Rates of overweight and obesity in US children and teens may
be levelling off, but many kids are still severely obese and need attention, says a new statement from the American
Heart Association.Between 4% and 6% of youth in the United States are severely
obese, with serious accompanying health problems, the researchers say.
A co-author of the statement, Aaron S Kelly of the University of Minnesota Medical School, says: "Between 4% to 6% of all children and adolescents in the US are obese and the problem needs to be addressed because it is too high".
This group is "growing at a relatively rapid clip and
that's concerning," he said.
"We don't have many effective treatment
"Last year, research from the US Centres for Disease Control and
Prevention showed a drop in obesity and extreme obesity among low-income
preschoolers. Yet, this new statement, using an updated definition of severe
obesity, identifies a subset of youth for whom current prevention and treatment
tactics don't appear to be working."
Kelly and his colleagues analysed data from the national
health and nutrition examination survey from 1999 to 2006 and smaller
studies to see how common severe obesity is among children and adolescents.
The researchers defined severe obesity by body mass index
(BMI), a measure of weight relative to height.
For children, BMI also takes
into account the range of weights in a child's age group.
Severe obesity is
defined in the statement as a BMI of at least 35kg/m2 or a BMI that is equal to
or greater than 120% of the 95th percentile for age, whichever is lowest.
The authors also recommend that this updated definition be
universally applied in clinical and research settings because it better
captures the children with the most severe problem. By this standard, they
conclude that 6% of two to 19-year-old youth have a body mass index (BMI) that
falls within the range of severe obesity.
Across all paediatric age groups, about 4% of children fall
into the severely obese category. It's slightly more common among boys than
girls and among Hispanics and blacks compared to whites, they report in the
Children in this group are at risk for the same serious
health problems that plague obese adults, including cardiovascular problems,
such as high cholesterol and high blood pressure, insulin resistance,
pre-diabetes and sleep apnoea. They're also prone to muscle and joint disorders
as well as psychosocial problems, the authors point out.
Dr Stephen Pont says depression, anxiety and liver cirrhosis are
other associated health risks that are not often thought about as readily as
high blood pressure or high cholesterol.
"Obesity is now becoming the
number one cause of liver cirrhosis and liver failure (in kids)," he said.
The good news, he says, is that severely obese children are
not necessarily destined to become severely obese adults.
you have it, is not a fixed condition; it's potentially reversible," said
Pont, who is the chair of the American Association of Paediatrics' Section on Obesity.
Current treatment options include lifestyle modification and behavioural
therapy, with family-based behaviour weight management recommended as first-line
Such programmes have shown modest success, but they may not
have lasting effects among severely-obese youth and may not be widely available
or affordable to many, the statement author’s note.
Medications, including the anti-diabetes drugs metformin and
exenatide (marketed as Byetta, Bydureon), appear to be promising options but
neither of these medications is approved by the US Food and Drug Administration for the treatment of obesity in children.
The only medication
the administration has approved for use in kids is orlistat (Alli, Xenical), which blocks
absorption of fats from food.
Bariatric surgery, also known as gastric bypass,
although highly effective, cannot be widely recommended because of its risk of
complications, and unknown long-term effects among children and adolescents,
the report states.
treatment options exist, such as the newer medications that have been approved
to treat obesity in adults and various bariatric surgery techniques, but they
require additional studies to be conducted in paediatric
No silver bullet
"There's no silver bullet," Pont said.
"Part of the
solution is working with doctors and the other part is working (with patients)
where they live," he said, citing a need for "advocates for healthy
Kelly said: "Referring to the statement by the heart association as a call to
action, we're calling on funding agencies to step up
and make it a priority to invest in solutions to this problem as far as
"Prevention of severe paediatric obesity is the
ultimate goal and ideal outcome, but widespread prevention is unlikely to be realised in the near
future, and the numerous children and adolescents affected by this condition
need safe and effective treatments now."