Childhood & Adolescent Obesity

Thomas Higgins, MD
Nanci Grayson, MS, RD, CDE

Obesity in childhood & adolescence has special implications above those that we described in our prior article on obesity. Much of what was said in the prior article translates nicely into this age group and we would refer the reader to that monograph. In this article we wish to focus on special implications of obesity in children & outline some of the special treatment requirements of this age group.

A normal BMI in children is from 20 to 24, 25 to 30 is considered overweight and obesity is defined as a BMI of over 30. As we have seen in the adult population, the prevalence of obesity in children is also increasing. In 1970, 22% of American children were overweight & 11% met the criteria for obesity. By 1994, the percentage of children classified as being overweight had increased by 30% and the number continues to grow.

Causes of Childhood Obesity

In studies of adoptees, only about 30% of obesity in children can be contributed to genetics & no single gene has been identified as a cause of obesity. Just as we have seen in the adult population, it is clear that environmental factors play the major role in childhood obesity. These environmental factors can be divided into 2 broad categories.

1. Caloric increase:

1. Packaging and processing of food has lead to foods with increasing caloric density.
2. "Supersizing" of food has dramatically increased portion sizes. Why go to a fast food restaurant and get a burger, small fries and drink when you can get the larger portions for very little more – and these larger portions frequently come with a toy for the kids. A few points deserve mentioning here. Industry has recognized a lucrative market in our children and is targeting them aggressively. Also "supersizing of foods" has helped us to lose perspective regarding reasonable portion sizes.

1. Sedentary Lifestyle:

The increased use of TV’s, cars, remote controls, computers, elevators, etc together with the decline in physical education participation has lead to a more sedentary lifestyle especially among our teens. As an example 35% of teens watch more than 3 hours of TV a day and some have been found to spend more time in front of the tube than at school.

Consequences of Childhood Obesity

If a child is obese at 6 years of age, the likelihood that he or she will grow into an obese adult is greater than 50%. If an adolescent is obese, 70% will develop into obese adults. These numbers are in large part independent of parental obesity.

As the obese teen develops into the obese adult, all of the morbidity & excess mortality associated with obesity in general occurs. Some of these comorbidities include a 70% incidence of type 2 diabetes, 56% incidence of hypertension and a 47% incidence of hyperlipidemia.

Obesity has other less direct health costs when it occurs at a young age. College acceptance rates are lower for the obese students despite comparable credentials to non-obese students. Among women (but not men), obesity in the teen years is associated with a lower number of years of education completed, lower family income & a lower rate of marriage than for the non-obese teen. There is a greater dissatisfaction with body image in the obese teen and psychological distress as well as binge eating occurs in a subset of obese teens.

Treatment of Childhood Obesity

Since the problem is due to more than simply eating too much, the treatment is complex. Treatment takes time, understanding and support. Some of the major aspects of treatment include:

1. Addressing caloric excess. This aspect includes reeducation as to portion sizes and the caloric value of foods, control of stimuli associated with eating and the control of the speed of eating.
2. Setting realistic exercise and activity goals.
3. Encouraging family participation both directly in the form of participation in the actual treatment program and indirectly by both removing junk food from the home & by providing healthy foods.
4. Setting reasonable behavioral goals and achieving them in small steps.
5. Dealing positively with lapses. Nagging is to be avoided at all costs.

It should be remembered that children have the ability to "grow out of obesity" and that weight maintenance rather than weight loss may be appropriate in some children. The main goal of treatment is to set the child up to be able to control their weight both during childhood and throughout their lives.

There are obviously no simple answers & no single visit with a dietitian, physician or behavioral health professional will suffice. The Boulder Medical Center will make referrals to Registered Dieticians when appropriate.

To date there is no pharmacologic therapy approved for the treatment of obesity in the childhood and adolescence age group. The Boulder Medical Center Research Department was chosen as a research site for the first clinical trial in the United States of diet medication usage in children between 12 & 16 years of age. This research program took place in July of 2000 & included one full year of monthly family based treatment.

Summary

Obesity is becoming a world wide epidemic involving affluent societies and with the United States out front in terms of prevalence. We can no longer afford to treat obesity as personal failure but must recognize it as a serious medical condition affecting a significant portion of our population. As with any other chronic medical condition, ongoing treatment is needed, a single visit to a health care professional may work for a respiratory infection but it does not work for obesity.

Ongoing research into obesity will continue to broaden our understanding of this illness and provide us with better treatments but waiting for a miracle cure is a mistake.