The Fight Against The Fat
Whilst observing a clinic the other day, my consultant saw a severely obese teenage girl. Her weight was rocketing way beyond the 99.6th centile and continuing to climb steeply. It was obvious that things were out of control! After a long drawn out discussion about the issue, the reluctant patient eventually agreed to think about how she could increase her activity level. However neither her nor her mother seemed enthusiastic about the task and we all left the consultation feeling a little bit depressed. I naively asked the consultant what services were available for obese teenagers in the area and was shocked to hear that the answer was ‘none’. The previous service ‘MEND’ had been withdrawn due to funding issues and there was a distinct lack of enthusiasm for leading the way in establishing new services.
Latest figures suggest that a 3rd of children in the UK are overweight or obese and the World Health Organisation has recognised it as one of the most serious global public health issues of the 21st century. At the beginning of my paediatric training I remember a local teenager hitting national news as she was crane lifted out of her house for medical treatment dubbed “the fattest teenager in the UK”. Surely paediatric obesity is an area that we can no longer ignore…
So how do we define obesity? In adults, we define it simply as a body mass index (BMI*) value over 30. In children due to their variation in body composition as they age, we need to plot their BMI on a sex and
age specific centile chart. Obesity is therefore defined as a BMI over the 98th centile with between the 91st and 98th centile classified as overweight.
So why does it matter? In the short-term, obese children are recognised as being more likely to be ill, or absent from school due to illness. They experience more health-related limitations and require more medical care than children of normal weight. It seems logical that obese children are more at risk as conditions such as type II diabetes and hypertension. However I was surprised to find that overweight or obese children are also at a 40-50% higher risk of asthma than their counterparts. Obese children also become obese adults with overall higher risks of morbidity, disability and premature death.
I recently became aware of the OSCA consensus guidelines for the investigation of childhood obesity which can be found on the RCPCH website. Essentially they advise that unless there are specific features on examination suggestive of a genetic cause of obesity or other endocrinopathy (e.g. cushingnoid features or short stature), the only diagnostic test required is a thyroid function test. At the end of the day, the cause is almost always a calorie imbalance.
Current day food products are often high in sugar and families may be unaware of the sugar content of products such as ‘Coca Cola’. A little education on the subject can go a long way. Last year I attended a lecture by Professor Russell Viner on the topic in which he explained that even the smallest imbalance in calories, caused by an extra spreading of butter on your toast can cause a substantial increase in weight over several years and that patients may genuinely not be stuffing their face all the time and downing coca-cola as I had previously suspected. Conversely to this, small changes in daily activity and diet can therefore help in the management of obesity.
As well as helping obese children to set achievable daily goals, our focus should be on the management of the associated co-morbidities. The OSCA consensus provides detailed guidance on early detection and management of these conditions and makes essential reading for all budding paediatricians. After all obesity is not going away any time soon….