individual or group can meet these challenges alone.” ¹
not meet the Food Guide Pyramid recommendations for
fruit, grain, and dairy groups or the Dietary Guidelines

It is widely recognized that the development of type 2 dia- for Americans recommendations for total and saturated
betes and its complications is highly correlated with be- fats. Both guidelines should be achievable for all Ameri-
ing overweight or obese. Obesity is also an independent can children over the age of 2. ⁶ Thus, there is a pressing
risk factor for hypertension and dyslipidemia in addition need to target young children for primordial obesity pre-
to cardiovascular disease (CVD) ¹. Added to this cluster of vention. Given that dietary patterns and physical activ-
obesity-related conditions is a newcomer: periodontal dis- ity are largely established and weight gain and adiposity
ease. Growing evidence suggests that obesity is a signifi- entrained by parents and guardians, this goal cannot be
cant predictor of periodontal disease, which reflects yet accomplished without targeting whole families.
another cascade of inflammatory events. ^{2, 3} It is theorized
that chronic stimulation and secretion of proinflamma- A study of 1,740 students in 12 middle schools reported
tory cytokines associated with periodontal infection con- a high incidence of risk factors for diabetes, including
tribute to insulin resistance, which may further increase impaired fasting glucose, hyperinsulinism suggestive of
diabetes risk. Obesity appears to be a precipitating factor insulin resistance, and body mass index (BMI) ≥ 85th per-
in this cascade. centile. ³ Another nationwide epidemiologic study found
that obese children were more than twice as likely to de-
The Obesity Pandemic velop diabetes as normal weight children. ³ These findings
According to the Department of Health and Human Ser- suggest the overwhelming need for population-based ef-
vices, “Calling obesity in the U.S. an epidemic or pandemic forts to decrease overweight/obesity and diabetes risk in
is more than rhetorical.” ¹ Five years ago, when the Na- childhood and adolescence.
tional Institutes of Health published clinical guidelines to
identify, evaluate, and treat adult obesity, an estimated After almost 25 years of research, the conditions known
97 million American adults were overweight or obese. ² collectively as the metabolic syndrome (MSyn), also re-
The classification of overweight and obesity now applies ferred to as “syndrome X,” have become accepted as a
to more than 60% of American adults and nearly 80% leading cause of death for the obese, diabetics, and other
of some high-risk subgroups, such as African-American subpopulations. ³ Alarmingly, an estimated 24% of adult
women, ¹ placing these individuals at greater risk for di- Americans have MSyn. This syndrome was derived from
abetes and subsequent CVD. Some authorities estimate investigators’ recognition that complications of obesity,
that 2 out of 3 Americans are overweight or obese. ¹ Obe- such as diabetes, hypertension, insulin resistance and
sity, which is now considered a chronic disease, substan- heart disease may be more related to central adiposity
tially increases the risk of morbidity from hypertension; (waist circumference) than overall obesity. Also included
dyslipidemia; type 2 diabetes; coronary heart disease; in MSyn are hyperinsulinemia, abnormal blood lipids (dys-
stroke; gall bladder disease; osteoarthritis; sleep apnea lipidemia), a procoagulant state, vascular abnormalities,
and respiratory problems; and endometrial, breast, pros- inflammatory markers, and hyeruricemia. ¹⁰ Genetic pre-
tate, and colon cancers. ⁵ disposition may underlie susceptibility to MSyn. ¹⁰ Central
adiposity is associated with insulin resistance, and both

The number of overweight children has more than dou- are important predisposing risk factors for MSyn and are bled among 2- to 5-year-olds and more than tripled among related to diabetes, high-fat diet, aging, certain medica- 6- to 11-year-olds. ¹ Approximately 10.4% of children 2- to tions, physical inactivity, polycystic ovary syndrome, and 5-years-old and 15.3% of children 6- to 11-years-old are low birth weight with imprinting of the brain. Because of its overweight. ⁶ It is generally known that childhood adiposi- association with insulin resistance, inflammatory markers, ty tracks into adulthood and significantly influences adult and the procoagulant state, MSyn is considered a major mortality and morbidity. ⁶ Some investigators note a “gap risk factor for CVD. ¹⁰ With a quarter of the U.S. population between current dietary practices and recommended di- with MSyn, it appears that a large number of individuals ets for infants, children, and adolescents.” ³ For instance, may not be aware of their increased risk for CVD. the American Dietetic Association states that the percentage of diets that “need improvement” among children 2 The increase in diabetes rates in the overall population to 3, 4 to 6, and 7 to 9 is 60%, 76%, and 80%, respective- translates into higher rates of pregestational diabetes ly. ⁶ Furthermore, the diets of most American children do and a shift toward increased prevalence of diabetes at