last, there are lifestyle limitations. For overweight children activity is harder, and the vicious cycle of a sedentary lifestyle causing weight gain, which causes a lower activity level, which causes weight gain, persists. Fueling this also is the fact that obese children will be offered fewer opportunities: they are rarely the first picked for the team, or the cool new job. Even their dating choices will be affected, partly by their appearance, but more by the damage to their self-esteem. There are also financial stresses, from the expense of processed foods, to increased medical costs, to fewer chances in the workplace.

So why do we do nothing about it?

First, we simply don’t see it. When our whole family, neighborhood, region, or country is overweight, after a while it becomes what we see as normal. Add on that our child has always been this shape. When shown silhouettes of children and asked which is most similar to their own child, parents of overweight children will pick out a thinner silhouette as theirs. The extra pounds become as invisible as the individual trees in the forest.

We don’t know what to do to fix it and, as adults, we are embarrassed to admit our ignorance. Add to this that people fear change. Grown-ups like to feel capable and comfortable in their lives. People generally take what they learned in childhood as true, and continue unquestioningly down that reassuring and undemanding path. It can take an unexpected event, like a child being diagnosed with diabetes, to shake them up and make them think about their choices. Even then, parents need to be able to find the resources to learn, and there are few easily accessible ways for an adult with only a few spare minutes to learn about nutrition, grocery shopping, cooking, and exercise. So we flounder, and persist in our habits.

If we do decide to change, it can be just too hard. Learning about nutrition, grocery shopping, cooking and exercise, in addition to working at our jobs and taking care of our families, is difficult to fit into the schedule. Then we have to actually do the grocery shopping, cooking and exercising. Add on fighting with children, and possibly a spouse, used to eating whatever they want and zoning out in front of a screen (TV or computer) whenever they want. It is immeasurably easier to let them snack on junk and watch a screen, than to make them eat vegetables and exercise.

Moreover, people believe that preparing nutritious food and getting their kids to be more active requires resources that they do not have. They truly believe fresh nutritious foods are expensive, when in actuality 4 servings of vegetables or 3 servings of fruit can be had for about a dollar. They believe their kids won’t eat healthy foods, and the groceries they spent their hard earned money on will rot. They have seen it happen before. When kids have both healthy food and junk options, flavor saturated junk wins, and healthy foods go bad. Similarly, parents believe that if they want their kids to exercise, they have to pay for expensive exercise programs and organized sports. In reality, play is free.

People see their behavior as acceptable, because everyone they know eats and behaves in the same way. Even the advertisements they see, and the TV and movies they watch, inevitably show people eating fast food and junk.

Last, the reason we hide even from ourselves: parents are unwilling to have change interfere with their own lives. They don’t want to spend what little free time they have preparing food and exercising with their children. They are comfortable with their routines. It is easier to let the screen entertain the kids, and they have no real interest in getting up and playing with their progeny. They are equally unwilling to do without the foods they like, even though they know they should do better. Since no one wants to cop to this, they instead pile the weight of conviction onto all the other, less guilt inducing, reasons.

If we want to improve our children’s health, these are the obstacles and the challenges. Human nature is an unalterable certainty. Ignoring it while trying to force change will get us nowhere. Next week’s blog will be about how to work within the confines of human nature to change the choices parents make, and help our children live healthier lives.