May 16, 2023 – Douglas Lunsford’s son Samuel struggled with obesity his entire life.
Shortly before his 14th birthday, Samuel, now 25, took part in a program on the Center for Healthy Weight and Nutrition at Nationwide Children's Hospital in Ohio. The program consisted of twice-weekly meetings with a nutritionist and included lessons on food portion sizes, the function of foods within the body, which foods will be used as complements to other foods, and similar topics, in addition to physical exertion.
Although this system was designed for adolescents with weight problems, Lunsford also participated.
“They trained us and exhausted us,” he said.
Father and son participated in this system together for 2 years. Since then, Lunsford has been committed to supporting chubby teenagers.
“Samuel’s struggle spurred us to action,” he said.
Eventually, Lunsford helped found the American Academy of Pediatrics. recently publishedClinical practice guideline for the assessment and treatment of children and adolescents with obesity.
Helping to bring about change
According to Dr. Sandra Hassink, co-author of the rule and vice-chair of the Obesity Clinical Practice Guidelines Subcommittee, the goal was to “help patients make sustainable changes in their lifestyle, behavior or environment, including involving families in the decision-making process at every step.”
The guideline recommends comprehensive obesity treatment, which can include dietary support, exercise, behavioral therapy, medications, and metabolic and bariatric surgery.
Ideally, a toddler would receive intensive behavioral and lifestyle therapy, although this approach will not be at all times available and will be difficult. The simplest treatments include a minimum of 26 hours of face-to-face, family-based treatment consisting of many alternative components and lasting 3 to 12 months.
The guideline suggests that physicians should prescribe medications to support weight reduction to adolescents ages 12 and older, along with health, behavioral, and lifestyle treatments, and that adolescents with severe obesity should consider metabolic and bariatric surgery while continuing intensive health, behavioral, and lifestyle treatments.
“We live in a time when obesity has been affecting our children and adult population for four decades. And we are seeing how, in addition to the risk of obesity, obesity itself is increasing. We are also seeing an increase in diseases associated with obesity, such as type 2 diabetes, lipid disorders such as high cholesterol and non-alcoholic fatty liver disease,” said Hassink.
She explains that when weight is gained, the cells within the fat tissue (adipose tissue) stop functioning properly and produce inflammatory chemicals that cause these diseases.
“So excess fat is a risk,” she said. “As pediatricians, we measure the body mass index [BMI] “We use a score — which is calculated based on height and weight — to determine if the child is at risk for developing these dysfunctional cells. If so, we screen for prediabetes, dyslipidemia or liver disease, and other obesity-related comorbidities.”
In addition, “we worry about the mental health of children with obesity because of the weight bias in our culture,” says Hassink. “A child is stigmatized, and this manifests itself in the form of bullying and teasing, and leads to low self-esteem, depression and anxiety. So we know we have a number of physical issues that we need to pay attention to, as well as the emotional and psychological impact of our culture's view.”
Are parents ready for the new approach?
A new report from Harmony Healthcare IT, a data management company that works with healthcare data, looked at how parents view their children's obesity. The company surveyed more than 1,000 parents and found that a tenth of respondents had overweight or obese children and over a quarter (26%) were concerned about their child's weight.
Nearly 40% of parents would consider weight-loss medication for their child if he or she became obese by age 12, and about 16% would consider weight-loss surgery. However, most parents would not consider this surgery until their child is an average age of 15, rather than the AAP-recommended age of 13.
Lunsford said his son considered surgery and medications but “never felt comfortable” with those approaches.
That's not unusual, Hassink said. “Not all parents think that way, and their opinion will be based on their experiences and what's going on with their child.”
The guideline is not intended to encourage every child to try medications or undergo surgery, she said.
“Today, however, parents know that there are potentially helpful options that were not available years ago, and these can be discussed with the pediatrician.”
Challenges for maintaining health
In our modern environment, it’s difficult to remain healthy and never develop obesity, said Hassink.
“There's a lot of processed food, a lot of sugar in our food, a lot of sedentary lifestyles and a decline in physical activity. In many communities, it's hard for people to get healthy food.”
Lunsford said when his son was in his late teens and went out with friends, they sometimes went to fast food restaurants.
“Sam said 'yes' to these foods even though he knew they weren't good for him because he wanted to be like everyone else,” he said.
According to the Harmony Health IT survey, many parents find it difficult to get their children to eat healthy and get enough sleep. Although just about all respondents (83%) said they struggle to organize healthy, home-cooked meals, 39% eat fast food a minimum of once per week, mainly because parents are too drained to cook.
Hassink said the COVID-19 pandemic also played a task.
“We knew that COVID would be hard on overweight children and that there could be weight gain due to the additional sedentary work and reduced physical activity. Plus, food costs are high for families who are already financially strapped,” she said.
In general, family support is important, said Hassink. “The family must be involved in treating obesity. The family lives in the same nutritional and activity environment as their child. Everyone must participate.”
Talking to children about nutrition and weight
The survey found that many parents struggle to seek advice from their children about weight-reduction plan and weight. The AAP guideline suggests that involving a physician will be helpful.
“If parents or caregivers are concerned about a child's weight, they can take the child to the pediatrician,” Hassink said. “The first thing the pediatrician will do is ask about the child's general health, review family history — because obesity often runs in families — and check for other conditions such as diabetes that run in the family.”
The pediatrician will perform a physical examination, including determining BMI. If BMI is elevated, additional tests could also be performed to envision blood sugar, lipids and liver function.
Ideally, the kid will probably be prescribed intensive lifestyle and behavioral therapy that addresses the kid's and family's weight-reduction plan, in addition to the kid's physical activity and amount of sleep, which is typically related to weight gain. If the kid is experiencing eating disorders corresponding to binge eating, they will be evaluated and treated accordingly.
Each child is viewed as a person with their very own needs. “There is no one-size-fits-all solution,” says Hassink.
Emotional support for kids with obesity
Pediatricians can assess the kid's mental, emotional and social well-being. “Children who are bullied or teased may need help to process that. Children who are suffering from depression may need treatment,” Hassink said.
Lunsford said Samuel was fortunate to rarely be teased.
“One reason for this is that although his weight was a problem, he never let his weight define him,” he said. “He was always an extroverted boy, athletic, very outgoing and friendly, and being overweight was never part of his identity.”
Lunsford encourages parents whose children are being teased or bullied to create a “judgment-free” zone at home.
“Make it clear to your children that their parents love them just the way they are,” he said. “Emphasize that weight is a 'number' and health is a 'lifestyle.' Try to highlight the good things in their lives and encourage them to be as active as possible in the things that interest them.”