Updated 27 September 2013

Severe childhood obesity in US needs to be addressed

Rates of overweight and obesity in US children and teens may be levelling off, but there are still too many severely obese kids.


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 options."

"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.

Severe obesity

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 journal Circulation.

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.

Potentially reversible condition

The good news, he says, is that severely obese children are not necessarily destined to become severely obese adults.

"Obesity, once 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 treatment.

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.

Other potential 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 populations.

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 community change.

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 treatment goes."

"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."




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