Child and adolescent obesity: AMA recommendations–but is more needed?

by James Hubbard, M.D., M.P.H.

The name of the report is the American Medical Association “Expert Committee Recommendations on the Assessment, Prevention, and Treatment of Child and Adolescent Obesity.” Do you want fries with that? If ever an acronym was needed …

It has good ideas, but the question is: How do we get people to put them into practice? I have a feeling answers are in the works.


Everybody’s Talking About It

All endorse the AMA recommendations.


Treatment Stages

As a preface, you need to know that the BMI chart for adults does not work for kids. There is too much variation at different ages and between sexes. The CDC has good explanations and charts but they have decided that “obesity” is politically incorrect in children so those in the 86th to 95th percentile are “at risk of overweight”; those over the 95th percentile are “overweight”

The AMA report (PDF download) is good and I encourage you to read it if you have children. It doesn’t take long. They have prevention recommendations for those at healthy weight and give “stages” of treatment recommendations for at-risk or overweight children. Treatment starts at stage 1. If that does not work, go to stage 2, etc. Each progressive stage has more structured recommendations than the last.


Prevention Recommendations

The prevention recommendations are for those at healthy weight. They’re more general and include:

  • limiting sugar-sweetened drinks
  • encouraging recommended amounts of fruits and vegetables
  • limiting television to one or two hours starting as young as 5 years old.
  • removing TVs and computers from bedrooms
  • eating breakfast daily
  • limiting eating out (especially fast food)
  • encouraging meals in which parents and children eat together
  • limiting portion size
They also recommend advocating for the government to increase physical activity in school and for supporting efforts to make communities more activity-friendly (such as preserving and enhancing parks, and including walking and bicycling paths).
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But What Now?

The report should be a good aid for motivated parents and children. I especially think schools should make physical activity a priority, and have only healthy food in the lunchroom and snack areas while teaching the basics of nutrition.

But how do we motivate the vast unmotivated? Most family physicians and pediatricians are way too overworked to be able diagnose, treat, motivate, educate and follow up with the obese kids. Besides, unless there’s a concrete disease–other than “obesity”–for a diagnosis, insurance won’t pay, calling it preventive medicine, and families can’t afford it. We can’t afford some massive new government program.

With all this news about the “crisis,” I wonder if the powers-that-be have something up their sleeve. I have a suggestion or two myself.

If insurance companies consider reimbursing weight-loss visits could they see savings down the road from better health? I think so. Some have suggested that better health means longer lives, which leads to more health-care expense. But what if the longer lives are healthier? If it does become feasible, some physicians could work with registered dietitians on-staff or freelance to educate, follow up and have group support sessions.

In most, ideal weight won’t come without an active lifestyle (see AMA recommendations).

In order to change our lifestyle, our way of thinking will have to change also, just as it has with tobacco. In fact, I’ll bet “big brother” is working on it as I write.

We know the problem. Now we need a solution. Does anyone have any suggestions? If not, why don’t we sit and enjoy a delicious ice-cream sundae?

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13 Responses to “Child and adolescent obesity: AMA recommendations–but is more needed?”

  1. DR Says:

    How about creating a tax deduction for people that actually exercise to keep fit. You would need a tracking mechanism for proof that you are actually exercising.

    How about this:

    To be eligible for the tax break, you have to register with a fitness club or running club or sports club, etc..

    When you participate in exercise, you have to sign in with your club (swipe card, sign in sheet, whatever)

    At the end of the year, if you have worked out X amount of times, you get the full tax deduction.

    Or, we could start installing adult sized playgrounds/fitness equipment in public parks.

    It’s already being done – http://healthhabits.wordpress.com/2008/04/15/fitness-alfresco/

    I prefer these “carrot” approaches to any punitive “stick” approaches that the gov’t is probably thinking off. i.e more taxes

    DRs last blog post..I Smoke, I’m Fat…and it’s Your Problem!

  2. James Hubbard, M.D., M.P.H Says:

    Thanks DR, for the ideas.
    The adult exercise equipment is interesting. It could give parents something to do along with the kids. The tax break might work, also, except for the lower economic groups.

  3. lhubbard Says:

    Hi. I love the idea of doctors working with registered dietitians. Great idea. So many people don’t understand the basics. We cover nutrition in every issue, and it seems there’s a never-ending supply of story ideas.

    DR: Adult playgrounds? Brilliant! Why does exercise have to be a chore? If the adults play, the kids will, too. Thanks for the link to your blog post about it. Interesting.

    If I may say, I think knowledge goes a long way, too. In many magazines and Web sites, people get iffy information, fad studies and quickie diets/fitness routines. This isn’t a solution; it just makes for a frustrating yo-yo. Educate the parents, and the kids will follow.

    Leigh Ann Hubbard
    Managing Editor
    James Hubbard’s My Family Doctor

  4. Mark Salinas Says:

    “increase physical activity in school and for supporting efforts to make communities more activity-friendly (such as preserving and enhancing parks, and including walking and bicycling paths).”A great idea! How about offering incentives community wide to keep active. Should the insurance companies have an incentive, preventative based program? I think so. Great post!

    Mark Salinass last blog post..Physio Ball Exercises

  5. James Hubbard, M.D., M.P.H Says:

    I wonder if insurance companies are thinking along those terms. They should.
    Thanks Mark

  6. Maria Olsson-Tysor Says:

    There are so many things in the discussion on childhood obesity that scares and upsets me… One major issue I think is all the horrible “foods” that are marketed to our children (sugary cereal, packaged snack foods, and other stuff filled with food colorings, additives, perservatives, substitutes, etc.) – even foods what most people consider “healthy” like yogurt (look at the sugar content), “juice drinks” (with 5% juice, the rest ??)…
    Until your kids start school it’s relatively easy to avoid some of this stuff (try to lead by example, eat together, introduce REAL food, try shopping at farmers’ markets and health food stores and skip the fast food places all together). But, even at places like the pediatrician’s office I’ve had to say thanks, but no thanks to candy being offered to my kids (no, we haven’t introduced that yet… and intend to avoid it as long as possible).
    What happens when they start school and what do they serve there? (no, I don’t intend to only send carrot sticks with my kids).
    To really deal with this issue I completely agree with that more accurate information needs to go out and we parents need to be educated (and motivated). Hopefully all together we can change this unhealthy trend!
    Be well!

  7. James Hubbard, M.D., M.P.H Says:

    I sympathize with parents with young kids. There are so many temptations. I sympathize, but not worry, about concerned people like you, Maria, because you will do the right thing. You don’t have to be perfect, just educated, persistent and, sometimes, assertive.

    Thanks

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    [...] Christine McKinney Eat Right, Stay Well Natural and Organic: Not the Same MyFamilyDoctor Child and adolescent obesity workoutmommy-Avoid being tricked by food [...]

  9. Sherry Sanders Says:

    I am a student and parent who recently completed a research paper on this subject with regards to utilizing weight loss surgery as a treatment for childhood obesity. Studies across the US are now under way to discover the effocacy of performing Roux-en-Y Gastric Bypass and adjustable gastric panding on youth between 12 and 18 years of age. The biggest question is whether these surgeries to reduce weight will result in more issues due to the lack of nutrition and impact on childhood physical development during important phases of growth in adolescence.
    I grew up as an overweight child and never received the help or assistance I needed to lose weight although I was told many times to do it. When you are a young person, it is hard to know what to do and how to do it to be successful, and there was no where for me to turn for help. After struggling for years, I ended up having gastric bypass weight loss surgery to treat my obesity. It has been a huge life change for me, but what do you do about all of the children who are already very overweight and are experiencing adult-like comorbidities of obesity that will surely shorten their life satisfaction and expectancy?
    I do not know what the answer is, but we cannot just make all of these recommendations and not do anything to make them come to life. Just like there have been movements for cancer, AIDS and other diseases, it is going to take a big effort in fund raising to start programs, educate parents, children and professionals to work with these children and much more to make this change happen for the sake of all children.
    Here is the concluding paragraph of the paper I just completed:
    “Once current studies are completed and there is more evidence in their use with children and teenagers, wide spread use of weight loss surgery with youth can be reconsidered. With the continued investigation of new weight loss methods that are less invasive and more effective for both children and adults, there is hope that there will one day be a better solution for morbidly obese patients needing this type of treatment. And with societal change, there will be a concerted effort to prevent children from becoming overweight in the first place and surgical treatments will be needed less frequently if at all. Preventing children from becoming overweight through diet and exercise education and practice as well as personal support for eating disorders and mental health issues is the key to preventing obesity later in life.”
    Thank you,
    Sherry Sanders
    Denver, CO

  10. jhubbard Says:

    Excellent. You not only have the experiences, but the knowledge. I agree with you, and hope that the day will come when weight loss surgery is a needless rarity.

    Please keep up the good work as you could become a leader this struggle.

    Thanks for your thoughtful, intelligent insight.

    James Hubbard, M.D., M.P.H.
    Publisher, James Hubbard’s My Family Doctor

  11. Kelley Germanson Says:

    Eating disorders do correlate with mental health issues, very insightful

  12. jhubbard Says:

    Thanks Kelley. I agree.

    James Hubbard, M.D., M.P.H.
    Publisher, James Hubbard’s My Family Doctor

  13. Sherry Sanders Says:

    Thank you Dr Hubbard and Kelley for your comments. Children are dependent upon their adult caretakers to take care of them, and all adults need to take repsonsibility for that and take charge in making this happen. It seems like everyone wants to blame everyone else for this problem when we really should just focus on getting things moving in the right direction with finding ways to implement the recommendations and programs to provide the needed education and services.
    Anyway, I could go on and on but thank you for your support.
    Sherry

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