Obesity affects more than 14 million children in the US. Typically, in adults, obesity is expressed by body mass index (BMI), however in children, percentiles are used along with their age, height and gender to be classified as overweight or obese. If you’re concerned that your child may be overweight or obese, charts with percentiles are available to the public free of charge on the American Academy of Pediatrics’ (AAP) website. The current recommendation is to start annual screening for obesity beginning at two years old.
Is my child obese or simply “big boned”?
The terms “big boned” and obese describe different concepts in relation to a child’s body make up. “Big boned,” in layman’s term, suggests a larger skeletal frame, however, this term isn’t medically recognized and is often used to downplay a child’s weight. It is true, however, that obese children do have greater bone density and larger bone size, compared to children of healthy weight, however their bone mass isn’t enough to support the excess weight without putting the patient at risk of orthopedic issues, amongst other complications. Obesity in children universally is defined as a BMI greater than the 95th percentile for the child’s gender and age.
Once a child is diagnosed with obesity, what needs to be done next?
Your child’s physician must perform a complete history and physical exam including measuring blood pressure at every visit starting at three years of age. It is essential to evaluate for associated conditions such as elevated cholesterol, hypertension, diabetes, depression, sleep apnea, and asthma. Diabetes can be evaluated through blood tests and the recommendation is to start screening obese children for elevated cholesterol at the age of 10. About one half of obese children have sleep apnea. Common symptoms parents should watch for include snoring, gasping during sleep, daytime sleepiness, learning issues in school, bedwetting, and headaches. If you notice these symptoms in your child, it’s important to alert their doctor so testing can be performed.
What initial changes can be made?
To address childhood obesity, it is important to involve a diverse team of individuals including pediatricians, dieticians, psychologists, nurses, exercise specialists, and school officials to improve the chance of the child reaching their healthy weight. On average, at least 3 to 12 months of a trial of lifestyle changes, including improved diet and more physical activity, should be attempted, after which approved weight loss medications and, in severe cases, bariatric surgery may be incorporated for children of a certain age and weight.
Can medications or surgeries be done if diet and exercise aren’t successful?
Children between the ages of 8-11 can be offered medication for weight loss in addition to continuing lifestyle and behavioral changes. There are medications available as pills your child can take every day, or shots you can give your child once a week for weight loss. Each of these medications have certain side effects so it’s important that you discuss with your child’s physician the risk, benefits, and alternatives, and the specific medications that are approved for their age. Weight loss surgery is safe and effective for pediatric patients who have class 2 or class 3 obesity which are weights that correlate to a BMI of 35 or 40 respectively.
Dr. Jordan Greenway is a third-year Family Medicine Resident at UNC Health Southeastern. In addition to offering services you’d expect from a community health care system, UNC Health Southeastern provides a number of specialized services that are unique to our healthcare system and not available anywhere else in the region. To schedule an appointment, call our referral line at (910) 735-8864. To learn more, visit UNCHealthSE.org. To submit questions for consideration for a Frequently Asked Questions article, email [email protected].
