The Closing Childhood Obesity Window

Fat Boy

The journal Childhood Obesity (Volume: 10 Issue 4: August 1, 2014) published an editorial by Dr. Stephen R. Daniels (University of Colorado School of Medicine) and Dr. Aaron S. Kelly (University of Minnesota Medical School). “Pediatric Severe Obesity: Time to Establish Serious Treatments for a Serious Disease” makes the case that the prevalence of severe obesity among teenagers is accelerating, and the need is obvious for more intensive interventions. The authors very strongly urge more drugs and more bariatric surgery for America’s youth.

How did we get to this point? What makes these health professionals advocate such extreme measures? Nearly 6% of children and teenagers in the U.S. qualify as severely obese. Extrapolation from longitudinal studies predicts that 90% of these obese kids will be obese adults, with all the comorbidities that come along with severe obesity. The authors spell out the consequences:

Children and teens with severe obesity … have higher levels of blood pressure, triglycerides, inflammation, oxidative stress, lower levels of high-density lipoprotein cholesterol, signs of subclinical atherosclerosis, and a higher prevalence of impaired glucose tolerance and prediabetes. Severe pediatric obesity is also associated with obstructive sleep apnea, nonalcoholic fatty liver disease, musculoskeletal problems, and reduced quality of life.

However, while diet and healthy lifestyle changes have a chance when implemented during childhood, the window of opportunity closes fast. Prevention is the best approach, and failing that, early identification of the problem and early intervention are crucial. Severely obese teenagers are another story. Although lifestyle modification therapy should be included in their program, the authors feel that lifestyle changes alone cannot be enough, and anything short of surgical treatment is “virtually ineffective.” They write:

The current state of evidence suggests that more intensive interventions, potentially including pharmacotherapy and weight loss surgery, may be required to elicit meaningful reductions in adiposity and the comorbidities associated with severe obesity in this lifestyle treatment resistant adolescent population.

The reason for this dictum is that even if lifestyle modification alone may seem to working the short term, by the time a teenager has become severely obese, the body has already made far-reaching adaptations. The hormones that manage appetite and satiety may be so out of whack that it will be impossible to maintain weight loss over the long term. According to the authors, better access to specialty medical weight management programs, pharmacotherapy, and weight-loss surgery are all important components of a more comprehensive strategy to combat severe obesity among teens. But they pin their best hopes on pharmacotherapy and bariatric surgery.

The additional bad news is, when it comes to pharmacotherapy those hopes at present are slim. Only one weight-loss drug has been approved for adolescents, but it doesn’t work very well and the side effects are considerable. Consequently, a segment of the teenage population experiences obesity so serious that surgery appears to be the only answer. Dr. Daniels and Dr. Kelly feel that surgery is underutilized. They hope that the widespread resistance to it will fall away, and also that more effective drugs will enter the market.

Meanwhile Dr. Pretlow asks, what else could this be, other than addiction? As Childhood Obesity News has discussed, Dr. Pretlow has developed a smartphone app known as W8Loss2Go, which is based on an addiction model of staged withdrawal in small increments from problem foods, snacking between meals, and excessive food amounts at meals. He says:

Intensive treatment using addiction medicine methods is showing potential for such young people, as evidenced by results from our three pilot studies involving 142 obese youth.

Your responses and feedback are welcome!

Source: “Pediatric Severe Obesity: Time to Establish Serious Treatments for a Serious Disease,”, 07/01/14
Image by Yun Huang Yong

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