The turning point happened last summer when Sherrie Boughter's son came to her in tears about his weight — at 8 years old, he tipped the scales at 184 pounds.
"I weigh more than Rey Mysterio," the professional wrestler, Justin told his mom. "You have to help me! You have to help me!" he pleaded.
"We sat and cried for an hour," remembers Boughter, 41, who lives in Medina, Ohio.
She and her husband, Brian, sought help from the Akron Children's Hospital Future Fitness Clinic, where she says the staff didn't beat around the bush. While Justin didn't have full-blown diabetes, which runs in the family, he had brown patches on the back of his neck that can be a warning sign of the disease.
"It was the worst day of my life when I was there and they're going, 'You're killing him. You're not doing him any favors by giving him another piece of cake,'" she says. "You give this child life and you don't stop that. I brought him here and basically now I was wrecking him."
Thanks largely to medical and public health advances, Americans are living longer than ever. The average life expectancy in 2005, the latest year for which figures are available, was nearly 78. That's up from 47 in 1900 and 68 in 1950.
But even as the market for anti-aging pills and products has never been hotter with Americans seeking a longer life, some experts say we as a nation are doing ourselves in with our couch-potato culture of eating way too much and exercising far too little. Some health professionals even raise the controversial notion that today's generation of kids like Justin — about a third of whom are overweight or obese — may be the first to live shorter lives than their parents.
'Like advanced aging'
"All of the signs are pointing in the wrong direction," says Dr. Jennifer Shu, an Atlanta pediatrician and spokesperson for the American Academy of Pediatrics.
"Young kids are getting what have traditionally been adult-type diseases — type 2 diabetes and heart disease," she says. "It's like advanced aging."
"These kids are headed for real trouble," agrees S. Jay Olshansky, a professor of public health and a researcher at the Center on Aging at the University of Illinois at Chicago. Their parents may not be faring so well, either, he says. Two-thirds of American adults are overweight or obese.
In 2005, Olshansky and colleagues published a paper in The New England Journal of Medicine predicting that in the coming decades, the obesity epidemic and its health consequences would reverse the upward longevity curve in America over the last century, slashing life expectancy by two to five years — more than the impact of cancer or heart disease.
Olshansky says he's particularly concerned about obesity in children, which has tripled since 1970, because they could be dealing with diabetes, heart disease and other weight-related health problems for a longer period of time and face a greater toll.
Predicting the future, of course, is a rather uncertain science. And researchers studying life expectancy may use different methods to go about it.
Olshansky's team, for instance, based their forecast on the prevalence of obesity and on reports of the years of life lost from it. They estimated the effect of obesity on life expectancy for the U.S. population based on reductions in death rates that would occur if everyone who was obese would lose enough weight to have an optimal body mass index (BMI).
But not everyone is convinced that the obesity epidemic will have such a dramatic impact — or even an effect at all — on life expectancies across the nation. Critics say dire predictions focus too much on body weight without taking the whole picture into account.
"It's extremely unlikely that today's children will have shorter life expectancies than their parents. From everything I see, we continue to make rapid progress at extending life as a result of improvements in medical technology and personal health practices," such as smoking less, says Samuel Preston, a professor of demography at the University of Pennsylvania in Philadelphia. "Yes, we are fatter than we used to be but the implications of that have not been nearly as severe as has been popularly assumed."
Preston, who wrote an editorial accompanying the Olshansky paper, acknowledges there is "some uncertainty" about the long-term impact of obesity on young kids. But, he says, "I haven't seen a single convincing study that relates adult deaths to childhood obesity."
Living vs. healthy living
Olshansky believes that, unfortunately, such hard data will come in time, once today's generation of young people grows older and begins to suffer the consequences of decades of obesity.
"The level of frailty and disability that we're going to see in this population is going to be enormous," he says. Besides the health impact of obesity, the monetary toll will be staggering, he says, noting that annual health care costs of treating obesity and its complications, such as diabetes, already total an estimated $70 billion to $100 billion a year in America.
Experts don't dispute that obesity, particularly morbid obesity, can lead to a host of serious and costly health problems. The question with regard to life expectancy, though, is whether those problems will be so great as to actually alter averages for the entire nation — and reverse decades of longevity gains.
David Freedman, an epidemiologist in the division of nutrition, physical activity and obesity at the Centers for Disease Control and Prevention in Atlanta, says he believes, as Preston does, that modern medicine will blunt the impact of the obesity epidemic because heavy people who develop diabetes or heart disease can live a long time with the right medical care.
"There are effective treatments for the complications of obesity," he says, such as medicines for high blood pressure, elevated cholesterol and excess blood sugar.
Of course, a lifetime of pills and doctor visits isn't ideal, particularly for the young generation who may "be the most medicated in history," Freedman says. "It would be better for people not to be moderately to severely obese. I think it would be a healthier life for people. It's not a matter of longevity in my opinion, it's more a matter of living a healthy life."
Clearly, it would be a mistake to conclude that obesity does not matter for our health or well-being, that it's without consequence to eat all the Krispy Kremes we want, throw out our sneakers and kick back and watch as our waistlines expand, says Dr. I-Min Lee, an associate professor of epidemiology and medicine at Harvard.
"Looking at dead versus not dead is not the only option," she says.
Lee says the confusion about the impact of extra pounds on our health relates to how much weight conveys which risks.
A federal study published last fall in the Journal of the American Medical Association, for instance, concluded that obesity (BMI of 30 or higher) is associated with more than 112,000 excess deaths a year from heart disease in this country while both overweight (BMI of 25 to 29) and obesity together are associated with more than 61,000 excess deaths from diabetes and kidney disease. However, the study also found that being overweight but not obese was not associated with deaths from heart disease or cancer. In addition, extra weight seemed to actually protect against deaths from pneumonia, injuries and some infections.
When looking at all the many factors that can determine life expectancy for an entire population of millions of people, it can be difficult to tease out the role of a single factor, Lee says.
Additionally, with weight, things aren't always what they seem. Research that speaks to the benefits of exercise has suggested that it's possible to be "fit and fat" — that overweight, active people are healthier than their overweight, sedentary counterparts and possibly better off than some thinner, sedentary people. And smokers tend to be thinner than nonsmokers, but they aren't necessarily healthier, she notes.
Another federal study that looked at the growing longevity gap between the nation's rich and poor — a whopping 4.5 year difference (79.2 years versus 74.7 years) between people living in the least and most deprived areas of the nation — cited lifestyle and various other factors that can play a role in health disparities and longevity. Among them: lack of health insurance, limited access to health care, low-paying jobs, smoking, physical inactivity, unhealthy diets and neighborhoods that lack parks and good grocery stores selling fresh fruits and veggies.
Breaking things down even further, a study out earlier this week concluded that women living in some of the poorest counties in the country are lagging behind other women in life expectancy, primarily because of smoking, obesity and high blood pressure.
As for Sherrie Boughter and her family, they're not waiting for researchers to sort out all the possible risks of being overweight. They're banking on shaping up and slimming down to boost their odds of long, healthy lives.
She and her husband are both overweight and take blood-pressure medicine, so they're working alongside Justin to shed pounds. And they're hoping to get Justin's 2-year-old brother off on the right foot. "We're all doing it," she says.
Since starting the weight-loss program last September, Justin has lost 33 pounds. He meets with a trainer every other week and with a doctor every six to eight weeks. As part of his program, he exercises at a recreational center about five times a week and he's drastically cut calories.
Take after-school snacks, for instance. "He would have a sandwich and take the bag of Doritos to the couch," says Boughter. Now Justin has a 100-calorie snack of an apple, banana or yogurt. "We don't buy Doritos anymore."
Boughter says improving Justin's health to help him live as long as possible is a top priority, but there are other perks to his program that are evident right now.
"I don't get the feeling that people look at him as 'the fat kid' anymore," Boughter says. "He looks taller and he moves better and he's more at ease with himself."