The challenge of chubby cheeks

Philip J. Goscienski, M.D.

December 2006

What could be cuter than a chubby toddler? Most mothers regard baby fat as evidence of good health and that attitude lasts right through adolescence. In fact, most mothers whose children are overweight or obese don't consider that to be a problem unless the child becomes the subject of teasing or is unable to participate in normal play activity. That concerns many physicians, who find such an unseeing attitude to be a major challenge to the health of coming generations.

Children's health is like a minefield. Dangers that lie ahead are deadly but not obvious. And like the mines of warfare their lethal effects may not be encountered for decades. Until very recently most physicians who care for children paid scant attention to childhood overweight. Although medical problems that will someday be disabling or deadly are detectable even in preschoolers, they develop so slowly and insidiously that most will not be obvious until the patient is in the hands of the internist or other adult-oriented physician.

Stone Age kids didn't become obese and neither do their modern equivalents, hunter-gatherers. Ask your parents to visualize their childhood playmates and they'll probably tell you that not many of them were fat. In my own childhood — circa the 1940s — I can recall only one classmate that was overweight and only one other among our sandlot group. Fast-forward half a century. One child in 4 is overweight and 1 in 6 is obese! It's worse in some regions of the country: 22 percent of kids in Arkansas and 24 percent in New York City are obese.

Where will these children be when they reach midlife? According to the Centers for Disease Control and Prevention, more than one-third of children born in the year 2000 will have type 2 diabetes. Half of Hispanic and African-American girls will develop that costly, lifestyle-threatening disease. What used to be called adult-onset diabetes is no longer rare in children, nor are its complications.

If you think that overweight kids will "grow out of it," think again. The fact is that most will not. Eleven percent of overweight kids already have high blood pressure, the single most important factor in the development of coronary artery disease and stroke. More than 35 percent of obese children have prediabetes; half of them will have overt diabetes within 10 years. Slipped capital femoral epiphysis, a painful hip disorder, usually occurs in overweight children and it happened to my chubby sandlot buddy. He was our catcher, and squatting behind home plate probably contributed to his hip problem. Young joints don't tolerate a heavy load very well and it's no wonder that degenerative joint disease and refractory scoliosis, curvature of the spine that responds poorly to treatment, are much more common in overweight children.

Can we hold back this juggernaut? If parents don't change their own lifestyle it will take lots of work by schools, civic leaders and lawmakers to provide an environment of more physical activity, programs that will keep kids away from TV and computer games, and legislation that will change the way we advertise and market foods that encourage obesity. That last item may be hard to swallow (I don't apologize for the pun) but the alternative is an intolerable and probably unaffordable burden on our health care system.

Philip J. Goscienski, M.D. is the author of Health Secrets of the Stone Age, Better Life Publishers 2005. Contact him at