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The challenge of childhood obesity.

For those of us who complain when another journal is launched, one can fairly ask why do we need yet another? In this case the answer is really straightforward. Not only has the problem of childhood obesity reached epidemic proportions in many parts of the world, but our understanding of why this is happening is rudimentary. This first issue of the journal very appropriately sets out the latest data we have on childhood obesity rates across the globe in the article by Wang and Lobstein (11). Indeed, the whole issue is dominated by an epidemiological perspective which quite rightly sets the scene for future issues and articles dealing with a wide range of related topics. The long-term implications of childhood obesity Not only is childhood obesity of immense public health significance (see later) but it poses many challenges which will come to fascinate the molecular biologist, the developmentalist and those interested in organogenesis; experts fascinated by body composition, the analysis of growth rates and the assessment with modern techniques of both intracellular and inter-organ fluxes will also need to be involved. The paper by Ness and his colleagues shows the importance of considering body composition in affluent societies as well as in lower income countries (12). The general clinician, of course, will be concerned with the appropriate indices of adiposity and whether the different fat distributions traditionally assigned to children in what we used to term the developing world, reflect a genetic propensity to small amounts of peripheral fat (e.g. as assessed by triceps skin fold measurement) in different ethnic groups or a programmed redistribution of body fat because of changes in such pathways as the hypothalamic /pituitary/ adrenal regulation of adrenal cortical hormones. Indeed the likelihood of children remaining overweight and entering adulthood at risk will also soon be illuminated by a range of Scandinavian cohort studies currently being analysed. Eriksson’s Swedish studies (1) on the predictors of middle aged coronary artery disease in relation to birth weight and early growth patterns are but one example with Danish studies (2) now being used to assess the impact of different BMIs of 7 year olds in predicting premature death from any cause including cardiovascular disease. As these data emerge we are going to be asked whether these reflect the impact of environmental circumstances long passed or whether we should now be applying these results to our current thinking.