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The spread of obesity

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    You don’t have to spend long in the United States to be impressed by the Bermuda-bursting buttocks of a very noticeable proportion of the population. Dine at any American restaurant and you are faced with massive food portions which make the ‘doggy bag’ a routine requirement. The increase in obesity in both adults and children in the USA over the last 30 years or so is well documented. For many energy intake is clearly well ahead of energy output; some hope that ‘they’ (the scientists) will find the answer through research into the genetics and molecular basis of obesity and its consequences, others favour an educational approach promoting less food and more activity. A study in Cincinnati, Ohio (Orit Pinhas-Hamiel and colleagues, Journal of Pediatrics1996;128:608-15) has shown one potential serious consequence of childhood obesity.  Previous studies have shown non-insulin dependent diabetes mellitus (NIDDM) to be about 2 or 3% of childhood diabetes. In Cincinnati the proportion in newly diagnosed child diabetics rose from 4% in the years 1982–91 to 16% in 1994. The incidence of NIDDM in adolescents was 0.7 per 100 000 per year in 1982 and 7.2 per 100 000 per year in 1994 and currently one in three 10 to 19 year olds presenting with diabetes has NIDDM. The mean age at onset of child or adolescent NIDDM was 13.8 years and the mean body mass index at presentation was 38. Sixty five per cent of patients had a first degree relative with NIDDM. At the time of diagnosis of NIDDM 17% were hypertensive and 6% had sleep apnoea.  In the 1970s British paediatricians were much concerned about childhood obesity and its consequences but lack of success in its management cooled many an enthusiasm. In 1830 Metternich said, ‘When Paris sneezes Europe catches cold’. It is to be hoped the American obesity virus doesn’t blow this way. I’ve a feeling obesity is set to be a growing topic again.

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