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Childhood obesity

Five percent of US children are severely obese

AHA calls for innovative approaches to fill the gap between early interventions lifestyle changes and medication

Researchers reviewing data on US children have determined that 5 percent have severe obesity, according to a scientific statement published in the AHA's journal Circulation.

The policy statement, which defines severe childhood obesity for other doctors, states that children are often assessed based on how their body mass compares to that of their age group. They are considered overweight if their BMI falls into the 85th to less than 95th percentile of others of their age and gender. Obesity is diagnosed if a child has a BMI equal or greater to 95 percent of their peers. Overall, one-third of US children are considered obese or overweight.

"Severe obesity in young people has grave health consequences," said study author Dr Aaron Kelly, a researcher at the University of Minnesota Medical School in Minneapolis. "It's a much more serious childhood disease than obesity.”

The AHA's scientific statement reveals a new definition for those who are severely obese: having a BMI at least 20 percent higher than the 95th percentile for their age and gender, or a BMI of 35 or higher. That means a 7-year-old girl of average height that weighs 75lbs or a 13-year-old boy who weighs 160 points would be considered severely obese.

Statement

The statement calls for innovative approaches to fill the gap between early interventions lifestyle changes and medication, and the final intervention -- weight loss surgery.

“Bariatric surgery has generally been effective in reducing body mass index and improving cardiovascular and metabolic risk factors; however, reports of long-term outcomes are few, many youth with severe obesity do not qualify for surgery, and access is limited by lack of insurance coverage,” the authors write.

He also noted that severely obese children face a significant risk of developing type 2 diabetes, high blood pressure, high cholesterol levels, and cardiovascular issues.

"Even highly intensive lifestyle interventions generally have left subjects still markedly obese, albeit with modestly improved cardiovascular and metabolic profiles," they note.

Specific suggestions from the statement's authors include conducting new studies on the effectiveness or lifestyle modifications like diets and physical activity plans and finding out how well kids will stick to them.

Nationally, childhood obesity rates seem to be levelling or falling slightly. In August 2013, researchers from the Centers for Disease Control and Prevention (CDC) reported drops in obesity rates among pres-choolers living in 18 states and the US Virgin Islands.

However, Kelly warned that while the national problem may be levelling, severe obesity rates among children are on the rise.

Recommendations

The American Heart Association recommends the following tips to healthcare professionals to address the obesity problem:

  • More research into the effects and safety of bariatric surgery.
  • Attention into the effectiveness of lifestyle modification interventions such as adhering to a diet and physical fitness.
  • Research into other useful weight loss tools including drugs and medical devices.
  • The recognition of severe obesity as a chronic disease that requires care and management.

Cardiologist, Dr Valentin Fuster, director of Mount Sinai Heart at The Mount Sinai Medical Center in New York City, said weight management is difficult for children because due to hormones they tend to want to eat more, while some have such low self-esteem from their lifelong struggles with weight, they simply give up trying.

He explained that it was too simple to argue kids are eating too much and that early interventions should target anxiety, family or genetic-related issues that may be contributing to obesity at such a young age.

"This is why it's so important to know the reasons for why you're obese," he added. "All society should be aware that this is a huge problem, leading to an epidemic of cardiovascular diseases."

"Alternative approaches are needed for youth who medically qualify for bariatric surgery but are not interested in this option, for youth who lack the family support or emotional maturity for the surgery and resulting change in food intake, and for children too young for surgery but with severe obesity and severe comorbidities," they concluded. "The task ahead will be arduous and complicated, but the high prevalence and serious consequences of severe obesity require us to commit time, intellectual capital, and financial resources to address it."

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