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 guidelines.)

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.

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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 jgcramermd@yahoo.com.