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Severe obesity on the rise among US children

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Some gains in the fight against child obesity have occurred in recent years. For example, a study released last month reported that child obesity had decreased in California. However, a new study reports that severe child obesity in on the rise among US children. A scientific statement from the American Heart Association (AHA) regarding this matter was published on September 9 in the journal Circulation.

The AHA researchers defined children over age two as severely obese if they have a body mass index (BMI) at least 20% higher than 95% of other children of the same age and gender. The researchers also said any child with a BMI of 35 or higher should be considered severely obese. They note that severe obesity afflicts between 4% and 6% of all US children, and the prevalence is increasing. Despite the serious immediate and long-term cardiovascular, metabolic, and other health consequences of severe pediatric obesity, current treatments are limited in effectiveness and lack widespread availability. The authors note that lifestyle modification/behavior-based treatment interventions in youth with severe obesity have demonstrated modest improvement in body mass index status; however, participants have generally remained severely obese and often regained weight after the conclusion of the treatment programs.

Medication tailored for these obese children is extremely limited. Currently, only one medication has attained Food and Drug Administration (FDA) approval for the treatment of obesity in adolescents. Bariatric surgery (surgery designed to restrict food intake) has generally been effective in reducing body mass index and improving cardiovascular and metabolic risk factors; however, reports of long-term outcomes are few. In addition, many children with severe obesity do not qualify for surgery, and access is limited by lack of insurance coverage.

The authors noted that in order to address these challenges, the purposes of their scientific statement are to: (1) Provide justification for and recommend a standardized definition of severe obesity in children and adolescents; (2) Raise awareness of this serious and growing problem by summarizing the current literature in this area in terms of the epidemiology and trends, associated health risks (immediate and long-term), and challenges and shortcomings of currently available treatment options; and (3) Highlight areas in need of future research.

The researchers stressed that innovative behavior-based treatment, minimally invasive procedures, and medications currently under development all need to be evaluated for their efficacy and safety in this group of patients with high medical and psychosocial risks.

Take home message:
If you have a severely obese child, the first step for improvement is lifestyle changes including diet and exercise. If improvement does not occur, medication and surgery should be discussed with a healthcare professional who is knowledgeable in regard to child obesity.

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