While 33 percent of the U.S. adult population is already considered obese, the kids are catching up to their weighty ways. Childhood obesity has increased at least 50 percent since 1976, says a pediatrician who has developed a bit of a fascination with the phenomenon.

Currently, 20 percent of all U.S. children and 27 percent of adolescents are obese, says Judith A. O’Connor, a gastroenterologist in the pediatrics specialty division at Wilford Hall Medical Center.

The trouble with tubby kids might be amusing to readers of a tabloid that recently enticed them with the tale of a 200-some-pound gradeschooler.

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"It is very hard to call someone fat. Even in my charting, I’ll say an 8-year-old is a ‘chubby female,’" she says. "It’s hard to say, ‘You’re not just fat. You’re obese.’ It’s not exactly a great bedside manner."

Too, because society often treats obesity as a matter of morality and self control, the subject is an emotional hotbed, she says, particularly when the problem is multigenerational. "If the parents are obese and you tell them that their kid’s obese, they take offense."

That’s an ingrained reaction in a society, including the medical ranks, that is often prejudiced against the overweight, she says. "We need to start accepting that this happens, that it’s a medical condition.

"Because of its increasing prevalence, the issue of obesity probably warrants more attention," O’Connor says, particularly when such known risk factors as heart disease and diabetes have been shown by studies to have more insidious health effects than previously thought. "The trouble is there are few studies and still fewer centers focused on childhood obesity. There has never been any study at this age."

From the simplest of perspectives, we have long known the essential fundamentals of caloric intake and energy expended. Whether it’s a Twinkie or a Papa John’s pizza pie with the works, calories consumed and not burned are stored as fat, and there is plenty of evidence that kids today have an unprecedented plethora of high-fat, high-sugar food options while their activity level has taken a collective seat on the sofa.

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""Nobody knows quite what to do with fat kids. ... The answer to the problem of obesity is not in the realm of medicine but in societal, political and economic realms," says Daniel Hale, M.D., associate professor of pediatrics at the University of Texas Health Science Center. "I spend 30 minutes with a child in the clinic and, with 30 minutes of watching TV, that child is exposed to so much food-directed advertising" that the bombardment quickly decimates the influence of the office visit.

Hale and his colleage Jorge Gomez, M.D., last year canvassed several West Side San Antonio junior high schools and came away appalled. While 29 percent of the females they questioned were obese, a whopping 40 percent of the males were. Diabetes and heart disease was also rampant in the families of this largely Hispanic population.

"The question becomes about society," says Hale. "In maybe 20 to 30 percent of kids we follow , their families follow the adjustment," the lifestyle changes recommended by their doctors, says Hale. "But 70 percent don’t."

What will motivate them to change? He asks. "One of the things we really spend time doing now is math lessons. The child will say, ‘I only drink three sodas a day,’ and we help them to do the math. Three sodas a day translates into 400 calories, and 400 calories a day for 365 days a year means 42 pounds a year on your butt.

"We tell them it takes 30 minutes of vigorous physical activity to burn off one soda," says Hale, who is rightously

In some cases of childhood obesity, however, there are more complex forces at work than a set of masticating mandibles and a giant sucking soda siphon.

"Obesity is a complex disease with genetic, behavioral and environmental causes," says O’Connor. "We are currently in the midst of a major shift in our understanding and attitudes about fatness and the treatment of obesity.

"We need to figure out how to impact this population. Are there metabolic things occurring, and can we interrupt these things?"

She cites studies that have shown that obese people don’t actually eat more than non-obese people and that obese who lost weight actually require less food. "There appears to be an internal set point."

Genetics can definitely play a role as the heavy. According to a recent study published last year in the New England Journal of Medicine, researchers found that children who are raised in homes where both parents are obese stand an 80 percent chance of being obese themselves.

In homes with one obese parent, the child had a 40 percent risk, children of homes where neither of the parents is obese had a far less chance of obesity, only 7 percent.

"Research has shown there is a biologic basis for the regulation of body weight which is familial and is influenced by environmental and genetic factors," says O’Connor.

She also cites studies that have revealed in this decade some of the most mysterious aspects of obesity may be in a substance called leptin, leptin receptors and a cycle of "complex regulation that we don’t understand internally," she says, theorizing that, "Perhaps if you leave your body in an obese state for a long time, you probably change your receptors."

Still other studies have shown that children who are fat preschoolers and kindergarteners are at a much greater risk of being a fat adults.

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The younger the child the more likely the obesity can be reversed.

The most successful diets are those that make permanent changes in eating behavior. These changes involved eating low-fat food, decreasing intake of high-calorie drinks, eating meals at defined times and avoidance of long fasts and gorging or snacking while watching TV. Unrestricted access to healthy low-calorie foods helps to avoid feelings of hunger. Like most experts, she discourages the use of severely restrictive adult diets for kids. "Very restricted diets should be avoided except for the morbidly obese and should be strictly supervised. Restricted dieting can result in growth disturbance."

She also notes that increasing technology will probably hinder rather than help the fight against obesity in children.

According to a recent article on childhood obesity in USA Today, "Too many of them are spending hours plopped in front of the TV or computer instead of riding their bikes, climbing trees, playing basketball, chasing butterflies and catching fireflies."

And a pediatric colleague concurs that the problem starts at home. "I physically have to throw my kids outside and away from the computer," says Deborah Neigut, M.D., a pediatrician at UTHSCSA whose grant proposal to Weight Watchers proposes dietitians in the pediatric clinic, where none have been before, in order to identify children at risk of obesity.

The American Dietetic Association, USA Today reports, is hosting a special session on overweight children at its annual meeting in October in Atlanta.

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Medical complications that are more common in obese children: hypertension, hypercholesterolemia, hypertriglyceridemia, increased LDL, increased VLDL, decreased HDL, inyperinsulinemia, insulin resistance, gallbladder disease and cholelithiasis, hepatic steatosis, musculoskeletal disorders, neurologic pseudotumors, pickwickian syndrome, obstructive sleep apnea and pulmonary function abnormalities.