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How Pediatricians Can Fight Childhood Obesity

For years, I had a straightforward approach to dealing with overweight children in my practice: at well-child visits, I would tell the family that the child was overweight, and we would discuss healthy eating and exercise habits. Off they would go, until their next well-child visit.

The thing is, it didn't work. They came back fatter the next year. We'd have the conversation again. And again, year after year. With a third of American children and two thirds of American adults overweight or obese, I'm not the only doctor out there failing.

I've been thinking recently about the definition of insanity attributed to Albert Einstein: doing the same thing over and over again and expecting different results. The way I was treating obesity definitely qualified as insane.

Obesity comes down to a simple energy equation: if you eat too many calories, or you don't burn off enough, or both, you gain weight. People know this. So why is everyone getting fat?
After talking with lots of overweight people, I think that there are four major reasons—the four "D's":

DENIAL. This is probably the main reason. People think that they, or their kids, aren't overweight (so many people are overweight that unless you are really obese, you don't stick out). They let themselves think that their diets aren't that bad, or that walking to the car from the store is enough exercise.

DELAYING. Next week they'll start the diet, or stop buying chips for the kids. Things are too nuts at work (or at home, or at school) right now. In the spring they'll join a gym or sign Junior up for soccer. It can wait (there's the denial again). 

DISCOURAGEMENT. The hard truth is that losing weight takes work and time. It's easy, and understandable, to get discouraged and start thinking, why should I make myself miserable eating carrots and going to the gym if it's not doing anything anyway? Why should I make my kid miserable if he's not losing weight?

DIFFICULTY. For many people there are real obstacles. Healthy foods are more expensive and not always easily available. Gym memberships can be expensive, too—as can fees for sports teams for children. Many families live in neighborhoods where playing outside isn't safe.
We need people not just in health care but in government, education, agriculture, industry, and the media to take action if we want to address all the factors that contribute to obesity. But doctors have a central role to play. We are the ones sitting in those exam rooms with those patients, talking to them about their weight and their health; we are the ones who know, or who can know, the details of their lives. We are the ones whose words—clear, authoritative, and personalized--can have the most impact. We need to do this—and we need to do it in a way that recognizes the realities of how our patients think and live.

Here's what I'm doing. I'm going after denial by being very clear with people when they or their children are overweight, and by scaring them. Which isn't hard, because the consequences of obesity are scary: a higher risk of diabetes, heart disease, cancer, and orthopedic problems, not to mention social and emotional problems. As kids get older, I talk to them directly; sometimes they get it better than their parents.

I don't let people delay. I work with them to find a change they can make immediately—taking a daily walk, for example, or not buying soda—and then I see them frequently. Which helps fight discouragement, too, because even if they don't lose weight I can celebrate every change in lifestyle--and every pound not gained. If one diet or exercise idea doesn't work, we figure out a different one together. The message is that I'm not giving up.

To fight the difficulties, I spend time understanding their lives so that I can help them find solutions that make sense. I'm also learning as much as I can about community resources, like low-cost exercise options, or farmers' markets, and connecting families to them. Bit by bit, I'm seeing some success. Not much, and not in every patient, but enough to give me hope.

If all of us—doctors, parents, employers, teachers, legislators, everyone—do things differently, I think we might just turn this epidemic around. Let's stop being insane. There are lives at stake.

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