CHAWK BOOK REVIEW

"The childhood obesity epidemic poses a major threat to our nation's future adults." Thus begins this book's foreword, written by renowned pediatrician T. Berry Brazelton.

Strong words? Not for the experts cited here, who see in obesity the possibility that American children today may be the first to have a shorter life expectancy than their parents.

Listen to Julie Gerberding, director of the federal Centers for Disease Control and Prevention, who in 2003 declared obesity "the number one health threat facing the United States."

Or obesity researcher Steven L. Gortmaker of the Harvard School of Public Health, who Okie quotes as saying: "We don't really know the magnitude of the health effects here, because we have never before in history had a population that was this overweight."

Or David L. Katz of the Yale School of Medicine, who says: "Children growing up in the United States today will suffer more chronic disease and premature death because of the way they eat and their lack of physical activity than from exposure to tobacco, drugs, and alcohol combined."

Words that make you sit up and take notice.

You've heard the statistics before, but they bear repeating:
· Since the 1970s, obesity in the United States has more than tripled among children ages 6 to 11 and more than doubled among kids 2 to 5 and adolescents 12 to 19.
· An estimated 9 million children over 6--that's 15 percent of all children--are obese today.
· An equal number weigh more than is desirable for their health and are considered "at risk" of becoming obese.
· Not only are more American kids obese than in the past, the heaviest children are much heavier than they were before.
· The statistics cross racial and ethnic groups.

Okie, a family physician and medical journalist who for many years wrote for the Washington Post, says childhood obesity has medical, emotional, and social consequences, putting children at greater risk for heart disease and diabetes, bullying, and depression. Okie spends several chapters outlining why children become obese, addressing how the human body regulates appetite and maintains itself at a constant weight; how genes contribute to the risk of becoming overweight, and how some environmental changes in the past 40 years may be interfering with our bodies' ability to maintain a healthy weight.

Armed with that knowledge, she turns to ways to fight the battle, interspersing suggested approaches with examples of communities that have tried them. Though we may point fingers at super-size sodas, sedentary TV watching, and video game habits, Okie goes to lengths to explain that it's unclear which individual factors contribute to making children obese. Nonetheless, she concedes, most children today live in a "toxic environment" that promotes unhealthy weight gain. Reducing obesity therefore must involve changes on several fronts, chief among them reforms to diet and lifestyle, she says.

At home, Okie advises, the whole family can practice portion control, eat more fresh foods, eat together as a family in a relaxed environment, eschew regular visits to fast-food restaurants, engage in more physical activity, and reduce time spent watching TV (which not only cuts into activity time, but also encourages eating fat-laden foods seen in advertisements). Families may also need to devise new ways to celebrate or carry out traditional customs, because many of those center around food.

But it isn't just parents' jobs to reverse this alarming trend, Okie says. Pediatricians, many of whom lack nutritional training, should start addressing weight during office visits.

In the community, citizens can work together to address obesity by:
· Putting pressure on advertisers to limit or regulate food and drink ads that target kids
· Making neighborhoods more accessible to walkers and bikers, and boosting other local opportunities for physical activity, and
· Trying to increase access in underserved communities to fresh and healthy foods.

Okie also calls on schools to get involved in the fight against obesity. Noting that "the food and drink children receive at school teaches them silent but powerful lessons," she calls for improving the nutritional quality of school lunch fare, food brought to school events, and food served in the classroom and sold in vending machines. She cautions that food should not be used as a reward or incentive.

Okie also encourages improvements in and expansion of physical education programs and incorporating physical activity into classes. And she calls on schools to teach such practical skills as reading food labels and measuring portion sizes. Our schools, she says, must "walk the walk."

It is only when "people who care about children's health are willing to become active at the community, state, or national level, working to create a healthier environment for kids by changing social policies," that the epidemic of childhood obesity can be addressed, Okie believes.

And this book-one I suspect will be read primarily by individuals who are already concerned about this issue-is a well-researched compilation of materials, resources, and suggested approaches to get you started.

-- Reviewed by Anne Bridgman