Fighting obesity a big-time challenge.

Byline: GUEST VIEWPOINT By Jimmy Unger For The Register-Guard

The childhood obesity `epidemic ` is real. This public health threat warrants action at many levels: individual, schools, families, organized medicine and industries - to name a few.

Experts in public health and obesity tell us that contemporary American trends have undeniably contributed to the epidemic:

Cable television, videos, video games and the Internet have increased young people's `screen time' to an average of 4 1/2 hours per day. The average high school graduate will have spent 15,000 hours watching television, compared to 11,000 hours in the classroom.

Between 1956 and 1996, soft drink consumption more than doubled among children ages 11 to 18. The 6 1/2 -ounce bottle that most Baby Boomers can remember has been replaced by the 20-ounce bottle - or even the 44-ounce `Super Big Gulp.'

Informal physical activity (a walk to the store, a neighborhood basketball game) is increasingly a thing of the past. Contemporary society focuses on children becoming elite athletes at ever-decreasing ages, excluding many children from organized sports at progressively younger ages. Modern American lifestyles value efficiency at all cost, replacing calorie-burning activities such as walking with transportation via private car or public transit.

Fast food and microwaveable foods, richer in calories than their home-cooked counterparts, play an ever-increasing role in the American diet.

The result is indisputable: The incidence of obesity in American children has tripled in the last 30 years. There has been a similar increase in the incidence of Type 2 diabetes (formerly called `adult-onset diabetes') in obese children. These patients are subject to the same life-threatening or life-shortening complications as Type 1 diabetics (once called `juvenile-onset dia- betics').

In Portland, pediatric endocrinologist Daniel Marks, a specialist in both obesity and diabetes in children, is seeing an extremely rapid increase in the numbers of new Type 2 diabetics; they now outnumber new cases of Type 1 diabetes.

The progression from childhood obesity to childhood Type 2 diabetes to an upcoming generation of adults saddled with early onset of Type 2 diabetes' complications (heart disease, stroke, kidney failure) is genuine, tangible and frightening.

This epidemic affects you, even if you are not a child, a parent or overweight.

Consider the following facts: If diet and activity is considered as an agent that causes disease, then it is the second leading cause of death in the U.S., accounting for about 300,000 deaths annually. (Tobacco is still No. 1.)

The U.S. Surgeon General estimates that in the year 2000, the cost of treating obesity complications was approximately $117 billion. Keeping in mind that this cost is for adults who did not grow up obese in numbers anything like today's youth, forecasters predict staggering implications for the future.

Unless action is taken to stem this tide, when today's overweight children mature our country faces a major struggle in taking on these health care costs.

What can you do about it?

Clearly, preventing obesity is easier and more cost-effective than either treating it once it's there or, worse, treating obesity complications. Childhood obesity can be prevented when parents, schools, day care providers and health care providers, among others, consolidate educational efforts.

Children will need to learn, starting in infancy, healthy options in their choices of food, beverages, physical activity and screen time.

As this shift in thinking occurs, we have to be careful not to stigmatize our children. Focusing on healthy habits rather than weight is of paramount impor- tance.

If educational efforts lead to more patients with anorexia, low self-esteem or depression, then they will have failed.

The fast food industry, the electronic media and the soft drink industry appear to have played roles in the problem's creation. It can be hoped that by embarking on more public-health-friendly marketing and sales strategies, they can play a role in slowing or reversing harmful trends.

A comparison to public health efforts to reduce tobacco-related disease offers hope.

It has been 40 years since the surgeon general first warned Americans that tobacco caused lung cancer. Progress has been made in many areas: changes in the public perception of tobacco, decreasing tobacco use in virtually all demographic groups and a decline in tobacco-related deaths.

With similar intense, multidisciplinary and enduring efforts, one can only hope for similar progress in `diet/activity'-related disease.

Dr. Jimmy Unger is a pediatrician and president of the Lane County Medical Society.