Dear Dr. Garner,

I am very upset. My 12-year-old son is overweight (more than 100 pounds), and he is constantly getting made fun of by the other children.

Besides the emotional pain, he actually has physical pain in his knees when he walks, which I think is due to his weight problem. His blood sugar is even a little bit high.

He has tried exercising, going on weight-loss regimens and changing his diet, but these things just don’t work.

Concerned Mother in Midwood

 

Dear Concerned Mother,

We are currently experiencing an obesity epidemic in our country. Statistics show over one-third of all people in the U.S. are obese.

Often, doctors do not treat childhood obesity aggressively. As a result, the child may develop diabetes, arthritis and other diseases later in life.

This past week, the American Medical Association decided to classify obesity as a disease. It is hoped that this will change the way doctors treat the condition and make them more aggressive in the fight against obesity. By labeling obesity as a disease, it stresses the difficulty in treating the condition, particularly in children, and highlights the need for support groups and monitoring on a long-term basis.

In addition, surgical intervention such as gastric bypass surgery may be necessary. In the past, this option was not available to children, but medical thinking has changed. While still controversial, it is being used more and more in adolescents.

The health problems that the obese child may experience later in life, such as diabetes, heart disease and arthritis, begin to develop in childhood. It is important to fully examine a child before labeling him obese, as some children with larger bone frames may have increased weight but not be obese.

While there are cases of genetic or hormonal childhood obesity, most of it is caused by children eating too much.

Factors that lead to childhood obesity include high-calorie diets, not exercising, a family history of obesity, psychological factors and socioeconomic factors, such as the high cost of healthy food and/or living in neighborhoods with a large number of fast food restaurants.

Health complications associated with obesity include: diabetes, high cholesterol, high blood pressure, sleep disorders/apnea, early puberty and asthma.

Childhood obesity often leads to bullying at school. As a result, low self-esteem and depression may occur.

Before going to the doctor, I suggest that you and your son make a diary which includes all the food he has eaten in the past month.

Some other suggestions:

Limit the TV to no more than two hours per day.

Groceries coming into the house should be low in calories and fat.

Eat meals as a family. It is effective in guiding proper eating.

Physical activity is important. This could be traditional exercise, walking up stairs or house work.

There are some prescription medications available for use in adolescents older than 12. It should be known, however, that the risks for long-term use of a weight-loss medication are not well known. Losing weight in a more balanced approach is preferred.

Statin medications for high cholesterol may be necessary.

Weight-loss surgery can be a safe and effective option for severely obese adolescents. It may be used after other methods available have failed.

It is important to be sensitive to your child’s needs and feelings. Being part of a support group is an excellent way for him to discuss his situation with other children. I believe that in adolescents who are morbidly obese, (over 100 pounds overweight) weight-loss surgery should be considered.

Finally, it is important for the parents to set a good example. Children take cues from the parents as to diet and lifestyle.

To end the obesity epidemic, it is necessary to encourage activity and behavior modification, including nutritional counseling. Weight loss is not always possible with diet and lifestyle, and in some cases, surgery may be the answer.[hr] Dr. Garner is a Fidelis Care provider who is affiliated with New York Methodist Hospital, Park Slope. He also hosts “Ask the Doctor” on The NET, Tuesdays at 8 p.m. on Channel 97 Time Warner and Channel 30 Cablevision.