Severe Obesity in 5% of US Kids; Should Be New Risk Class

September 09, 2013

Around 5% of children and adolescents in the US are severely obese and therefore at high risk for developing type 2 diabetes and premature heart disease, says the American Heart Association (AHA) in a new scientific statement, also endorsed by the Obesity Society.

While childhood obesity rates are starting to level off, severe obesity has increased, say Aaron S. Kelly, PhD, from the University of Minnesota Medical School, Minneapolis, and colleagues in the statement, published online September 9 in Circulation.

They therefore propose that "severe obesity" among kids and teens be a newly defined class of risk and stress the grave consequences of this condition. "Accumulating evidence suggests that severe obesity in childhood is associated with an adverse cardiovascular and metabolic profile, even compared with obesity and overweight," they note.

The definition of severe obesity in children over the age of 2 years is a body mass index (BMI) that's at least 20% higher than the 95 percentile for the child's gender and age or an absolute BMI score of 35 or higher.

Treatment Options Limited, Greater Awareness Needed

Dr. Kelly and colleagues note that treatment options for children with this level of obesity are limited, as most standard approaches to weight loss are insufficient for them.

For example, lifestyle-modification/behavior-based interventions in youth with severe obesity have demonstrated modest improvement in BMI, but participants have generally remained severely obese and often regained weight after the conclusion of the treatment programs, they observe.

And the role of medical management is minimal, because only 1 medication is currently approved for the treatment of obesity in adolescents.

Also, while bariatric surgery has generally been effective in reducing BMI and improving cardiovascular and metabolic risk factors, reports of long-term outcomes are few, many youths with severe obesity do not qualify for surgery, and access is limited by lack of insurance coverage.

Hence, the AHA is calling for greater awareness of this condition as a chronic disease requiring ongoing care and management. And future research aimed at closing the gap between lifestyle, medication, and surgery is vital, the authors add.

"Innovative behavior-based treatment, minimally invasive procedures, and medications currently under development all need to be evaluated for their efficacy and safety in this group of patients with high medical and psychosocial risks," they conclude.

Dr. Kelly reports receiving research grants and support from Amylin Pharmaceuticals, National Institutes of Health/ National Institute of Neurological Disorders and Stroke and the Thrasher Research Fund and being on the advisory board of Novo Nordisk. Disclosures for the coauthors are listed in the article.

Circulation. Published online September 9, 2013. Abstract

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