A diverse group of young children running in the grass
A diverse group of young children running in the grass
A diverse group of young children running in the grass

Childhood and Teenage Obesity: Partnering with Your Pediatrician

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You want the best for your child, including a healthy body and strong self-esteem. If you think your child might be overweight, it’s important to talk with your pediatrician.

Sheila Ravendhran, a pediatrician with Johns Hopkins Community Physicians, has special certification in addressing obesity. Ravendhran regards parents as partners working with her to support their child’s well-being.

She helps parents understand the implications of weight, noting, “The doctor and the parents need to be united in wanting what’s best for kids.”

Obesity — a Real Health Risk for Children and Teens

In the United States, close to 20% of children ages 2 to 19 are living with obesity, including nearly 13% of children under age 6. Obesity is more common in certain populations, including Hispanic and Black children, children from middle income families and those growing up in homes headed by adults with lower education levels.

Health care professionals are seeing earlier onset of type 2 diabetesheart and blood vessel disease, and obesity-related depression and social isolation among children and teens. The longer a person suffers with obesity, the more significant obesity-related risk factors become.

What is childhood obesity?

How easy is it to diagnose the condition in children? “Actually, it’s really hard,” Ravendhran says. “Studies show that parents, physicians and nurses have trouble looking at a child and predicting their body mass index.”

Body mass index (BMI) is a number based on the ratio between a person’s weight and height. For adults, a BMI above 25 means the person is overweight.

But, Ravendhran says, BMI doesn’t necessarily define obesity in children the same way it does in adults. Looking beyond the number, she says if a child’s BMI is higher than 95% of other kids who are the same age and sex, that gets her attention.

“There are lots of different ways to define and diagnose obesity, and what works for adults may not be applicable to kids, since their body composition changes,” Ravendhran says.

“For instance, measuring fat on the upper arm doesn’t work for very young children babies and toddlers are supposed to be fat. On the other hand, I’ve learned that it is pretty normal to be able to see ribs on kids aged around 4 to around 7. If a parent is noticing an expanding waist circumference or creases or rolls in the belly, chest or back in a child over 4, then I’d be concerned.

“I counsel parents the same way, no matter where the kids are on the chart. I look at the current diet, genetics and other factors. If a child’s numbers show they’re at risk, I make it clear to the parents that there’s not anything wrong with the child, but we might discuss some interventions to head off health issues later on.”

Treatment for Kids Who Are Overweight: What can parents expect?

If your child’s BMI meets the criterion for obesity, does the child need treatment? Not necessarily, Ravendhran says. She explains there are reasons to proceed cautiously when helping children and teens lose weight.

And underlying mental health issues can spark an eating disorder in vulnerable kids. “Sometimes it’s a slippery slope,” Ravendhran says. There isn’t much evidence-based data on teenage weight loss regimens, since people under age 18 are not allowed in most studies.

“Treatment goals are different for kids at different ages,” she says. “For instance, for younger kids, the goal is weight maintenance, not loss, since they’re getting taller.” Rapid weight loss can cause changes in metabolism, with an impact on a child’s growth and learning ability.

Nutrition and Exercise

Ravendhran says treating obesity in children and teens starts with addressing nutrition and exercise. For teenagers, she may prescribe a gradual weight-loss regimen aiming for loss of about two pounds per month.

If, despite those measures, obesity becomes worse or the child develops weight-related health problems, the doctor may recommend intensified therapy. “A comprehensive team approach may expand to include mental health support and other subspecialists as indicated,” Ravendhran says.

“Once age, BMI and the presence of multiple chronic conditions increase,” she says, “the options for treatment begin to include medications and bariatric surgery.”

Obesity Medications for Children and Teens

Ravendhran notes that new medications have shown promise in trials with adolescents. Ask your child’s doctor about the best treatment options.

Bariatric Surgery for Children and Teens

Bariatric surgery is a weight loss procedure that changes the digestive system’s structure by, for example, making the stomach smaller.

“If a teen has a BMI that’s greater than the 95th percentile and is living with health problems such as asthma, type 2 diabetes or cardiac findings, we are more likely to refer earlier for bariatric surgery,” Ravendhran says. “Teens can have very good outcomes in terms of metabolism after these procedures, particularly sleeve gastrectomy.” 

How can parents support their kids’ healthy weight?

“It’s hard for parents to know what to do when there’s so much disinformation out there,” Ravendhran says. “Snacks and foods marketed for kids are high in refined and processed carbohydrates and sugar, which, over time, can take a toll on the body’s sensitivity to insulin. These foods act on the brain’s pleasure centers while suppressing the sensation of fullness.”

Ravendhran says well-child checks should be performed as often as the pediatrician recommends. During these visits, parents can ask about their child’s health and nutrition.

Kids, Screen Time and Exercise

Staying active is key to maintaining a healthy weight, and the sedentary time that kids spend on computers, tablets and phones should be limited.

Ravendhran recommends the following screen time and use according to age groups:

  • Under age 18 months: Avoid screen use except to see greet close family members who are away from home.
  • 18 months to 23 months: Children may interact with educational content with parents and guardians at their side. The emphasis should be on learning, not the screen.
  • 2 to 5 years: Anything noneducational should be limited to an hour per day on weekdays and three hours or less on weekends.
  • 6 years and older: Most of older kids’ time should be spent learning, socializing, playing sports and having fun with friends in real life. Parents and guardians should can set online time limits based on the child’s health and activity level.

Regarding exercise, Ravendhran says mild to moderate activity is essential for all children, regardless of weight. Children diagnosed with obesity can and should exercise, she adds, but for vigorous activities, she advises obtaining physician clearance first to help ensure their safety.

“At least an hour a day is recommended,” she says regarding exercise, “and obese children may actually need more. It takes 40 minutes of fast walking for a child to burn off the calories in one juice box.” 

One Simple Step for Tackling Obesity

Speaking of juice boxes, according to Ravendhran, one simple and effective measure in helping kids control their weight is to cut out sugary drinks. Sodas, power drinks and smoothies are very high in sugar, which can add hundreds of calories to a child’s daily intake.

Fruit juice is also a no-no. “Parents look surprised when I say ‘no juice,’ but a glass of orange juice, store-bought or fresh squeezed, has the sugar of six to eight oranges,” Ravendhran says. “The processed kind may not have any fiber.” She recommends kids eat a piece of whole fruit instead.

“In the past 10 years, we’ve seen a decline in obesity among young kids,” Ravendhran notes. “Limiting sugar-sweetened beverages, taking the vending machines out of schools and not promoting fruit juice is having an impact.”

Supporting Kids’ Mental Health When Discussing Obesity

Ravendhran says she’s careful with language and encourages parents to watch their words as well.

“According to research, kids living with the stigma of being ‘overweight’ or ‘obese’ have a quality of life score that’s equivalent to that of kids living with cancer,” she notes.

Mental health is an important part of the treatment plan for obesity. She works with parents to promote children’s relaxation and stress reduction, which she says has a positive effect on well-being and a physiological benefit to their insulin levels. “Positive self-care and feeling good are great interventions for children’s general health and weight control,” Ravendhran says.

With that in mind, she notes that yoga is a good option for children since it combines healthy exercise while addressing stress.

“I’m looking at yoga and mindfulness training to break down some of the barriers that keep kids from being physically active,” she says. “I like yoga because it’s not competitive. There’s no judging or expectation.

“It’s about what feels good in the moment and being thankful for the body you have.”

Addressing Obesity Long Term for Healthier Lives

Ravendhran notes that obesity is a chronic condition that requires lifelong active management for conditions such as diabetes or asthma.

“That does not mean that people will have to be on medications lifelong,” Ravendhran says,“ but parents and caregivers should remember that there will be the potential for triggers as children mature that could result in them experiencing a relapse.”

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