John E. Monaco, M.D.
People like me have said it before. And now even the government is getting into the act. The difference now is that anyone who hasn't been living under a rock for the last couple of years has gotten the message.
We, as a society, are in the midst of an obesity epidemic that has now surpassed smoking as a public health concern. What is most concerning about this epidemic is that it has hit children particularly hard. The question has even been raised: Could this be the first generation in recorded American history that may actually experience a decline in life expectancy?
Since researching and then co-authoring Slim and Fit Kids: Raising Healthy Children in a Fast Food World in 1999, I have been acutely tuned in to this problem. But even this did not prepare me for the child I cared for on our pediatric unit last week.
Andrew is 11 years old. He has asthma, severe asthma, life threatening asthma. Andrew weighs 250 pounds. The morning I met him, I thought he was much older. He was huge. He was taller than me (no great accomplishment at 5 ft. 9 in.) and looked like an NFL lineman. His hair style (before the shave) reminded me of Warren Sapp of the Buccaneers, and I told him so.
He was a very sweet kid, but it was difficult not to talk to him as if he were much older, because he simply looked it. It was only after I saw him playing Super Mario Nintendo while hooked up to his oxygen, IV's, pulse oximeter and frequent breathing treatments that I realized he was just a kid. A preteen, actually, and worse he was suffering from very severe asthma.
He has had asthma since preschool, but his mother was exceptional and had kept him out of the hospital until this illness. This time his breathing was very bad and it scared her. It frightened the ER doctor, as well, when he put his stethoscope to Andrew's chest and could not hear breath sounds.
The combination of Andrew's incredibly thick chest wall and his very severe bronchospasm made his breath sounds appear absent. In pediatrics, this is an ominous sign.
He nearly required intubation (a tube put into the lungs to help wth breathing) and mechanical ventilation as he was just that close to respiratory failure, but heroic action by the ER staff kept him from that horrible fate.
Andrew's mother was a little shaken by this experience, but not completely overwhelmed like some parents might have been. You see, she was experienced. Not just from taking care of Andrew's asthma, either.
She has another son, Mark, age 16, who has asthma as well. And he is overweight. He is 6 ft. 2 in. and weighs 400 pounds. He has an appointment, his mother informs me, for gastric bypass surgery at another tertiary care facility near us.
The odd thing about fat kids is that we treat them unfairly, and not in the manner you would think. It's not just the discrimination and ridicule that they must put up with. We are simply not honest with these kids and their parents.
We, the medical establishment, know that Andrew and Mark face horrible futures of repeated asthma attacks of increasing severity until they develop chronic lung disease as if they had smoked packs of cigarettes for years. The incidence of sudden death is much higher for these kids.
Yet because obesity is such a frustrating and unrewarding condition to treat, we avoid the topic. And worse, we joke about their size and advanced maturity and how much food they can eat and how often they need to eat it. It is not mean spirited. It is just frustration.
So the time has come, the wake up call has been sounded, and kids continue to get fatter and fatter and their diseases, like asthma, become more and more difficult to treat. Let us join together to help children like Andrew and Mark, so they can get back their health, and their lives.
John E. Monaco, M.D., is board certified in both Pediatrics and Pediatric Critical Care. He lives and works in Tampa, Florida. He welcomes your comments, suggestions, and thoughts on his observations.
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