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Tackling Childhood Obesity

Date: 01/16/2014

One Fall night two overweight, yet highly energetic, 8-year-olds, Imani and Kyra, bounded into the lobby of the Mt. Washington Pediatric Hospital in Baltimore. The girls had reason to be excited: it was graduation night.

Their moms, only slightly less enthusiastic, followed behind, and chatted while waiting for an elevator up to the third floor. But Imani wouldn’t have that. “This is Weigh Smart,” she scolded, hands on hips. “We take the stairs!”

The two girls have taken some significant steps against America’s fastest growing epidemic—childhood obesity. In 1965, according to data from the Centers for Disease Control and Prevention (CDC), 4.2 percent of American kids ages 6 to 11 were overweight. In 2004, the number had more than quadrupled—to 18.8 percent.

And if the problem persists, it’s certainly not for lack of awareness. For more than a decade, pediatricians and policymakers have debated how to treat children who are already overweight, and how to prevent bad eating habits from taking root in the next generation. Some blame America’s videogame culture, the alarming growth of fast food, the ubiquity of soda and snack food machines in schools.

Johns Hopkins pediatric gastroenterologist and weight expert Ann Scheimann, says obesity and overweight are nearly always multi-factorial problems. But, she adds, the greatest drivers are lifestyle habits that begin at birth.

“The key to healthy eating is getting a buy-in by every single member of the family,” Scheimann says. “And it has to be incorporated in a stepwise fashion, or else you’ll get right back on the same old bandwagon.”

This whole-family concept is at the heart of the Weigh Smart® program launched by Scheimann—a “no-fault,” family-based group therapy approach to healthy living. During two-hour evening sessions over 10 weeks, small groups of overweight children and their families first meet with a nutritionist to talk about what they eat—and how much—and learn how to choose healthier foods and smaller portions. The therapy session is always paired with 60 minutes of group exercise in the hospital’s gym. Now after two years, hundreds of children have completed the program—and it’s working. Weigh Smart kids like Imani have shredded away pounds, including body fat, and kept the weight off over time.

“I’m here because I’m a healthy girl, but I weigh a lot,” Imani says. “I want to make better choices.”
What’s Fueling the Weight Woes?

Of those who enter Weigh Smart, the average participant is 12 years old, 5’3”, and 200 pounds. Most are well above the 95th percentile of BMI for their age. They spend an average of five hours a day in front of a computer or television screen, have terrible eating habits and get a significant portion of their caloric intake from soda or sugar-rich juice. And as they’re eating more unhealthy food, schoolchildren are getting progressively less physically active. Social and school habits aside, kids inherit both genes and eating habits from their parents, Scheimann says.

Because parents are buying and preparing the food the Weigh Smart program emphasizes behavioral modification for the whole family. Imani’s mother remembers being an overweight child.

“I struggled with weight my whole life, and so did my husband,” she says. Two years ago, both parents opted for gastric bypass surgery. “And suddenly we lost all of this weight,” she says. “But at the same time, Imani was gaining.”

When the family's pediatrician recommended Weigh Smart, they agreed to try it. “I hope she can look back on her childhood,” Imani's mom says, “and say that my mother helped me feel better about how I eat.”

Perhaps most alarming is that childhood obesity brings with it a host of chronic health problems, from the relatively benign social isolation and acid reflux to the more ominous fatty liver disease, hypertension and type 2 diabetes. Though obesity-related health problems have been recognized in adults for years, physicians have only recently started paying attention to obesity-fueled pathologies in children.

The most universal, and perhaps most overlooked, health issue is the psychological stigma of being overweight. “There aren’t cool clothes that you can wear,” Scheimann says, “and people will say things.” The social stigma feeds a vicious cycle of lowered self-esteem that makes its victims all the more likely to overeat.

As for severe medical complications, Scheimann was among the first researchers to study the frightening prevalence of nonalcoholic fatty liver disease (NAFLD) in children – 9.6 percent in all children and adolescents ages 2 to 19 years, and 38 percent in obese children (Pediatrics, October 2006). Also, NAFLD is an insidious disease with few, if any, early sypmtoms, detectable only through blood tests or ultrasound.

NAFLD is highly reversible through diet and exercise, but left untreated the health consequences can be grim. Between 5 percent and 10 percent of patients, will progress to NAFLD hepatitis, scarring and, sometimes, full-blown cirrhosis and liver failure. Scheimann is currently working with researchers from five other pediatric hospitals conducting an NIH-funded clinical trial to elucidate the course of the disease and best treatments.