Obstacles to Treating Childhood Obesity
On 9/11/2001, I was in Buffalo, NY, watching news footage of the twin towers attack with Professor Leonard H. Epstein. I'll never forget his kindness to me and my sound engineer and our shared horror, grief, and fear for our country. I have followed his career closely ever since. Epstein is a pediatric preventive and behavioral health expert. He's spent 30 years researching how to prevent and treat childhood obesity.
Epstein's work is even more vital than when I interviewed him 22 years ago. Back then, the prevailing approach was watchful waiting or withholding treatment to see if a child grew out of the weight problem. Today, nearly 15 million children and teens in the US, about one out of every five, are medically obese. Numerous studies over the years have also shown that obesity increases the risk of developing life-threatening conditions like diabetes, heart and liver disease, and some cancers. This year the American Academy of Pediatrics (AAP) issued new guidelines calling on doctors to be more proactive and treat obesity in children at earlier ages and more aggressively. The main recommendation is intensive behavioral and lifestyle therapy, which includes nutrition and exercise counseling and other behavioral changes like role modeling by parents. However, these programs are time-consuming, usually requiring about 26 sessions, and there aren't many programs like this, certainly not in underresourced communities where they're needed the most. Obesity is more prevalent among Native American, Black, and Hispanic children compared to White and Asian children. (American Indian Native Alaskan (31.2%), non-Hispanic Black (20.8%), Hispanic (22.0%), White (15.9%), Asian (12.8%)
That's why a study Epstein authored, which appears in this week's Journal of the American Medical Association, is important. The study shows that family-based behavioral interventions to treat childhood obesity delivered in a pediatrician's office can work. Epstein and colleagues studied 452 6- to-12-year-olds, their parents, and siblings. The kids underwent treatment with a parent. The pairs were randomly assigned to either the family-based treatment or usual care. The kids and parents in the treatment group got 26 sessions over two years in which they learned healthy eating, physical activity, and parenting behaviors.
The researchers found that after two years, the children in the family-based treatment program lost more weight and were more successful at keeping it off. Their parent and siblings also had better outcomes. Still, the main finding, a 6.27% reduction in percentage above the median BMI after two years, was less than the 9.2% reduction threshold used for other trials not conducted in specialty clinics.
The authors of an accompanying editorial point out that while Epstein's ideas aren't quite ready for real-world pediatric offices, they're an essential step toward making behavioral obesity treatments for children more widely available. In addition to behavioral therapy, the AAP says doctors should offer weight loss drugs and bariatric surgery to teenagers 12 and older who are medically obese. This recommendation helps improve insurance coverage of these treatments for children. However, while the new weight-loss drugs, originally meant to treat diabetes, are highly effective in adults, the AAP's recommendation has been controversial. Parents worry about cost, a lack of long-term safety data, and that their kids could need to take the medicines for the rest of their lives. Complications that can happen after bariatric surgery are also worrying, and teens would still need extensive dietary and lifestyle counseling. Parents weigh these treatment fears against the possibility of their children developing obesity-related health problems later in life.
Clearly, there are no easy answers. Obesity is also a complex problem involving genetics, behavior, and other social determinants of health factors, including a person's ability to obtain healthy foods or have a safe place to exercise. So, in addition to behavioral specialists, doctors, and pharmaceutical industry researchers working together, solutions may also require community-led strategies.
~ Vicky Que - VP Content Strategy SHR