Bethany Beard, MD
I’ll be the first to admit, chubby babies with mushy Michelin thighs are very cute and fun to squeeze on. I see these kiddos frequently for well child checks and I actually applaud the mother on her job well done to grow and nourish her baby. There is no other time in life when wrist and ankle rolls are cute, so when does this ideal end and become a health concern? At what age is fat no longer preferred? The human body’s future metabolic “programming” can actually be modified by diet and nutrition in early infancy, so maybe that chubby infant shouldn’t be so admired.
America’s children are fat and quite frankly, it’s not cute. This epidemic is spreading through the United States each year. Childhood obesity has more than tripled in the past three decades and statistics from the CDC indicate that obesity in children age 6-11 has increased from 6.5% in 1980 to 19.8% in 2008, and that obesity among adolescents age 12-19 years increased from 5% to 18.1% respectively.
Interest in this topic began during my undergraduate study of nutrition. I learned all about flavonoids, phytochemicals, biochemical nutrient metabolism, blah, and blah; however, nutrition’s real life importance did not come to fruition until later in my career. At a nearby table in the Riley cafeteria sat a morbidly obese toddler, roughly three years old. The child was accompanied by what appeared to be some sort of health coach. I observed the “coach” help the child count green beans, carrots, and apples as if to re-program her mind about healthy foods and appropriate portion sizes. I assumed she worked at Riley’s POWER clinic, which was established for overweight and obese children. Shortly thereafter, before the food was gone, the woman took everything away and said “ok, that’s all for now. Let’s go”. I put my cheeseburger down. My emotion was initially sadness, then it was later followed by motivation to learn more about childhood obesity and it’s harms on today’s youth.
So what’s the big deal with childhood obesity and what impact are we seeing across the country? Childhood obesity results in multiple health related illnesses including hypertension and hyperlipidemia, diabetes, worse asthma control, sleep apnea, and mental health disorders such as depression and body image issues. As emergency physician’s we are seeing these children present more commonly with lower extremity injuries, commonly knee pain and sprains, compared to their normal weight for age peers. Obese children perform worse academically and miss approximately 4x more school days than their classmates. They also sleep worse. Probably the most startling statistic is from a study in 2005 which shows that if obesity continues at the current rate, children of today’s generation will have a shorter life expectancy than their parents for the first time in over 100 years! In addition, these children present challenges in the health care setting. Obese children are more difficult to obtain IV access and intubation, their belly rolls limit the sensitivity of ultrasound, and there are dosing difficulties for both medication and defibrillation during resuscitation. Aside from numerous co-morbidities, the heath care system also feels the impact of childhood obesity, as these children are 3x more expensive compared to the cost of normal weight children.
Obesity results from a combination of a little genetic and mostly multifactorial environmental influence. Some influences include a lack of education on what’s healthy and what’s not, limited access to healthy food, and sedentary lifestyles as technology and television viewing increases. Another challenge is that our nation’s schools have limited resources. School lunches lack fresh fruits and vegetables and due to budget cuts, physical education was reduced leaving the majority of elementary schools without daily gym classes. The biggest contributor to childhood obesity, in my opinion and that of expert researchers, is the parents of these children. As a mom, I realize that it is both cheaper and easier to warm up prepackaged chicken nuggets, hotdogs, cookies, etc. I get it; especially when parents are busy and on a budget. However, the quality and quantity of food a child receives is controlled by the parents and directly impacts a child’s weight.
The chance that an obese child will grow into an obese adult is 70%; therefore, it is our job as physicians to identify these children early. One study suggested targeting obesity at six months of age as these infants were most likely to remain obese at their two-year visit. Although there is no strict age cut off, most pediatricians and researchers believe that obesity should not be diagnosed before two years of age. The first step is to simply target those children at risk. This can be achieved by calculating a BMI on all children who present to a primary care clinic or the emergency department. With electronic medical records, this should already be calculated when both height and weight are submitted. The next step is to identify those with BMI 80-94% which will classify the child as overweight. Those with a BMI >95% are obese.
The consensus of obesity experts in the National Association of Children’s Hospitals and Related Institutions (NACHRI) Obesity Focus Group recommends that identification of obesity and treatment should occur in all inpatient and outpatient settings in a children’s hospital. Promotion of healthy behaviors at the hospital is also encouraged. Change is currently underway at Riley Hospital, as McDonalds will soon be replaced with healthy food options and Andrew Luck’s ‘Change the Play’ campaign was established to promote the importance of physical activity and wellbeing.
Cornerstones of obesity treatment are focused on promoting a healthy diet and increasing physical activity, along with parental involvement and support. Emergency department visits are an opportunity to have discussions with patients and families about weight loss and encourage regular follow-up with their primary care physician for monitoring. Exciting initiatives are also supported nationally. In 2010, three events occurred: Michelle Obama’s “Let’s Move” campaign, the Patient Protection and Affordable Care Act, and the White House Task Force on Childhood Obesity report. Together as physicians and advocates for children’s health, we can combat the childhood obesity epidemic, make a positive impact on their adult health, and hope for change in generations that follow.
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