Working to reduce obesity in America "is going to be a long haul," according to Richard Kreipe, M.D., professor of pediatrics and chief of the division of adolescent medicine at Golisano Children's Hospital at Strong Memorial Hospital in Rochester, N.Y. Kreipe is also the director of the Leadership, Education, and Adolescent Health Program and the director of the Child and Adolescent Eating Disorders Program at the University of Rochester Medical Center.
Kreipe gave a presentation titled "Youth and Obesity" at Cornell's Ecology of Obesity conference held June 6 and 7, 2005. He noted that the top two public health issues of major concern to the nation are declining physical activity and increasing overweight or obesity, as outlined by Healthy People 2010, the national public health framework designed to identify the most significant health threats to Americans and to establish national goals to reduce those threats. Physical activity and overweight/obesity are also the World Health Organization's number one and two health indicators.
There has been an "epidemic increase," Kreipe said, in overweight children, according to the National Longitudinal Survey of Youth, conducted over a 12-year period from 1986 to 1998. The study found that all racial groups experienced increasing rates of obesity. The study examined physical activity in 2,400 girls (half of them African American, half Caucasian), and found a decline in physical activity in 100 percent of African American girls and 56 percent of Caucasian girls. By the age of 16 and 17, there was no habitual leisure physical activity in 56 percent of African American girls and 31 percent of Caucasian girls. This is "very concerning to us all," Kreipe said.
Kreipe pointed to several developmental issues that relate to adolescent obesity. First, while the onset of puberty has always been considered age 11 in most girls, now the average age for the onset of breast development in girls has dropped to age 8 or 9, which Kreipe attributes primarily to increased nutrition, although there may be other environmental causes as well.
Second, obesity may change how adolescents grapple with autonomy: issues of self-control, readiness to change, and their relationships with parents and other authority figures. That is, being larger may give some adolescents a physical advantage over their peers and may make them more likely to challenge adults.
According to Kreipe, obesity also may interfere with the process of understanding identity--namely, self-esteem and self-concept--another key developmental issue in adolescence. To the degree that an adolescent's perception of herself or himself is determined by physical appearance, size, or weight, her or his drive to either gain or lose weight could be affected. Part of the process of developmental progress also includes family history. Kreipe said that if adolescents know they have a family history of obesity, then they might feel as thought they're fighting an uphill battle to lose weight or to stay thin.
Cognitive processes also can play an important role, Kreipe said. Adolescents may have a difficult time considering the long-term consequences of issues when faced with the immediate gratification of eating some high-calorie, good-tasting snack, especially when they are in a social situation or when they are feeling depressed. Finally, nutrition concepts are difficult to understand for adults and may be even more so for adolescents.
The obesity epidemic should be addressed in a comprehensive, community-based way, Kreipe pointed out. He cited an article by Karen Pittman, executive director of the Forum for Youth Investment, entitled "What's Health Got to Do with It?" in the Forum's May/June 2005 newsletter. That article notes that civic engagement, physical health, vocational readiness and success, educational attainment, and social and emotional health are all important issues that must be addressed to reduce delinquency and violence, sexual activity, substance abuse, unemployment, isolation, depression, dropping out of school, and illiteracy among America's youth. …