Viewpoint: When is a crisis also an opportunity?

October 1, 2009
Julia A. McMillan, MD

Julia A. McMillan, MD, editor-in-chief of Contemporary Pediatrics, is professor of pediatrics, vice chair for pediatric education, and director of the residency training program, Johns Hopkins University School of Medicine, Baltimore.

An editorial that examines the prominence of pediatric metabolic syndrome over the last few years.

Two years later, Dr. William Dietz2 reviewed the many complications of childhood obesity, including hyperlipidemia, hypertension, polycystic ovarian disease, psychosocial development, and insulin resistance. He warned of the potential for childhood obesity and its complications to affect adult health.

More than 10 years later we have watched this problem become an epidemic and, some would say, a crisis. Cardiovascular disease remains the most important cause of morbidity and mortality among adults, and a generation of children is likely to grow into adults who experience increasing complications earlier in life than their parents and grandparents.

In 1996, Dr. Pinhas-Hamiel and colleagues wrote, "To address this potential epidemic of obesity, NIDDM, and hypertension among American children, a concerted public health effort aimed at promoting dietary change and physical activity among the young is critical, with particular focus on those ethnic groups at greatest risk."3

"Crisis" is defined as "an unstable or crucial time or state of affairs in which a decisive change is impending." Perhaps we have reached a crisis point in dealing with the challenges identified more than a decade ago. If so, according to the definition above, a decisive change will ensue. It's a change that will require contributions from virtually all sectors of American society. Pediatricians must participate, but without effort from politicians, educators, local governments, and parents, the crisis will become the "new normal," and the opportunity to reverse this horrible epidemic will be lost.


1. Pinhas-Hamiel O, Dolan LM, Daniels SR, et al: Increased incidence of non-insulin-dependent diabetes mellitus among adolescents. J Pediatr 1996;128:608

2. Dietz W: Health consequences of obesity in youth: childhood predictors of adult disease. Pediatrics 1998;101:518

3. Pinhas-Hamiel O, Zeitler P: Insulin resistance, obesity, and related disorders among black adolescents. J Pediatr 1996;129:319