Jay Perman feels a touch ashamed now of the thoughts he had when he first started seeing droplets of fat in the livers of adolescent patients.
Like any person on the street might, the pediatrician believed these hefty kids simply needed to stop gorging themselves on fried foods and sweets. He had yet to grasp the big picture.
Decades later, as the president of the University of Maryland, Baltimore, Perman has an entirely different take on childhood obesity. He regards it as the leading pediatric health challenge of our time, an endlessly complicated tangle of social, economic and medical problems with the potential for devastating, nation-changing effects.
His conviction is strong enough that he wants to focus all the resources of his university — medical, scientific, social and legal — on the problem. Perman wants UMB to be a national center for battling childhood obesity, and he will formally kick off that effort by hosting a summit on the issue Tuesday and Wednesday.
"It takes a multi-pronged approach because it's a complex problem," said Perman, who has preached interdisciplinary collaboration since he took the presidency last year. "We need to take the things we do well as academicians, turn them on a societal problem and throw the kitchen sink at it."
He envisions his medical researchers looking for genetic links to obesity while behaviorists address the attitudes of schoolchildren toward exercise and law students devise public policy solutions to the nutritional deficiencies in poorer areas.
"Dr. Perman wants to bring the various disciplines together to solve problems, and I think he sees this as a great case study," said Joshua Sharfstein, Maryland's secretary of health and mental hygiene. "He's a person interested in making progress on public health issues and bringing the mighty resources of his university to the effort. It's just a tremendous help."
Sharfstein said he hopes policy makers will leave the summit with new ideas for battling the problem in their respective counties.
"There's no vaccine and it's not just medical," he says. "It's community health, it's access to parks and nutritious food. This is not a problem that's going to be solved with one big report."
Childhood obesity has entered the national spotlight in recent years, with first lady Michelle Obama criss-crossing the nation to urge better exercise and nutrition habits for young children. Doctors, public officials and economists warn that unchecked, this generation of obese children could go on to battle diabetes, heart disease and mental health problems in volumes that will overwhelm the nation's health system.
About 17 percent of U.S. children ages 2 to 19 are obese, nearly triple the rate in 1980, according to the Centers for Disease Control and Prevention. The percentages are worse among minorities and children from low-income families. In Maryland, the prevalence of obesity among pre-school-aged children from low-income families is greater than 20 percent.
Because the statistics are so alarming, policy centers are springing up around the country to fight obesity, said William Dietz, a pediatrician and longtime obesity researcher at the CDC. He said universities such as UMB are well suited to address the issue because they can come at it from so many perspectives.
"It has clearly become a high priority because of the costs and the risks involved," Dietz said. "But there are just so many questions. It's quite clear that there's no silver bullet here."
Perman said the nation's approach to fighting childhood obesity has been scattered, with doctors and policy makers gathering too infrequently to share best practices. He hopes the summit will help change that.
Planned discussion topics range from prevention strategies to disparities between racial and economic groups to school nutrition to media coverage of obesity. Perman plans to end the summit, which will gather state and county officials and researchers from around the country, by outlining concrete steps that can be taken to address the problem in Maryland. He said the university also will make a major announcement about its continuing commitment to battling childhood obesity.
Perman, a pediatric gastroenterologist, said that about 20 years ago, he noticed an uptick in the number of young patients referred to him with liver problems. At first, he though hepatitis was the culprit, but he quickly realized that the common link between cases was, in fact, obesity.
He had been trained in an era when infectious disease was the chief enemy in pediatrics. But there was no vaccine that would hammer out obesity with one neat stroke. The problem was even trickier than smoking, a single behavior that could be stigmatized through the use of sobering health statistics and made costly through taxes.
"The frustrating thing for me was that I was perfectly adept at diagnosing what was going on," he said of obese patients. "You see a kid who's 10 years old and weighs 300 pounds, it's obvious what the problem is. It's the 'Then what?' that's not so obvious."
For example, he said, it's easy to tell a kid from West Baltimore to eat more nutritiously and exercise more. But what if the child lives in a neighborhood where it's not safe to play outside for two hours every day? What if the family is stuck in a "food desert," one of the large swaths of downtown where it's hard to find a corner market that sells fresh fruit and vegetables?
Because of such underlying problems, he said, the success rate of anti-obesity programs is dismal. When Perman was dean of the medical school at the University of Kentucky, he took his own stab at a solution. As part of a program called Jumping Jaguars, he sent medical students to teach exercise and nutrition to elementary school students in a poor section of Lexington.
He and others believe that such programs are the best answer. Making students feel bad about being overweight won't do it, they say. The students have to feel good about exercising and taking healthy recipes home. Parents need programs that will teach them how to cook healthy food on modest budgets. They need safe places to take their children for after-school play.
Sharfstein touts ChopChop Maryland, a state program that distributes healthy recipes from a professional chef to families via text message.
"I think we can make more progress without stigmatizing," Sharfstein said. "I'm not sure the answer is a campaign telling people all problems. More than a lecture, we need ways to help people address the issues."
Dietz, the CDC researcher, will speak about prevention strategies at the summit. In general, he supports policies targeted at child care centers that would require an hour a day of physical activity, ban sugar drinks and limit time in front of computer and television screens. But data on the impact of such approaches remain scant, he said, and it's unclear if changes at school will work without corresponding changes in homes and neighborhoods.
"What we're talking about," Dietz says, "is the need for a change that's really transformative."