Making America healthy again through science

I’m an Iowan farm girl, economist, MD’14R’17, now community pediatrician, and most recently mom of 3 generation alpha little women. I’m excited that our country is awake to what I’ve been observing in the office/hospital for years which is the fact that children (and adults) are in fact sicker than before. A study published by Wisk and Sharma earlier this month found prevalence of chronic conditions in children is rising from 22.57% in 1999-2000 to 30.21% in 2017-18, or about 130,000 additional children per year. This amounts to 1.2 million youth with a chronic condition or functional limitation who currently turn 18 each year.

These changes are multifactorial and complex and will involve massive public health initiatives and cultural shifts to move the needle. The increase in chronic conditions in children is primarily driven by ADHD, autism and asthma, with increases in prediabetes and asthma for young adults.

While you might want to blame vaccines, there is not a correlation or causation that demonstrates that. However, each of these conditions is directly correlated with metabolic health and pediatric obesity: a study in 2022 showed higher association of asthma in children/teens with obesity, and narrative review from 2019 notes that children with obesity also have a 40% higher likelihood of ADHD. Please note that correlation does not mean causation but with our current trends, it gives this scientist pause.

As a pediatrician, the continued rise of obesity is not surprising given trends in food consumption, screens and physical activity of children. As of 2018, NHANES data showed our children eat a diet composed of 70% ultra processed foods. This is concerning for two reasons — 1. These foods are less nutritious and 2. consumption of these foods leads to an average weight gain of 2.2 pounds over 2 weeks in healthy adults when compared to a diet of real food (Hall 2022). This is adult data, but I would argue could plausibly extrapolated to healthy children and teens with the obesity rates we are viewing.

We also know that children spend more hours on screens than they have ever before. During July 2021 through December 2023, half of teenagers ages 12—17 had four hours or more of daily screen time. Teens with more than four hours of screen time daily were twice as likely to have anxiety symptoms (27.1% compared to 12.3%) and almost 3 times the risk of depressive symptoms (25.9% compared to 9.3%). Not only do screens increase risk of isolation, loneliness and mood disorders, but Robinson et al 2017 demonstrated that obesity is one of the best documented outcomes of screen time. Interestingly this was not because of decreased physical activity time, but rather screen time led to increased caloric consumption in children and therefore increased BMI gain.

All data trends and associations lead to one obvious conclusion from my perspective — that metabolic dysfunction and obesity lie at the heart of our children’s health crisis and there are three identifiable targets to evoke change for our children: 1) decrease screen time 2) increase real food and 3) build a culture of adequate support for our families and parents so they can afford and have time to cook real food and play with their children. We must get back to the basics and support natural food, sunlight, movement, play, mindfulness/spirituality and good sleep — and this feels like the core of what our MAHA moms are bringing to light. Our current American cultural standards are failing our children, and we all know we can do better.

But somehow in this movement, vaccines have gotten confused as being a part of the problem. There is zero evidence that proves this (Andrew Wakefield’s 1998 fraudulent study linking autism to MMR), and in fact data clearly demonstrates that vaccines save and improved the quality of all our lives.

What we do know is that infants born to mothers with obesity and pregestational diabetes have almost 4-fold risk of autism spectrum disorder (Hazard ratio of 3.91) and infants born to mothers with obesity and gestational diabetes have 3 times the chance of Autism (HR 3.04), Li et al. These are also correlations, not causation but give pause when looking at our current trends. I bring this up not to shame anyone but rather encourage us as a society to take metabolic health seriously and stop blaming vaccines.

I would argue that compared to the damaging impact of screens and processing of foods, the vaccines are technically an unsung hero — saving innocent babies from death and disease, while again the food corporations and ultra processed foods leave us in a pickle with continuing increasing obesity leading to more autism, asthma and ADHD in children.

I can assure you that every pediatrician wants your child to be their best, healthiest version of themselves. I know we can make great changes toward this by evaluating every aspect of our current situation, and please know that parents are not to blame — this is a system failure for families where we have been surrounded by chemically altered food that causes increased consumption and weight gain.

But amid all this, please don’t fear the science and the research. We need science find the truth amid all the fear, and research to discover the answers. Please help your children and your community eat more real food, get your kids off their screens and outside to play, put your own phone away and fight against the polarization of the world via the Internet. Oh, and please, get vaccinated too.

Dr. Padget Skogman is a pediatrician in Cedar Rapids.