3: Understanding Childhood Obesity with Dr. Tami HannonMar 06, 2023
Pediatric obesity is now of epidemic proportions in the United States, with 1 in 5 children meeting the definition of pediatric obesity. Even more concerning is that minoritized populations, including black populations and Hispanic populations, have closer to 1 in 4 children meeting that definition.
These staggering numbers are disheartening to hear because we know that childhood obesity can lead to significant health problems further down the line.
Implications of an Obesity Diagnosis for the Pediatric Population
Typically you can see issues such as dyslipidemia, so high lipid levels where triglycerides are usually high. There is often an imbalance of the bad cholesterol and the good cholesterol, with the levels of cholesterol that protects our cardiovascular system lower.
Hyperglycemia, or high blood sugar, can happen in two basic forms. There is pre-diabetes where your blood sugar is elevated some of the time, but not enough to give you a diagnosis of diabetes. But we also do see diabetes in increasing numbers in kids.
In addition, we see something called insulin resistance, which is not really a diagnosis that you can make with labs per se, but a physiologic phenomenon where your body is having to make more insulin to do the same amount of work than it maybe did before. For instance, the more body fat you have on your body, the more insulin resistant your body is to the actions of a certain amount of insulin, so you’re having to make more insulin.
Non-alcoholic fatty liver disease is also becoming more prevalent with the rise in childhood obesity. This is something we see primarily from the diets that we eat that are high in processed foods and sugars and results from a build up of lipids in the liver.
What has contributed to the recent rise in childhood obesity?
Over the past few decades, we've seen these obesity trends among children and adults skyrocket. It's very clear that genetics play a huge role in the amount of body weight we carry. Studies of how much body weight you carry related to genes vary from 40% to 70%, and so we're learning more and more about that link. But genes definitely play a part.
However, in the context of a ubiquitous obesogenic society, we eat mostly processed foods. Most of the foods we eat aren't natural to our bodies because they're not fruits, vegetables, or things that grow on the earth, so there's no doubt that the food environment has come together with the genetic background of increased risk and promoted more people having higher BMIs.
How do I get help for kids struggling with weight?
The first thing I recommend is to talk to a trusted healthcare provider, or pediatric healthcare provider. That could be a pediatrician, a family practice doctor, or whoever is there for you, who you trust to discuss your concerns with.
To get immediate help, the number one most impactful thing that a parent can do is eliminate sugary beverages. Sugary beverages are not good for anybody. Good research that sugary beverages promote obesity and diabetes. Therefore reducing sugary beverages can potentially prevent or reverse these things.
In fact, a recent study showed that the soft drinks industry levy, the ‘sugary drinks tax’, in England was followed by a drop in the number of cases of obesity among children. According to research led by the Medical Research Council’s (MRC) Epidemiology Unit at the University of Cambridge, taking into account current trends in obesity, their estimates suggest that around 5,000 cases of obesity per year may have been prevented.
To what extent do genetics play a role in obesity?
If one in four children or one in five children has the genetic background to develop obesity in our environment, it's really hard to counteract that without making some changes. Although daily exercise is a life skill and very important for our bodies and minds, it is not going to lead to weight loss most of the time without dietary changes.
There are forms of genetic obesity that do benefit from other treatments, including medications. There are FDA approved medications for children aged 12 and up who have known genetic mutations that are associated with gaining too much weight. They are also approved for kids who may not have known genetic mutations, but have many genetic reasons for having a hard time with weight struggles.
A study  has shown there is actually a common genetic variant in Labrador Retrievers which has a significant effect on those dogs that carry it, so it is likely that this helps explain why Labradors are more prone to being overweight in comparison to other breeds. The gene affected is known to be important in regulating how the brain recognizes hunger and the feeling of being full after a meal.
Based on this, although not scientifically proven, it’s completely possible that humans would have some of these mutations to be food seeking because we have survived in times where we didn’t have enough food. We also see the situation where people are exposed to the same foods, but one sibling, for example, might be a higher weight.
When is it appropriate for a family to try to seek out help through obesity medication?
Recently, the American Academy of Pediatrics has published clinical practice guidelines. This is really the first time the American Academy of Pediatrics has put forth evidence-based recommendations for treatment of childhood obesity. There have been task force recommendations before, but these guidelines are based on all the evidence that we have of showing what works and doesn't work for pediatric obesity.
The guidelines state that all kids from age two and up should be screened and evaluated for comorbid conditions associated with obesity (with BMI and other lab tests). The guidelines also state that children aged 12 and up should have a discussion with their family as to whether or not this might benefit them. This is because we know that lifestyle interventions alone don't really translate to weight loss in children most of the time, and there could be a number of reasons for that.
Developmentally kids are supposed to grow, they’re not programmed to lose weight. From the studies that have been done, with randomized clinical trials in kids that have included at least 26 hours of face-to-face counseling, most led to either weight maintenance or up to a five kilo weight loss on average in kids. So when we’re talking about having a lot more weight to lose, that's generally not sufficient. There are also not many programs that offer intensive health behavior and lifestyle therapy for children. Therefore the American Academy has recommended that in combination with lifestyle therapy, medications are to be considered and discussed with families.
Who should prescribe these weight loss medications?
Anybody who delivers chronic healthcare to children and families. That includes pediatricians, family practice doctors, pediatric endocrinologists, and pediatric obesity medicine specialists. The medicines need to be prescribed in a way that involves comprehensive care surrounding the child and the family. Ideally, they would have access to mental healthcare, physical care and cognitive behavioral therapy offered. But again, this is the ideal situation. Unfortunately not many programs actually provide these resources.
What are some top tips to support children with this at home?
As previously mentioned, cutting out sugary beverages is key. In addition to that, it’s hugely important to eat with your kids. We have an epidemic of not eating together and sharing the time together. That can make a huge difference to the way in which we consume food.
Keep your kids active where possible. That doesn’t mean they have to be running around doing 12 sports or even any sports, but they should be in a club. They should have something that they're interested in other than just their phone. Stay in school, stay active, be interested in something. I think in the long run, the more we can get kids to do those basics, the better off we will be.
What is the ‘Health at Every Size’ movement?
Many doctors today approach health through what’s known as the “weight-centric” model. This is where weight is considered one of, if not the, most important marker of health. In contrast, the ‘Health at Every Size’ movement, commonly known as HAES (pronounced “hays”), is an alternative approach, also referred to as a “weight-inclusive” model of healthcare.
HAES-informed practitioners do not routinely weigh patients, or use weight to determine how healthy a person is. Other indicators such as blood pressure and cholesterol levels are used to assess physiological health. They would also consider how various social, economic and environmental barriers in a person’s life may be impacting their ability to pursue health. For example, they might look at if you live near a grocery store, have time to cook, etc.
A HAES provider will still encourage you to be more active or change your eating habits, but they’ll only recommend changes that are attainable and realistic for you. Most importantly, they don't tell you to do these things to lose weight. In this model, weight loss is never a goal of treatment because your body is never viewed as a problem to be solved. You have the right to pursue health in the body you have, as opposed to trying to change your body so it can be deemed ‘healthy’.
More about Dr. Tami Hannon
Dr. Hannon is a board certified pediatric endocrinologist with specific training and expertise in patient-oriented clinical research in youth with obesity, conditions of insulin resistance, and diabetes. She serves as Director of the Pediatric Diabetes Program at Riley Hospital for Children, a program serving more than 1800 pediatric diabetes patients across the state of Indiana and surrounding states. She is currently an investigator on multiple projects to prevent diabetes or restore insulin secretion in individuals with diabetes. Her undergraduate degree is in Nutrition Science, from Purdue University. She received her medical degree from Indiana University and did her pediatric residency and pediatric endocrinology fellowship at Riley Hospital for Children in Indianapolis, IN.
 Raffan, E et al. A deletion in the canine POMC gene is associated with weight and appetite in obesity prone Labrador retriever dogs. Cell Metabolism; 3 May 2016; DOI: 10.1016/j.cmet.2016.04.012
Non-alcoholic fatty liver disease