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Greg CritserRSS Feed of this column.

Greg Critser is a longtime science and medical journalist whose work appears in the LA Times, the Times of London and the New York Times. He is the author of California (National Geographic 2000)... Read More »

Close to supermarkets or not, fat poor kids are different than fat rich kids

Over the past decade, the American obesity epidemic has provoked a wide range of possible solutions, from soda-pop bans in elementary schools to salad bars in high school cafeterias. Some cities have begun retooling their recreation infrastructure, making playgrounds and public sports fields safer and more accessible.

The jury is still out on such measures, but there remain two fundamental truths. One: Obesity, especially childhood obesity, is real and getting worse. Two: Obesity eludes simple, popular fixes.

One evening last spring, Peter nearly stopped breathing.

He was riding in the car with his mother, April, who was taking the 11-year-old boy back from a visit to the ER for one of his chronic asthma attacks. He seemed to be getting better — and then his throat began to constrict. He began to wheeze loudly. He rolled his head back to get more air.

"That was wrong. 'He should be better than this by now,' I remember thinking. I knew something was wrong then," April recalls. "They had given him some meds and the usual advice, but it was not working."

In 2006, the pharmaceutical giant Pfizer released a state of the art clinical study of a new drug designed to treat high cholesterol, torcetrapid. The results were puzzling. The compound lowered low density lipoprotein, aka LDL or “bad” cholesterol. It also substantially pushed up high density lipoprotein, or HDL, the “good cholesterol.” By all accrued medical wisdom, torcetrapid should have lowered the rate of cardiovascular events—heart attacks, strokes, and, ultimately deaths.

But it did not. Instead, it increased both—by 61 percent. Worse: more heart patients died than those in a control group. What had happened? Why hadn’t the “good” cholesterol improved their odds of living longer?

Anthropomorphizing, the process, as Twain might say, of “underestimating the animal by assigning to him human traits,” has had a good year. The reasons range from the continuing dominance of the Obama dog, Bo, on Fox News (Bo: “Socialist or simple anarcho syndiclist?”), to the rise of kitty cat “jammers” for tabby sleepover night. Not kidding. On the sleepover thing.
Will Los Angeles go the way of Paris?  The City of Angels can learn a lot about public health from the capital of croissants.

Not long ago, I came across a book about the trials and tribulations of a giant city. This city was reeling from a seemingly endless migration of rural peoples from its south. Its traditional family structure was strained - papa and mama both had to work. Most of them had to live in housing close to sources of polluted air. Infectious disease was rampant but largely untreated. Most had  known hunger in their lifetimes. Their mothers likely experienced some kind of trauma while pregnant, thus predisposing their children to chronic disease. 
Is there a pill that might inoculate us from smog?

Is there a gene we can target that would make us resistant to resurgent infectious diseases?

And is there a way to use genetic data to insulate new immigrants from some of the metabolic challenges of living in a new land of plenty?

Welcome to the slowly emerging world of environmental medicine and its inevitable outgrowth, environmental pharmaceuticals: compounds specifically suited for mitigating the physiological challenges of mega-city life in the 21st century.

The inchoate drive for such pills — disparate, proceeding in entrepreneurial fits and starts — is fueled by twin facts: