Since I had seen her last year, my 5-year-old patient Tiana had gained so much weight that I almost didn't recognize her. I knew that when I looked at her growth curve it would now include a steep upslope. The change had not caught her mother, Mafia, by surprise. Tiana's weight was the first topic of her answer to my usual, "How are things goin'?"

Over the years we had had many discussions about how she might remedy the girls" sleep problems. Now we had a new issue to discuss: impending obesity.

My simplistic understanding of obesity has always been that if someone takes in more packets of energy than are burned, those packets will accumulate in the body as fat.

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