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Dr Shapiro completed his undergraduate education at UC San Diego earning a B S in Biochemistry and Cell Biology and a B A in Political Science He furthered his education at UCLA where he earned a Masters Degree in Public…
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Childhood Obesity: A 'Band' of Hope
As I finished a routine physical exam with an extremely overweight teenager just the other day, I wondered whether he grasped the implications of his weight and the recommendations I gave him. I emphasized the importance of adhering to specific dietary guidelines and daily exercise (please see my earlier blog "Childhood Obesity -- What Can We Do?" for my more detailed message on how the entire family can get involved), and as I usually do, asked him to reschedule an appointment in three months time to follow up his progress. But as I drove home that night, I felt quite skeptical that substantial progress would be made. He was someone who one day would probably need a "pill" or some interventional surgery to assist him in losing weight.
But maybe that day will be here sooner than I think. As the U.S. Food and Drug Administration (FDA) continues to study weight-loss medications in the adolescent population, the results of a small study investigating the benefits of gastric banding were just released at The Endocrine Society's annual meeting in San Francisco. The investigators found this minimally invasive weight-loss surgery helped morbidly overweight teenagers not only lose a substantial amount of weight, but also provided beneficial changes in a variety of health markers. Some of these benefits included:
- An average waist size shrinkage by 5 inches, with an average weight loss of 20 pounds six months after the surgery.
- A reduction in blood sugar as measured by hemoglobin A1c, which is good news in light of the recent disappointing news that there are now 24 million Americans with diabetes, an increase by 15% since 2005.
- An increase in HDL cholesterol--the so-called "good cholesterol".
- A reduction in the level of CRP, an inflammatory marker with links to heart disease.
- Improved liver function.
One does need to take into account this study only included 14 teenagers who were, on average, 174 pounds overweight and the fact that the FDA has not yet approved lab band surgery in the adolescent population.
But what this small study does provide is a ray of hope in our battle against childhood obesity.
Dr. Jeremy
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Displaying comments 12-1 of 12
Got a Question?
I worked for a large public health non-profit organization and we repeatedly told parents to start teaching kids healthy habits at an early age. I don't think weight loss medication is going to be the end-all cure., and it's only a quick fix for the interim. Parents need to take ACTION now for the long term or the kids are going to be in serious health trouble as adults, and are risk for serious illnesses/diseases.
This offers some great information about how to instill healthy eating habits in kids at an early age--words to live by, parents!
http://buzz.prevention.com/communi...
To be sure there are some "emergency" cases. But,...
In highschool my son had a dietary exercise as an assignment where they had to track what they eat...showing them their food group balance. Is that just because we are in California? I was encouraged.
Unfortunately, he was a latch key child...not overweight, because he had scouting activities, but much the same experiences as a lot of kid these days.
Nowdays it is not safe for children to go out and play to expend energy and rev up their metabolism. Not to mention the reduction of physical play at school which was supposedly due to money but really for minimizing liability for schools.
It is a shame kids can't play, they can only sit inside infront of some kind of monitor and eat for entertainment.
Having said that, it is also a shame that the answer would be surgery for such a young person. I think he should come back to you in just a month or three weeks holding him a little more accountable in some way, this gives you an opportunity to encourage him not with a lecture but with something that inspires him.
The teenage years are very tricky because there are so many socially significant issues for them.
If he is on MySpace he could also sign on to this site and see that there are many others in his situation with ideas and solutions...my advise to him would be "take what you need and leave the rest".
I guess my point is; have him track what he is eating with the calorie count. Then, tell him what the daily calorie intake is for the weight he needs to be for his long term health, vitality and survival.
Also mention to him it will increase the things he can participate in when he begins to drive and engage in "play" as an adult. ;) Worth a try! Keeping a dialy food diary is inexpensive.
What I would suggest is some sort of FREE health classes for the parents AND child/ren in the household. This is the ONLY way to fight obesity and it's unfortunate diseases. If a few doctors like yourself took dietician courses, diabetes education courses, and fitness training courses and joined together to offer free or severely discounted boot camps in which you taught proper work out routines, healthy eating menus and diabetes courses then this would help the future of so many FAMILIES not just the children. I suggest free or severely discounted because the majority of obese are poor; living under the poverty level. The problem lies in cheaper foods being worse for you. Thus causing weight gain. So it would be great if we could learn ways to stretch a buck out of foods that are better for us coupled with working out and getting to know diabetes better. Even without the diabetes education this would be so helpful to so many. I'm sure that one could do a study and find this to be most helpful and in turn get some kind of government backing for a program like this.
I would hope before people jump on the surgery bandwagon as a fix they try ALL other alternatives, and I mean really do the work. Most would find a healthy diet with proper exercise will cause the weight to drop off. The surgery really will only help a select few, and those few will stand out because they will have to follow a VERY strict diet.
Is this a recent weight gain or a weight problem that has existed his entire life? A lap band is a temporary fix. For an adult where growth has completed fine and an adult can make an informed decision. However, this child needs support and it is possible that it is not coming from home. Perhaps more frequent follow up visits from you would help keep him on track and maybe you could start a support program out of your office for overweight teens? I was a overweight child and by age 4 I was placed on a low fat diet. Most of my problem then was my parents who felt "a fat baby was a healthy baby." However, as time went on I became involved in outdoor activities and grew into my body at a healthy weight. However, no one ever called me "fat" to my face when I was a child or made fun of my weight. Now we have TV and peers who tell adolecents that they should be made fun of. How we ever allowed a tape meausure in the classroon was a big mistake. All it does is set a teen up for ridicule. Teens think they are invincible and giving them info on how the weight is going to hurt their health down the road is not the answer. They don't have the maturity to grasp such information. Heck, look how much information we give them on how not to drive a car? Does that stop them from doing dangerous things in an auto. NO, because their maturity is not fully developed. Children need activity, that's what we are missing. I know myself, my weight creeps up when I don't move. Start a support program doctor or prescribe one!
Sinceerely,
Bethlynn, RN and previous RD
Dr. Jeremy
I am very scared by this suggestion that surgery is the answer for young people whose bodies are not even developed yet and who may have all kinds of reasons for overeating. Society seems to despise fat people so much that it will now go to the lengths of physically attacking our bodies. Would doctors be happy with a similarly invasive treatment for underweight teens where their stomach was expanded so they were not full til they had eaten a large meal in order to gain weight? Where does this fear and loathing of fat people come from? Why is it that an underweight child receives counselling and help to solve the problem of why they cannot eat enough, and an overweight child gets nagged and blamed and then cut open?
having said that, I think its the doctors responsibility to at least mention dietary alternatives, and let the patient decide which way is best, instead of just immediately assuming the patient wouldn't be open to alternative methods. I think most would be open to the possibility, if they knew it would help. I think most patients in general just don't know a specialized diet would help so much.
So again...thank you for making a point of addressing it with that young man! Thanks to you, too, pianogirl...i would love to have had that where i live!
As far as childhood obesity goes, the lap band study offers a ray of hope to yougsters!
I applaud your efforts.
A few years ago, I sponsored free talks on weight management in my office after hours. The first session drew about 20 people. I talked about nutritition and exercise, the basic energy in/energy out nuts and bolts. People did not like the message. I was not selling any supplements or gimmics. I asked them all to journal their intake and activity and return in two weeks. Only 5 returned. Resistance to change is our biggest enemy in this battle. It is frustrating.