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AHA: Severe obesity affects 5% of US youth
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About 5% of all US children and teens can be considered severely obese, a newly defined risk class, according to a scientific statement released by the American Heart Association.
The AHA recommends that children aged at least 2 years be classified as having severe obesity if their BMI is at least 120% higher than the 95th percentile for their age and sex, or if their BMI is at least 35 kg/m2.
“We recommend that this definition be used consistently in clinical and research settings to standardize efforts to better characterize the unique features and risk factors associated with severe obesity, particularly compared with less severe categories of adiposity, and to evaluate novel approaches for the management and treatment of youth with severe obesity,” the statement reads.
Aaron Kelly
“Severe obesity in young people has grave health consequences,” Aaron Kelly, PhD, statement author and researcher at the University of Minnesota Medical School in Minneapolis, said in a press release.
Immediate health risks may include insulin resistance, adverse changes to vascular structure and function (ie, increased arterial stiffness and endothelial dysfunction), and other metabolic risks. Comorbidities of severe obesity can include obstructive sleep apnea, nonalcoholic fatty liver disease, musculoskeletal problems, psychosocial problems and disordered eating. Long-term risks for severe obesity early in life can include elevated levels of blood pressure, lipids, liver function enzymes, insulin resistance and manifestations of the metabolic syndrome, the authors wrote.
Limited options
Treatment options for severely obese children are limited because most standard approaches to weight loss may be insufficient at this level of obesity.
“Only a few medications have been evaluated for the treatment of pediatric obesity, and results have demonstrated that treatment elicits only modest reductions in BMI/weight and has relatively little impact on the cardiometabolic risk factor profile in obese youth,” the authors wrote.
Lifestyle and behavior modification interventions are recommended for the treatment of severe pediatric obesity, although the authors said it may be associated with modest short-term efficacy and poor long-term sustainability. Medications such as orlistat (Xenical, Roche; Alli, GlaxoSmithKline), exenatide (Byetta, Bydureon; Amylin) and metformin have been shown to have effects on weight loss in children.
Surgical procedures such as Roux-en-Y gastric bypass and adjustable gastric banding also have been evaluated as potential treatments for severe pediatric obesity in recent studies. However, “the step from lifestyle change and medication to surgery is unacceptably large because weight-loss surgery isn’t appropriate for or available to all severely obese children,” Kelly said in the release.
Call to action
The statement serves as a call to action for novel approaches to future research and therapies for severely obese children to fill the gap between lifestyle modification or medication and surgery. Recommendations include:
- More research on the safety and efficacy of bariatric surgery in severely obese children.
- Evaluation of the effectiveness of lifestyle modification interventions, including adherence to dietary and physical activity plans.
- Funding of research to find other useful interventions, including better drugs and medical devices.
- Recognition of severe obesity as a chronic disease requiring ongoing care and management.
“Treatment will need to be broad-based and target not only adiposity but also the risk factors associated with it. … 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,” the authors wrote.
Disclosure: Kelly reports research grants/other research support from Amylin Pharmaceuticals, NIH/NINDS, Thrasher Research Fund and consultancy/advisory board participation for Novo Nordisk. See the statement for the other authors’ relevant financial disclosures.
Perspective
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Valentin Fuster, MD, PhD
There are two major aspects to this paper; one is the general problem and the other is what we can do to solve it. The general problem is that obesity and severe obesity is increasing; consequences such as high blood pressure, diabetes, dyslipoproteinemia and alterations of cholesterol, are very significant.
The therapies we’ve used have failed. Bariatric surgery has been proven to alter some of these significant consequences. However, surgery is not completely safe surgery or without risk. There are barriers to access and because the patients are children, it is not so simple.
The paper by Kelly and colleagues has a great objective: to make the community aware that this is a problem that is increasing and research is needed.
In order to solve this problem, there is a need to identify the obese child as early as possible because a lot can be done. There have been published programs which have proven to be very successful to start in children aged 3 to 5 years regarding their health in general, including physical activity and nutrition.
The next thing to do is to identify the origin of obesity. Are the eating habits of the family unhealthy? Is it an issue of anxiety? Much can be done to understand the child once the origin of obesity is identified. That is, individualized management. If the diet at home is poor, it is clear how to correct it. If the problem involves anxiety, it must be dealt with.
Overall, severe obesity within the pediatric patient population is increasing and we have to be aware of that fact and that we are failing in treating obese children. Bariatric surgery does not appear to be the answer. Therefore, more research is needed.
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