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