DALLAS – Preventing severe pediatric obesity in the future likely will require various combinations of diet changes, behavior modification, medical therapy and minimally invasive procedures, according to a scientific statement from the American Heart Association. It is unlikely widespread prevention will be achieved in the near future, according to the statement that appeared on-line Sept. 9 in Circulation, the journal of the Dallas-based A.H.A.
“Treatment will need to be broad-based and target not only adiposity (fat stored in the fatty tissue of the body) but also the risk factors associated with it,” the A.H.A. said. “Increased research funding will be needed from the National Institutes of Health, other funding agencies and industry.”
Severe obesity affects between 4% and 6% of all youth in the United States, according to the A.H.A., which sought to recommend a standardized definition of severe obesity in children and adolescents, to raise awareness of the issue, and to highlight areas in need of future research.
Severe obesity is more prevalent among Hispanic or Mexican American children and non-Hispanic black or African American youth. According to NHANES data from 1999-2004, severe obesity was prevalent in 5.2% of Mexican American youth and in 5.8% of black youth (non-Hispanic) of the ages 2 to 19, which compared with 3.1% in white youth (non-Hispanic).
The A.H.A. recommends that severe obesity in children age 2 years and older and adolescents be defined as having a body mass index (B.M.I.) equal to or greater than 120% of the 95th percentile or an absolute B.M.I. equal to or greater than 35.
According to the A.H.A., lifestyle modification/behavioral therapy has had modest short-term efficacy in terms of B.M.I./weight reduction and cardio-metabolic risk factor improvement. Long-term sustainability of the improvements is poor. Treating pediatric obesity with medications has resulted in modest reductions in B.M.I. and weight, and it has had little impact on cardio-metabolic risk factors. Access to bariatric surgery, such as gastric bypass, is limited for most youth because of lack of insurance coverage, according to the A.H.A.
The A.H.A. listed many health problems associated with severe obesity in childhood that track into adulthood. High B.M.I. in childhood is associated with increased risk of cardiovascular disease, type 2 diabetes mellitus (T2DM) and premature death, the A.H.A. said.
“Stakeholders at all levels will need to work together to engage the growing problem of severe pediatric obesity,” the A.H.A. said. “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.”