Bryn Mawr College
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Confronting Famine Abroad and Obesity at Home
By Jennifer Fisher Wilson

Sue Y.S. Kimm ’60

In the early 1970s when Sue Y.S. Kimm ’60 was chief of pediatrics at the Haile Selassie University Public Health College in Gondar, Ethiopia, she witnessed the tragic effects of famine that struck sub-Sahel Africa. With severe shortages of medicine and few hospital beds, there was little that she could do as hundreds of children died from hunger and thousands more suffered from severe malnutrition.

"Before even making rounds every day, I would go to the front of the outpatient clinic where many, many children with their mothers would be lined up waiting for the clinic to open. Literally every child that came in was at end stage, and the first thing I had to do was quickly triage who was beyond help. That was the hardest thing for me to learn to do, to walk away from those children who were going to die," Kimm says. "It was very humbling that, despite my education and training, I could not cure this severe malnutrition."

When Kimm returned to the United States, she wanted to be involved with better treatments and prevention for kwashiorkor — a form of malnutrition caused by inadequate protein intake — but could not find a single case of severe pediatric malnutrition to study here. Instead, Kimm realized that she saw just the opposite — widespread obesity.

"I was seeing the whole spectrum of caloric intake. If you have ‘small c’ calories, you see the malnutrition we saw in Ethiopia, and if you have ‘big C’ calories, you have obesity. I realized that it all depends on the issue of caloric intake," Kimm says. As a result, she started studying the effects of childhood obesity and promoting health intervention for overweight children.

Tackling Obesity

While this new focus meant that Kimm no longer had to make life-and-death care decisions for starving children in Ethiopia, tackling obesity in the United States didn’t prove easy either. As with malnutrition, the long-term effects of obesity are staggering: obesity and inactivity lead to long-term complications, such as heart disease, diabetes, depression and even shortened life span.

Childhood obesity today is one of the biggest health concerns facing America, yet it was all but ignored 25 years ago. Physicians believed that it was a psychological rather than a medical problem. Over the years, Kimm endured skepticism from her peers and resistance from the public at large about the severity of obesity as a medical problem, but her ideas have slowly gained acceptance and medical opinion has changed.

"I’m very stubborn. I was determined to pursue the problem of obesity and come up with a better strategy for its management in children," says Kimm. She established the first pediatric obesity and hypertension clinic at Duke University before serving as the acting head of the nutrition research section at the National Institute of Health’s National Heart, Lung and Blood Institute while on sabbatical. Kimm is now a professor in the department of family medicine at University of Pittsburgh School of Medicine.

Career Challenges

An upbringing rich in challenging experiences prepared Kimm well for facing hurdles in her career. By the age of 18, she had already moved from Seoul to Tokyo during the Korean War in 1950 and then to the United States to attend Bryn Mawr. After graduating, Kimm enrolled at the Yale University School of Medicine, where she was one of just a few female students, and the only Asian woman. Kimm specialized in pediatrics and became interested in public-health issues, enrolling after her residency at the Harvard School of Public Health. While there, she met her husband, Seymour Grufferman, who is also a pediatrician.

In the summer of 1968, Kimm joined the American Medical Association's Volunteer Physician Program for Vietnam and was assigned to a hospital in Long Xuyen, near the Cambodian border. She provided care to local Vietnamese children and conducted a village survey on sanitation. Data from the survey were used in establishing a new department of preventive medicine at the University of Saigon Medical School. Kimm then joined her husband who was stationed with the U.S. Air Force in Tachikawa, Japan. After her husband completed his military assignment in 1971, they remained interested in international health and relocated to Ethiopia for two years.

Culture Shock

After years abroad, Kimm experienced genuine culture shock upon returning to the United States.

"I was gone from 1968 to 1973, a time of major social upheaval in this country with the antiwar and hippie movements. The culture also changed in terms of medical treatment practices, with an increased emphasis on laboratory tests, for example. I felt like Rip van Winkle," Kimm says.

But Kimm adjusted and started a campaign against childhood obesity that has made her one of the most sought-after obesity specialists in the country today. After a recent paper in New England Journal of Medicine (volume 347, issue 10, pages 709-715) on declining activity levels in American adolescent girls, she fielded dozens of interview requests from the media.

Kimm’s current research focuses on the development of obesity during adolescence and ethnic differences, on the establishment of peak bone mass in girls, and on environmental and biologic factors, including genetics, that contribute to the establishment of obesity. While at NIH, she also developed and directed a research initiative for a large-scale, long-term randomized clinical trial of the effects of a fat-modified diet in children with elevated low-density-lipoprotein cholesterol.

Call for Action

When Kimm discusses the alarming decrease in physical activity among American women, she points to a New Yorker cover. It shows a woman in 1900 kneading dough, in 1950 standing in front of a long freezer chest, in 1970 using a microwave, and in 1990 dialing a local take-out restaurant for delivery as her daughter lies on the floor and plays a video game.

"Today we can even get food while lying on our stomachs," Kimm says. The solution to preventing obesity isn’t to sue fast food chains or tax sugary snacks, she says, since every food has calories. Instead, the overall balance of caloric intake and physical activity needs to be adjusted to today’s lifestyles.

In a recent editorial in the journal Pediatrics (volume 110, number 5, pages 1003-1006), Kimm exhorts physicians to pay more attention to the growing problem of obesity among America’s youth. She offers population-wide suggestions for preventing obesity that include revamping the school lunch program to incorporate lower-fat, lower-calorie foods, such as skim milk instead of whole milk and water instead of sugared drinks. Physical-education goals also need to be reassessed, Kimm says, and schools may need to incorporate more opportunities for physical activities, such as stair climbing.

"We have to come together as a society in order to prevent obesity. It cannot be addressed on an individual basis," Kimm says.

Kimm is hopeful that, with time, the American culture of inactivity and overeating can change to one of increased physical activity and improved nutrition. "We need to systematically identify — without bias — major sources of calories in different age groups. We also have to think of ways to expose people to greater physical activity," she says. "We need fresh ideas, and we need to be bold and innovative."

About the Author

Jennifer Fisher Wilson is a contributing editor for The Scientist. She writes frequently about science and medicine for various publications, including Lancet Neurology, Science and UCLA Magazine.