When I first started taking care of children and adolescents as a pediatrician in the late 1980s, obesity in childhood was rarely seen as a medical issue. Many colleagues wondered why I was interested in kids with obesity and why they would need a doctor’s help. A common misperception — which exists to this day — saw obesity as something that can be “fixed” if only the patient would “eat less and exercise more.” Culturally, individuals with obesity have been blamed for their condition, since relatively few experts understood how obesity changes some of the body’s essential systems. Metabolism and energy regulation, the immune system, even the way genes are expressed in the cells, are all altered when someone has obesity.
For me, however, the toll obesity was taking on my patients was alarming. Every time I walked into clinic I encountered diseases stemming from obesity that I never expected to see in kids: A 9-year-old with severe sleep apnea who had to wear a breathing mask at night; a 12-year-old with obesity-related liver disease that if unchecked could result in a liver transplant; another 12-year-old who needed emergency surgery to pin his hips due to an obesity-related hip injury called slipped capital femoral epiphysis. Kids and adolescents were also suffering from bullying and teasing, low self-esteem and at times, depression. One teenager burst into tears when I asked her what she planned to do after graduation. She desperately wanted to join the police force but was terrified she would not be able to meet the physical entrance requirements for this profession. Another patient felt she couldn’t go to her prom because she would never be able to find a prom dress in her size. I heard these stories every day.