Confronting Famine Abroad
and Obesity at Home
By Jennifer Fisher Wilson
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
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.
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 didnt
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.
"Im 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 Healths 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
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.
After years abroad, Kimm experienced
genuine culture shock upon returning to the United
"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,"
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
Kimms 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
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 isnt
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 todays
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 Americas 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
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.