Dear DOCTOR Owen:

I am concerned about my children’s health. I see all their friends getting very fat and inactive. They are not participating in activities that I thought of as “normal kids’ play.” Many of their activities are based around the computer and TV, and I cannot coax them to go outside. With the millennium celebration right around the corner, what does the future hold?

Millennium Mother

Dear “Millennium”:

There are four reasons why attitudes toward obesity will change in the next 20 years:

• An epidemic of environmentally induced diseases caused by our progressive diet and inactivity. Currently, 50% of children are considered obese, compared to 15% in the 1950s. Look at the incidence of diabetes, high blood pressure, heart attack, and stroke among that generation. We are already seeing diabetes and high blood pressure in younger adults. It is estimated that the incidence of diabetes will double in the next 20 years. High blood pressure, heart attack, and stroke go hand in hand. It is estimated that the age of diabetes onset will be around 35 years old whereas now it is approximately 60. If people’s average age of onset of these illnesses is in the 60s, we can expect—in the next 20 years—to see the new cases starting in people who are in their 30s and 40s. Incidences of sleep apnea, spine and joint problems, acid reflux disease, and depression will also increase.
• The promotion of new methods and standards for treating obesity-related diseases. A model that uses integrated treatment teams, which I use at my clinic, will spread to the general medical and fitness communities. The team approach optimizes patients’ efforts and keeps them focused. Presently, your physician may hand you a 1200-calorie diet sheet and say, “Lose weight and exercise,” while the people at your fitness center will give you other directions, and your diet counselor says something else. However, the next 20 years will see a merging of approaches and methods.
• The Internet is transforming the delivery of education material and support. Behavioral curricula and support will be routine, and will be as close as the computer/TV. For example, your doctor will give you a Web site address and will be able to follow your progress right from his/her own computer. Thus, doctors will once again be able to make “house calls.” Right now, across continents, doctors can “see” patients via computer, listen to their hearts and lungs, check their blood pressure and pulse, and even look into their body cavities. Adjustments in medication will take place at home instead of in a congested doctor’s office.
• An explosion of obesity research will help us understand the fundamentals of the human brain and how it acts, reacts, copes, and adapts. Some new drug therapies may emerge, and surgery for obesity will become commonplace.
• The end of obesity discrimination. People will no longer look at obesity as a lack of willpower. “Will” implies fortitude or character. “Power” means control or strength. Obese people are now looked at as having no character or power. That subconscious feeling is acted on throughout our culture. The obese will become empowered by knowledge and skills, and will understand the root causes of their situation and its related conditions. Discrimination will erode also as the general non-obese public becomes educated about these issues. I grew up in the integrated South. I know that things can change!

A powerful lobby for these changes, the American Obesity Association (AOA), will emerge. Started in 1995 and now with membership in the tens of thousands, the AOA will surpass the American Association of Retired People (AARP) in number. (There will be many more fat people than old people; the AARP will have fulfilled its role, and the AOA will step in.) This is sort of like the changes made by the NAACP since the 1960s. That organization raised consciousness, organized the masses, made political and cultural changes, and then settled down for the long term.

That is what I see. We’ll see. I am very optimistic. Of course, I am always optimistic. Happy New Millennium!