Weighty matters

Weighty MattersRetired physician known for work in field of childhood obesity.

Dr. William Klish is a nationally recognized expert on childhood obesity, but, ironically, he started his medical career and found his specialty — pediatric gastroenterology — working at the opposite end of the nutritional spectrum.

When he was still a medical student at UW-Madison, Klish spent three months in Cartagena, Colombia, treating children suffering from malnutrition and diarrheal diseases. That first exposure to nutritional and gastroenterology issues made a lasting impression on Klish, a 1963 UW-Eau Claire biology and chemistry graduate.

Later, following his internship in pediatrics at Baylor College of Medicine and service as a medical corps officer during the Vietnam War, Klish returned to the Baylor-affiliated Texas Children’s Hospital to finish his residency. There he met Dr. Buford Nichols, an important figure in the field of nutrition and developer of the USDA/ARS Nutrition Research Centers now scattered throughout the United States. When Nichols offered Klish a fellowship to begin with three months’ research in Mexico City, he didn’t hesitate.

Berthiaume“I learned a tremendous amount about malnutrition and nutrition in the Third World,” Klish said, noting that his research focused primarily on kwashiorkor, or protein-calorie malnutrition.

Back in Texas, Nichols was starting a training program to add pediatric gastroenterology at Baylor, and when Klish returned he became the first trainee. A pediatric gastroenterologist treats children for diseases of the digestive organs, including the stomach, esophagus, intestines, pancreas, liver and gallbladder.

“Since I was the first trainee, I kind of developed the program as I was going through it, and thanks to Buford I ended up getting a very large base in nutritional education, which was unique even in those days,” said Klish, who estimates that only 25 percent of medical schools in the United States include nutrition education components.

It’s terrible that physicians don’t know much about nutrition, because now, with this obesity epidemic, we have a whole generation of physicians who don’t quite understand all the implications and how to go about treating it. — Dr. William Klish

“It’s terrible that physicians don’t know much about nutrition, because now, with this obesity epidemic, we have a whole generation of physicians who don’t quite understand all the implications and how to go about treating it,” he said.

So Klish started the first nutrition education program at Baylor after he became a faculty member there and later instituted a similar program at the medical school of the University of Rochester in New York.

During the six years Klish was in Rochester, he developed the pediatric gastroenterology program at Strong Memorial Hospital. Later he returned to Baylor and Texas Children’s Hospital, where for many years he worked to strengthen its program. Starting with three or four specialists, he built a program that now employs 26 full-time pediatric gastroenterologists.

Vegies 1But Klish has always considered nutrition the most interesting part of his research, so he continued to be involved in issues such as infant formula development and body composition studies. Many of his published papers have a nutrition focus.

This interest enabled Klish to recognize, early on, the seeds of what would blossom, in the 1990s, into the much-discussed childhood obesity epidemic. In Rochester he had helped start a behavior modification program for weight control in children, so he started a similar program in Houston — Weigh of Life, now one of the longest-running weight-control programs for children in the nation.

But Klish said it was the National Health and Nutrition Examination Survey that really began to tell the tale. Starting around 1975 the rate of obesity began going up about 1 percent per year, but in the early 1990s that gradual slope began a dramatic uphill climb that continues today. That was when Klish went on the road, giving presentations and gaining a national reputation for spreading the word about the dangers of childhood obesity.

“There are two things that I find most frightening about this epidemic,” Klish said. “The first is type 2 diabetes. When I trained, it was called adult-onset diabetes because you never saw it in children. Now, well, my youngest patient is 5 years old, and I had a child almost die from a hyperosmolar coma (a complication of type 2 diabetes) at 6. It’s a new disease for pediatrics. But at least diabetes has a treatment — weight loss — although that’s never easy.

Sport Tykes“The other disease, which I think is even worse, is called nonalcoholic fatty liver disease (NAFLD) or steatohepatitis,” Klish said, noting that this was the condition doctors were so surprised to see developing in Morgan Spurlock — writer, director and star of the 2004 movie “Super Size Me” — after only 30 days on a McDonalds-only diet. Klish appeared briefly in that film, warning of the developing obesity epidemic.

“Fifteen percent of obese children have NAFLD, and there is no treatment other than weight loss and no medication other than liver transplantation,” Klish said. “And there is no way we can transplant them all, because there just aren’t enough livers available. But we’re already starting to do some transplants for kids as young as 17 or 18 years old. It’s going to cause early death in a lot of kids if we don’t get this epidemic under control.”

Klish’s repeated warnings about early deaths have gotten him in trouble with activist groups that claim that the obesity epidemic has been exaggerated and that there is no scientific evidence to prove that life expectancy is going down. In response, Klish points out that the generation he is so worried about is still too young to influence those life-expectancy statistics and that improvements in treatments for cancer and heart disease are creating offsetting statistics that mask the depth of the growing obesity problem.

Recently, Texas Children’s Hospital developed a bariatric surgery treatment program for obese children, but Klish says bariatric surgery isn’t the answer. It’s so expensive that most insurance programs don’t cover it, and it is generally only done on adolescents because the long-term effects for growing children still aren’t fully understood.

Vegies 2“And although people tend to think that bariatric surgery is 100 percent successful, it’s simply not,” Klish said. “At least 20 percent of the kids in our program gain the weight back. There are still a lot of problems with it.”

In fact, Klish said he was approached twice to be on “The Oprah Winfrey Show” — the second time to provide the “con” side of the arguments on a show on bariatric surgery.

“The day before I was to fly to Chicago, they called and canceled my part, so there was no ‘con’ part of the show,” Klish said. “In this field, you have to be aggressive as hell to get your point across because many people simply don’t want to hear it.”

Some critics also contend that obesity warnings have contributed to increases in eating disorders such as anorexia, but Klish disagrees.

“Only once in my career did I ever see an overweight child convert to an anorexic child,” Klish said. “They are, in my opinion, two distinct problems with two distinct sets of genetics associated with them. They simply don’t overlap the way some activists claim.”

Klish also says that, for him, the obesity issue has never been about appearance.

Berthiaume 2“It’s the comorbidities associated with obesity that concern me, and these are what may eventually bring our health care system to its knees,” he said.

Perhaps Klish’s most important message is simply that the whole issue of obesity is a lot more complicated than most people want to believe. And although Klish thinks more effective weight-loss drugs will continue to be developed, he doubts any magic bullets or simple solutions are likely to materialize.

“Overeating is not the only cause of obesity,” Klish said. “There are definitely some people who tend to be hypometabolic (with slow metabolisms), and we are learning that overweight people tend to conserve energy when they move around. It’s not a singular disease and it’s not a singular genetic problem. There are some 200 genes that we’ve identified that affect weight, metabolic rate, satiety (fullness) signals, etc. We definitely have a way to go before we understand the obesity issue.”

In the meantime, Klish, who retired in July and has returned with his wife to live just blocks away from UW-Eau Claire, said he’ll look for new ways to advocate for the health and well-being of future generations.