May 16, 2023 – Douglas Lunsford’s son Samuel has suffered from obesity his whole life.
Before turning 14, Samuel, age 25, participated in a program at the Ohio-based Nationwide Children’s Hospital’s Center for Healthy Weight and Nutrition. the program It consisted of twice-weekly meetings with a dietitian, including lessons on food portion size, what food does in the body, what foods can be used to complement other foods, and similar topics, as well as physical exercises.
Although the program is designed for youth with weight issues, Lunsford also participated.
He said, “They would practice us and practice us.”
Father and son did the program together for two years. Since then, Lunsford has advocated for obese youth.
“Samuel’s struggle pushed us into action,” he said.
Eventually, Lunsford helped create the American Academy of Pediatrics recently releasedA clinical practice guideline for the evaluation and treatment of obese children and adolescents.
Help bring about change
According to Sandra Hasink, MD, co-author of the guideline and vice chair of the Obesity Clinical Practice Guidelines Subcommittee, the goal was to “help patients make changes in lifestyle, behaviors, or the environment in a sustainable way and also to involve families in decision-making every step of the way.” “.
The guidelines recommend a comprehensive treatment of obesity that may include nutritional support, exercise, behavioral therapy, medication, metabolic surgery, and bariatric surgery.
Ideally, the child will receive intensive behavioral and lifestyle therapy, although this approach is not always available and can be difficult to deliver. The most effective treatments include at least 26 hours of face-to-face family therapy, consisting of many different components and lasting 3 to 12 months.
The guidelines say that doctors offer teens 12 and older medication to help lose weight, along with health, behavior and lifestyle therapy, and that obese teens should consider metabolic and bariatric surgery while they continue healthy behavior. Intensive and lifestyle therapy.
“We live in a time when we have watched obesity affect our children and the adult population for 4 decades, along with the risk of obesity, we have seen a rise in obesity, we have seen an increase in diseases that go away along with obesity, such as type 2 diabetes, and fatty diseases such as High cholesterol, and fatty liver disease not caused by drinking alcohol.
She explained that as you gain weight, cells in your fat tissue begin to malfunction and produce inflammatory chemicals that cause these diseases.
“So having extra adipose tissue is a risk,” she said. “As pediatricians, we measure BMI [BMI] – which is calculated based on height and weight – as a way to find out if a baby is at risk of developing these dysfunctional cells. If so, we screen them for prediabetes, lipid disease, liver disease and other obesity-related comorbidities.”
In addition, “we worry about the mental health of obese children because of the weight bias in our culture,” says Hasink. “The child gets stigmatized, and that takes the form of bullying and teasing, and it leads to low self-esteem, depression, and anxiety. So we know we have a bunch of physical problems that we need to look out for, as well as the emotional and psychological implications of how our culture sees things.”
Are parents ready for the new approach?
New report From Harmony Healthcare IT, a data management company that works with health data, looked at how parents deal with their children’s obesity. The company surveyed more than 1,000 parents and found that a tenth of respondents have children who are overweight or obese and more than a quarter (26%) are concerned about their children’s weight.
Almost 40% of parents would consider weight-loss medication for their children if the child becomes obese at the age of 12, and about 16% would consider weight-loss surgery. But most parents wouldn’t consider this surgery until their child’s average age is 15 instead of the 13 recommended by the AAP.
Lunsford said his son is considering surgery and medication but he has “never been comfortable” with these approaches.
Hassink said this is not unusual. “Not every parent will think the same way, and their perspective will be based on their experience and what’s going on with their child.”
She said the guide was not designed to encourage every child to try medication or have surgery.
“But parents now know that there are potentially beneficial options here that we haven’t had in years, and they can be discussed with their pediatrician.”
Health challenges
Hassink said it’s hard to stay healthy and not become obese in our modern environment.
There are too many processed foods, too much sugar in our foods, too much sedentary behavior, and a decrease in physical activity. In many societies, it is difficult for people to obtain healthy foods.”
Lunsford said that when his son was in his late teens and out with his friends, they would usually go to fast food restaurants.
“Sam would say ‘yes’ to these foods, even though he knew they weren’t good for him, because he wanted to be like everyone else,” he said.
The Harmony Health IT survey found that many parents say it’s difficult to get kids to eat healthy foods and get enough sleep. Although almost all respondents (83%) said they try to prepare healthy home-cooked meals, 39% eat fast food at least once a week, mostly because parents are too tired to cook.
Hasenck said the COVID-19 pandemic also played a role.
“We knew that Covid would be difficult for obese children, there could be weight gain due to extra sitting time and less sporting activities, and there was a high cost of food for families already in economic hardship,” she said.
Family support is generally necessary, Hasenick said. “Treating obesity requires family involvement. The family lives in the same feeding and activity environment as their child. Everyone should be on board.”
Talk to children about food and weight
The survey found that many parents struggle to talk about food and weight with their children. AAP guidelines suggest that involving a healthcare professional can help.
“If a parent or caregiver is concerned about a child’s weight, they can take the child to the pediatrician,” Hasink said. “The first thing the pediatrician will do is ask about the child’s general health, review the family history — because obesity tends to run in families — and see if other conditions, such as diabetes, also run in the family.”
The pediatrician will perform a physical examination that includes a BMI, and if it is high, other tests may be performed that look at blood sugar, lipids, and liver function.
Ideally, the child will be prescribed an intensive lifestyle and behavior therapy that takes into account the child’s and family’s nutrition, as well as the physical activity and amount of sleep the child is getting, which is sometimes associated with being overweight. If a child has an eating disorder, such as binge eating disorder, it can be evaluated and treated.
Each child is seen as an individual with a specific set of needs. “One size does not fit all,” Hasink said.
Provide emotional support to obese children
Pediatricians can assess a child’s mental, emotional, and social condition. Children who are being bullied or teased may need help coping. Children with depression may need treatment.
Lunsford said that Samuel was fortunate in that he was seldom ridiculed.
“Part of the reason is that even though weight was an issue, he didn’t let his weight define it,” he said. “He’s always been an outgoing kid, athletic, very outgoing and friendly, and being overweight has never been a part of who he is.”
Lunsford encourages parents whose children are being bullied to create a ‘non-judgmental’ zone at home.
“Let your children know that their parents love them for who they are,” he said. Emphasize that weight is a number and health is a way of life. Try to highlight the good things in their lives and encourage them to be as active as possible in the things that are important to them.
