Child Obesity, Cancer, and the Built Environment

by: Goutham Rao, MD, Clinical Director, Weight Management and Wellness Center, Children's Hospital of Pittsburgh, Associate Professor of Pediatrics, University of Pittsburgh
Author of Child Obesity: A Parent's Guide to a Fit, Trim and Happy Child (Prometheus Books, 2006)

Scope of the Problem

Not a single day passes without a news report about the worsening epidemic of obesity among children. Obesity is associated with serious problems for children, not only when they become adults, but even during childhood itself. For example, Type 2 diabetes, a disease normally associated with overweight adults, was rare among children 20 years ago. Today, type 2 diabetes makes up nearly half of all new cases of diabetes among children, and the increasing rate of childhood obesity is the cause. Furthermore, obesity increases the risk of many types of cancer, including cancers of the colon, breast in pre-menopausal women, uterus, esophagus, and kidney.

Real Solutions

What can be done about childhood obesity?

Across the country, hospitals are setting up obesity centers for children. As the Clinical Director of the Weight Management & Wellness Center at Children's Hospital, I believe the work our center carries out is extremely valuable. Unfortunately, we can, at best, care for roughly 1,000 children a year. Our focus is on the most obese children, including those who have already developed serious obesity-related medical problems. Specialized centers like ours, though necessary, are not the solution to the childhood obesity epidemic.

What about surgery?

Obesity surgery is appropriate for a very small number of adolescents, in whom the immediate health risk of obesity outweighs the serious risk of major surgery. Of the 1,500 children I have seen since our center opened, I have referred only two for surgery.

What about medications?

Medications for the treatment of obesity have an unimpressive track record. Thyroid hormone was first used to treat obesity in the 1940s. It was associated with heart rhythm disturbances and sudden death. In the 1960s, amphetamines were used. These were associated with addiction and in some cases, death. More recently, "phen-fen" was introduced for treatment of obesity and soon withdrawn from the market when several patients developed heart problems. Today, there are only two medications available for the long-term treatment of obesity. Both are associated with only modest weight loss in adolescent patients. The bottom line is this: a safe and highly effective medication treatment for obesity among children is unlikely to be available for many years to come.

Today, most experts agree that the most rational, long-term solution to this important problem is changing our "built environment." The built environment refers to the settings in which children live, study, and play. In the broadest sense, the built environment has three parts: the built physical environment, the availability of parks, sidewalks, and other structures that promote healthy living; the community food environment, the variety of eating options available in a community, (in some poorer communities in Pittsburgh, for example, food is easily accessible only through fast food restaurants, convenience stores, and gas stations); and community-based services and programs, not only organized recreational programs (e.g. soccer program for children) but also services available through professionals who can help reverse the obesity epidemic. Community-based pediatricians, for example, are key providers of community-based services and health and wellness information who can influence the rates of obesity in their communities. There is now strong evidence to suggest that an unhealthy built environment promotes obesity among children and adults. Children with less access to recreational facilities, for example, are more likely to be obese. Obesity puts people at double risk. Fat is directly damaging to health and has been called a natural hazardous waste site, because it can attract and store a number of known and suspected cancer-causing agents that are encountered in the environment today.

What can you do?

Whether or not you or your child has a weight problem, you can become an effective advocate for a healthier built environment. The movement to ban soft drinks in schools, for example, began with a few small petitions from concerned parents to school boards.¹ In even our poorest communities, residents have lobbied politicians and others, often successfully, for better housing, social services, policing, etc. Why shouldn't they also lobby against urban sprawl and the related dependence on the automobile by both adults and children, and for real supermarkets, healthful foods in school cafeterias, sidewalks that encourage walking, and improved lighting for safety? Take a trip through your own neighborhood and make notes about what you think promotes or prevents obesity and all its consequences. The results might surprise you. Become an advocate for the sake of your community's children.