If your New Year's resolution is to lose weight, you aren't alone. (Although given the lack of follow-through among many of us, it should be named a New Year's dissolution.)

But this year, the ranks of tens of millions of adults trying to shrink the ever-expanding waistlines are swelling with an increasingly larger (no pun intended) population - overweight and obese children.

Case in point: the January issue of Pediatrics. The majority of articles touch on the staggering consequences of overweight/obese pediatrics and adolescents, and their future looks anything but rosy.

Anyone with children under 5 years of age, take note of research reported by Daphne Gardner, et. al., evaluating whether early weight gain (0–5 years) is an important contributor to childhood obesity and consequently metabolic risk. The authors found that most excess weight before puberty is gained before 5 years of age. "Weight at 5 years of age bears little relation to birth weight but closely predicts weight at 9 years of age," the abstract states. ^"If metabolic status at 9 years of age means future risk, diabetes/cardiovascular prevention strategies might better focus on preschool-aged children, because the die seems to be largely cast by 5 years of age, and a healthy weight early in childhood may be maintained at least into puberty."

Elisabeth Kvaavik and colleagues extended their studies of childhood physical fitness and activity into adulthood in the Oslo Youth Study. The authors measured physical fitness, physical activity, and CVD risk factors at ages 13, 15, 25, 33 (self-reports of weight and height only) and 40 years. Interestingly, while the inverse relation between physical fitness and BMI present at age 13 was also apparent at 15, 25, and 33 years of age, the authors found that the gradients progressively diminished in magnitude with increasing follow-up time such that the association was lost at 40 years of age. "There is a suggestion that higher physical fitness may confer protection against later obesity and raised BP, although these effects diminished over time," the authors conclude.

Early intervention seems to be a crucial step in the fight against childhood weight problems, but what if doctors aren't diagnosing children properly? Lacey Benson et. al. found that although the numbers of overweight children are already frighteningly high, they should actually be higher. "Although clear BMI definitions of pediatric weight problems exist, a large percentage of overweight and obese patients remain undiagnosed. Diagnosis increased during the study period but remained low among overweight children, for whom early intervention may be more effective. Identification of overweight and obese patients is the first step in addressing this growing epidemic."

So what are some of the problems overweight and obese children experience? Obstructive sleep apnea, for one, leading to excessive daytime sleepiness.

What can we do to help mitigate the growing obesity trend? Exercise, of course, is one solution. Walking is an easy way to build up physical fitness without major stress on joints and bones, but what if you just had to guess at how far you were walking? Would that impact your confidence, your fitness level, your weight loss? Naim Mitre and others from the Mayo Clinic investigated the accuracy of measuring walking steps with commercially available pedometers and an accelerometer-based step-counter. "Commercially available pedometers do not correlate well with walking steps, and this may not satisfy expectations, especially when offering them to obese children as tools to assess physical activity," the authors say. The pedometers showed significantly greater error in overweight children compared with normal children, perhaps because of slower walking speeds and the angle at which the pedometer is worn. The step-counter was more accurate, with no significant difference between the two groups.

A more extreme option is gastric bypass, which has reduced CV risk factors in adults. Thomas Inge and colleagues discuss significant weight loss and remission of type 2 diabetes mellitus after Roux-en-Y gastric bypass in extremely obese diabetic adolescents, including improvements in insulin resistance, β-cell function, and cardiovascular risk factors. This study is a hit in the lay press - Inge said in a HealthDay News article in the Washington Post that "These early surgical research findings suggest that diabetes may not be a diagnosis kids have to live with for the rest of their lives. ... They may not have to face diabetic retinopathy, progressive coronary heart disease and renal failure. In fact, there is good reason to be optimistic about their future cardiovascular health."

I thought the HealthDay reporter, Steven Reinberg, did a fantastic job addressing the counterpoint: that while bariatric surgery will definitely help these kids, shouldn't we try to prevent the need for the surgery in the first place? Reinberg quotes Dr. David Katz, director of the Prevention Research Center at Yale University School of Medicine, as saying that a "large and growing proportion of all children and adolescents are subject to obesity, and its complications. ... Surgery can mitigate those complications, but can we really condone ushering more and more young people through the OR doors for a major surgical procedure to fix what policies and programs that foster healthful eating and regular activity could have prevented in the first place?"

For other angles on the story, check out USA Today, AP and ABC News.

Also check out a thought-provoking special article by Todd Varness and colleagues, who suggest childhood obesity could constitute medical neglect and could warrant removal of the child from the home.