The word "epidemic" is tossed around too loosely, Stanford Medicine pediatrician Tom Robinson, MD, told listeners at the Childx conference Thursday afternoon. But in the case of childhood obesity, the topic of a panel discussion that Robinson moderated, that label is warranted, he said as he flipped through charts and graphs showing obesity rates in children leaping up as decades passed.
"We've never seen a chronic disease change so rapidly and broadly as we have with childhood obesity in the United States," Robinson said.
The problem is hard-hitting — boosting the likelihood of a laundry list of conditions ranging from diabetes and depression to asthma and liver disease — and complex.
"We've created a world on purpose where calories are highly tasty and prevalent, promoted heavily and they are cheap at the same time we're engineering opportunities for physical activity out of our lives," Robinson said.
Similarly, solutions stretch across different fields. Robinson said his group has approached the problem from a variety of angles ranging from using plates with rims to promote smaller portion sizes to encouraging girls to enroll in ethnic dance classes.
He's not shy about employing slightly sneaky strategies: As moderator, Robinson urged the Childx audience to give each speaker a standing ovation: "It makes them feel really good and [you] get up and moving."
Speaker Anisha Patel, MD, a Stanford pediatrician, is pursuing a more straightforward goal: ensuring that all school children have access to drinking water.
Drinking water, rather than juice, flavored milk, or other sweetened beverages, can help children maintain healthy weights and reduce their caloric intake. But Patel said her team has found it is not enough to simply install old-school water fountains -- if they are dirty, inaccessible, or don't include access to cups or reusable bottles, children and teens just won't use them, she said.
Much more successful are non-fountain water sources such as the bottle refilling systems common in airports or even just a container of water and spigot that is refreshed daily, Patel said.
For speaker Julie Parsonnet, MD, an infectious disease specialist, the correlation between rising rates of obesity, falling rates of infectious disease, as well as lower body temperatures is striking, and intriguing. Measles infections, for example, raise body temperatures and burn extra calories, she noted, yet now vaccines have largely eliminated severe childhood diseases in countries like the United States, which is a good thing, she was quick to add.
By studying babies and their environments in both the United States and other countries, as well as examining data on body temperature, Parsonnet said her team is hoping to gain a deeper understanding of the microbial players in the obesity epidemic.
Speaker Douglas Jutte, MD, shown above, is thinking of the problem on a scale much greater than a virus or bacterium. As executive director of the non-profit Build Healthy Places Network, Jutte and his colleagues aim to improve health in lower income communities by making neighborhoods themselves healthy.
"Right now, the connection between [health and community development] isn't very well acknowledged, we don't measure it and we are not paying for it," Jutte said.
Many doctors realize the importance of their connection and may even feel frustrated at their inability to help a particular patient who faces challenges outside the doctor's office.
Improving conditions requires creating partnerships between community organizations, health leaders, governments at all levels and funding sources: no easy task. "There's a lot of work that needs to be done," Jutte said.
But it is possible. He pointed to the HOPE SF project in San Francisco that is working to transform blighted public housing into a vibrant community that encourages healthy behaviors.
"The biggest challenge is tackling poverty," Jutte said. "[Now] we're doing it in a disorganized way."
With a better alignment and coordination of efforts between educators, community development leaders and health care workers, among other players, it's possible to create "safe, healthy places where kids can grow up," he said.
Photo of Douglas Jutte, Anisha Patel and Julie Parsonnet by Cris Gebhardt