Obesity rates in the U.S. have started to stall in recent years, but the fastest growing percentage of obese children are those at the heaviest end of the spectrum, according to the American Heart Association (AHA).
In a new statement, published in the journal Circulation, researchers from the AHA report that about 5% of kids in the U.S. are severely obese. This includes children over age 2 who have a body mass index (BMI) that’s at least 20% higher than the 95th percentile for their age and gender. With the statement, the scientists suggest that doctors use a threshold criterion for severe obesity in children of a BMI that is 35 or higher. In adults, severe obesity is defined as having a BMI of 40 or greater, or a BMI of 35 or greater with an additional risk factor for heart disease, such as diabetes or or high blood pressure. Under the revised definition for children, both a seven-year-old girl of average height who weighs 75 pounds or a 13-year-old boy who weighs 160 pounds meet the criteria for severe obesity.
This extreme obesity poses greater health risks for children, says the AHA committee responsible for writing the statement, putting the youngsters at higher risk of developing diabetes, heart disease and stroke. But what are the safest and most effective ways of helping heavier children shed pounds? Most childhood obesity experts recommend a multiple step approach, starting with lifestyle changes, including both diet and exercise programs. And if these interventions alone aren’t enough, medication and sometimes even surgery are needed to address severe obesity.
Yet there is currently no national database that tallies the number of procedures done in younger patients, so it’s difficult to know if more teens are finding themselves facing this last resort for treating their weight gain. “What we have seen is that there has been a population-based increase in the number of severely obese teenagers that have been undergoing bariatric procedures in the last decade or so,” says Dr Marc Michalsky, the surgical director for the Center for Healthy Weight and Nutrition at Nationwide Children’s Hospital in Columbus, Ohio. “Certainly locally here in Ohio we have definitely seen an increase in the numbers. There is some evidence that we are underestimating the number or kids presenting for these types of operations.”
The AHA also says there hasn’t been much research into how damaging such surgery could be for young patients, and called for more research into the safety of weight loss surgery for children.
Still, despite this lack of data, the AHA experts acknowledged that some severely obese patients may have few options other than surgery, and that the procedures should at least be a part of the solution for kids who have exhausted all other weight loss strategies. “It’s very rare that a patient who wants weight loss surgery has not tried a myriad of other weight loss techniques. It’s a false perception that teens want an easy way out. I have not met that patient yet,” says Dr. Evan Nadler, the director of the bariatric surgery program at Children’s National Medical Center in Washington, D.C. Insurers also require that patients exhaust other options before asking for reimbursement for bariatric surgery.
Before these patients get to that point, however, Michalsky says doctors can do more to help prevent obesity among their youngest patients. “By no means do people in the surgical community think that everyone should be coming in for surgery. I think prevention and early childhood treatment are really the key here,” he says.
Even at age 4 or 5, doctors can detect those at highest risk of weight issues by their early birth weight, diet and activity levels. With children in particular, however, the solution rarely lies with simply urging the child to make changes. Advising that the entire family eat a healthier diet and exercise more regularly is one way to reinforce the importance of these changes in young children, and establishing these healthy habits early on can also help them to endure through adulthood, says Michalsky.
“Obesity is a stigma in society, but people do not realize that you cannot blame the obese person. There are so many factors involved, both conscious and unconscious and it doesn’t help to be critical We need to identify what the origins of obesity are and we need to identify them earlier,” says Dr. Valentin Fuster, the director of Mount Sinai Heart at the Mount Sinai Medical Center in New York. “[The paper shows] we have a problem, and we are struggling and not winning.”
By identifying a subgroup of young children who are most vulnerable to developing weight-related health problems, the AHA hopes the statement serves as a call to action for pediatricians and family physicians to address obesity sooner rather than later in a child’s life, and intervene when changes are easier to make and more effective for the long term.