It’s a crippling, hereditary disease that afflicts 1 in 3 adolescents and teens in the U.S., exponentially outnumbering pediatric cancer cases. It’s the entry point for a range of related, potentially irreversible diseases that get worse over time, from depression to diabetes and kidney failure.
Yet when Dr. Claudia Fox, a pediatrician and specialist in the aliment, says she can help treat the disease — childhood obesity — with medication, people are stunned.
“Most people when they hear this are kind of confused. The most common reaction I get is, ‘Are you kidding me?'” They’re alarmed, she said, that a doctor would prescribe weight-control pills for a child, let alone an obese one, and aren’t shy about telling her what they think..
“They say, ‘Why do we even need medication for obesity? Wouldn’t it be better if the kid learned to stop eating Doritos, get off the couch and play?'” said Fox, who was part of a panel addressing childhood obesity at the U.S. News & World Report Healthcare of Tomorrow conference in Washington on Tuesday. “I wish it were that simple.”
Declared an epidemic in the U.S., epidemic, childhood obesity has become so prevalent and is spreading so quickly overseas the World Health Organization considers it among “the most serious public health challenges of the 21st century.”
Speaking at a breakout session on the topic (“A Population Health Imperative: Tackling Childhood Obesity”), Fox and the panelists of pediatricians who specialize in obesity — Dr. Evan Nadler, Dr. Fatima Cody Stanford, Dr. Ihuoma Eneli and moderator Dr. Sarah E. Barlow — agreed that obesity is prevalent in the U.S. and becoming more of a problem overseas. Yet as an illness, they concluded, it’s largely misunderstood and widely stigmatized, which only increases the problem.
Nadler, director of the Child and Adolescent Weight Loss Surgery Program at Children’s National Health System, called childhood obesity “the biggest problem in pediatric health care in America,” yet there isn’t a national drive or much urgency to solve it, even within the health care system.
“What can be more compelling than trying to tackle the most prevalent disease in children and the most expensive disease in children?” he asked. “It’s embarrassing, frankly, that our health care system hasn’t taken a more active interest.”
Kicking off the panel, Barlow, who is the director of the Children’s Health Integrated Program in Childhood Obesity at UT Southwestern Medical Center in Austin, laid out the sobering facts: Obesity in the U.S. ranges between 13% for adolescents up to just over 20% in teenagers 17 to 19 years old. Juvenile obesity hits hardest among African Americans (22%) and Latinos (25%) and the number of young people with a body mass index of 30 or higher has skyrocketed since the 1980s.
And the nation is paying a hidden price, she said, including $142 billion in medical costs and $66 billion in lost workplace productivity. Moreover, she said, obesity doesn’t go away with age: 1 of 3 young adults can’t serve in the U.S. military because they weigh too much.
“It’s not new,” she says. “We’ve been facing this problem for the last 15 to 20 years.”
Stanford, a pediatrics professor at Harvard University and an obesity medicine physician scientist, said the problem has gone unchecked largely because of stigma associated with obesity. Contrary to what many assume — that children would lose weight if they ate properly and exercised — obesity is a “multifactorial” disease that involves genetic and environmental factors, including childhood trauma and psychological issues.
“What we do know is weight is more heritable than height,” she said. “The likelihood that parents with obesity will have a child who is lean is very low. That’s important for us to recognize. We don’t think about heritability when we think about treatment.”
Fox said it’s one reason why lay people are taken aback when she tells them medications can help control childhood obesity. While drugs alone aren’t the answer — some children need more drastic interventions, including combinations of bariatric surgery, psychological counseling and lifestyle changes — they could be an important tool in combating the issue, she said.
Yet there are aren’t many government-approved weight-loss drugs on the market for young patients, and drug companies aren’t competing to create new ones, says Fox, who teaches pediatric medicine at the University of Minnesota and is co-director of the university’s Center for Pediatric Obesity Medicine.
That “is a sad commentary,” she said. “If this were childhood cancer, parents and practitioners and the entire community would be up in arms.”
Nadler and Eneli, a pediatrics professor at Ohio State University and director of the Center for Healthy Weight and Nutrition at Nationwide Children’s Hospital, agreed that multi-faceted approaches are needed to tackle the disease. But both also said there are significant barriers to treatment, including medical insurers and longstanding stigma surrounding obesity and children.
Nadler said the prejudice and judgment against obese children even lives within the hospital walls; he’s overheard surgical colleagues bad-mouthing the concept of gastric-bypass surgery for pre-teens. The doctor also noted that only a handful of U.S. pediatric hospitals offer the procedure, and institutional support for it is hard to find.
Eneli said obesity “happens to be the last condition where people think it’s still OK to make fat jokes,” even among people whose loved ones have the disease. . Indeed, she said, “the worst kind of bias and stigma is what happens in the home, not at school.”
Then she suggested a PR campaign similar to those that raise awareness of breast cancer and support for research.
“Obesity needs a ribbon,” she said.