Treatment for childhood obesity

What are risk factors for childhood obesity?

There are several substantial risk factors for the development of pediatric obesity.

1. Genetics: While several genetic syndromes are associated with obese stature (for example, Prader-Willi syndrome), genetics are not responsible for the obesity epidemic currently taking place. There has been no change in the gene pool over the last 30 years. Most recent studies indicate that if one parent is obese the likelihood of having an obese child is three times higher than otherwise. If both parents are obese, the likelihood is 10 times higher.
2. Social: Limited school athletic activities coupled with excessive time-utilizing social networks, TV, and computer games are a prime reason for pediatric obesity. Watching TV while eating a meal as well as the excessive consumption of takeout/fast food are also both risk factors for both pediatric and adult obesity. Recent studies indicate that only 20% of children experience more than two episodes of vigorous play per week, and 25% of these children watched more than four hours of TV per day. This does not include additional time engaging in computer games, texting, or talking on the phone with friends. Having a TV in the bedroom is a strong predictor of pediatric obesity.
3. Cultural: Many societies follow either a healthier food palate (traditional oriental, Mediterranean, etc.) or eat smaller portions of higher-fat-content foods (European). The Americanization of such foods coupled with excessive portions is a prime cause of obesity.
4. Diseases: Thyroid disease, polycystic ovary disease, brain tumors, mental retardation, and other conditions are a small contributor to the risk factors for obesity.
5. Medications: Chronic oral steroids, some classes of antidepressants, and other drugs may also contribute (in a very small way) to pediatric obesity.
6. Psychological: Many individuals overeat in an attempt to deal with emotionally stressful lifestyles. Often the excessive weight further aggravates their emotional turmoil.

What the risks, complications, and long-term health effects of childhood obesity?

The consequences of childhood obesity may be grouped into three areas: physical, mental, and economic. The known physical side effects of obesity are multiple and broad spectrum in character. These include: (1) increase in risk of developing type 2 diabetes mellitus due to excessive insulin secretion and organ resistance to insulin; (2) menstrual irregularity and infertility; (3) heart attack and stroke due to hypercholesterolemia, hyperlipidemia, and hypertension; (4) pulmonary issues centering on asthma and obstructive sleep apnea; (5) orthopedic issues of bowed legs and hip instability (for example, slipped capital femoral epiphysis); and (6) metabolic issues (nonalcoholic fatty liver disease, gallstones and gastroesophageal reflux [GERD]).
Equally as important as these physical side effects of obesity are the psychological consequences. These include (1) lowering of self-esteem often reinforced by teasing and bullying at school as well as a recurring barrage of the normal/ideal physique displayed by the media and entertainment industries and (2) depression, leading to possible further eating or an exaggerated overcorrection leading to eating disorders such as bulimia and anorexia nervosa.
The economic costs of childhood obesity are not often considered but are very important. Such effects include: (1) the direct costs of medical office visits, diagnostic studies and therapeutic services; and (2) indirect costs are both long- and short-term and include decrease in productivity, absenteeism, and premature death. Estimates for both direct and indirect costs for 2008 were $147 billion.

What is the treatment for childhood obesity?

The treatment for childhood obesity is no different than many diseases -- determine the cause and control or eradicate it. Since the overwhelming number of obese individuals are consuming too many calories relative to their energy expenditure ("burning them off"), therapy is directed toward reversing this metabolic equation. Simply put, consume fewer calories and use more up. There are many dietary programs that attempt to address this issue. None is superior over the long term unless the participant embraces these nutritional changes as part of a larger lifestyle recommitment. Drugs and surgery should be restricted to severe cases of childhood (and adult) obesity.

Can childhood obesity be prevented?

Benjamin Franklin's famous dictum "an ounce of prevention is worth a pound of cure" is ironically the perfect approach to childhood obesity. The CDC has recently raised the notion that should the alarming increase in childhood obesity not be reversed, the consequences may make the current pediatric population be the first generation to not exceed the life span of their parents. Studies have indicated that childhood obesity must be attacked prior to the teen years. Twenty percent of obese 4-year-old children will grow up to become obese adults; 80% of obese teens will continue their obesity into adulthood. All of the above reviewed consequences of pediatric obesity are brought forward into the adult years. Two amazing observations: (1) children 6 months to 6 years of age watch an average of two hours of television per day; (2) children 8-18 years of age spend an average of seven and a half hours per day involved with entertainment media activity such as television, computer games, video games and cell phone calls/texting.
Social and cultural changes are necessary to effectively address the pediatric obesity epidemic. A basic approach would entail the following:

1. Advocate breastfeeding during the first year of life. Studies strongly reinforce that breastfed children have a lower risk of infant, childhood, and adolescent obesity.
2. Drastically overhaul the school breakfast and lunch programs to favor heart-healthy food choices. Encouraging salad bars, banning sugar drinks, and flavored milk are options.
3. Guarantee safe neighborhood environments which foster outside play activities.
4. Limit TV/computer/social-network communication or other activities which encourage sedentary behaviors.
5. Encourage vigorous physical education programs for 45 minutes daily.
6. Revamp restaurant portion sizes. Studies had repeatedly demonstrated a link to the rise in pediatric obesity with fast-food restaurants' adoption of supersized portions as well as the bundling of food options (for example, deals for hamburger, french fries, and soda meals).
7. Encourage the development of activity-friendly infrastructure in communities -- bike lanes, regional parks, etc. Many studies have shown that the social and cultural changes above must be accompanied by a strong family and community support structure, without which these approaches often fall short.