Joseph Cramer, M.D.: Missionary candidates must watch weight -- or wait
America is getting heavier every day. Many are familiar with this Centers for Disease Control graphic
of the states first becoming one color then another as the percent of
the population with body-mass index of obesity grows and grows like a
plague across the land.
There is not a trickle-down effect to children; it is a mudslide
effect with kids and young adults swallowed up in the overweight mire.
This challenge permeates the culture. Seats in airplanes, sports
stadiums and school desks are all getting too small. I am testing
children as young as 5 years old for metabolic disorders because they
fulfill the criteria of abdominal obesity, hypertension and body-mass
index greater than 97 percentile. The added frustration is the paucity
of clear therapeutic options beside the traditional eat right and eat
less, and do physical activity more and do it often.
Within the Latter-day Saint community there is another consequence.
There are medical complications of obesity that could prevent young men
and women from serving Mormon missions. The health concerns of the
50,000 full-time missionaries are utmost in the minds of both the
church leaders and to the parents of those called to serve in all
territories and climes. The problem of missionary obesity was
recognized because of the number of supposedly healthy young people who
were forced to come home due to injuries, musculoskeletal pain or
troubles with mobility, sleep, fatigue or the other assorted
consequences of being overweight.
One tool to define obesity is the body-mass index. The BMI is the
weight divided by the height divided by the height again in
kilograms/m-squared. Healthy range is 18.5 to 25. The threshold for
obesity is 30. When a missionary candidate is significantly beyond the
obesity threshold there are medical reasons to protect the candidate
until lower numbers are reached. (Potential missionaries should consult
with their bishops or stake presidents, who should have more specific
Obesity significantly increases risks for type-2 diabetes, stress
fractures, mobility issues, high blood pressure, sleep apnea and other
medical problems — all things that get in the way of preaching
repentance. There is also the Word of Wisdom itself and trying to teach
someone about health while being obviously unhealthy.
This crisis is, of course, not solely for the members of The Church
of Jesus Christ of Latter-day Saints. Nor is it just about serving
full-time two-year missions. However it does create issues for those
who are desirous to part of God's army.
For the families of these young people, understanding this provides
both opportunity and challenge. A 19-year-old male or a 21-year-old
female doesn't just wake up overweight. There is a long trail of
inactivity, dietary overindulgence, nutritional malnourishment and
perhaps unidentified emotional problems. If families and their
primary-care physicians could track BMI and other contributing factors
for risk years before, earlier intervention may be more valuable than
late or no conversation at all.
The difficulty is in the whole battle of the bulge and the sad
results that come out of the multitude of studies. This is a societal
as well as an individual disorder. There are some drugs, some theories,
some home remedies, some diets — but with only some limited and
inconsistent results. Twenty years from now the headlines with state,
\"Latest scientific discovery: eat less, exercise more.\"
There are some things everyone can do. Keeping a food diary will at
least increase the awareness of what is eaten. Redesigning meals with
smaller servings, tinier utensils and decreased visual contact with
food might assist. Increase water intake, add fiber of 35 grams/day,
include Omega 3, DHA and adequate vitamin D could force the focus on
better diet. Exercising at least one hour per day with stretching and
muscle toning in addition to aerobic conditioning is valuable. Walk
10,000 steps a day.
In today's unhealthy world, preparing for a mission means not only
being spiritually ready but also being a lean, mean praying machine.
Joseph Cramer, M.D., is a fellow of the American Academy of
Pediatrics, practicing pediatrician for more than 25 years and an
adjunct professor of pediatrics at the University of Utah. He can be
reached at firstname.lastname@example.org.
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