Lisa Kohler, MD - AkronCantonMDNews

Recommendations to Combat Childhood and Adolescent Obesity
This past summer, recommendations for the management of
overweight and obese children were released by the Expert Committee
on the Assessment, Prevention and Treatment of Child and Adolescent
Overweight and Obesity. The writing committee was comprised of
representatives from 15 health professional organizations, including:
• American Academy of Child and Adolescent Psychiatry
• American Academy of Pediatrics
• American Association of Family Physicians
• American College of Preventive Medicine
• American College of Sports Medicine
• American Dietetic Association
• American Pediatric Surgical Association
• American Psychological Association
• Association of American Indian Physicians
• The Endocrine Society
• National Association of Pediatric Nurse Practitioners
• National Association of School Nurses
• National Hispanic Medical Association
• National Medical Association
• The Obesity Society
“Childhood obesity is a major public health problem,” said Cecil B.
Wilson, M.D., board chairman of the American Medical Association.
“Overweight children tend to have health problems more commonly
found in adults, like diabetes, high cholesterol and high blood pressure.”
In early 2005, the expert committee began meeting to review
scientific data regarding the assessment, prevention and treatment of
children who are overweight and obese. The 22 recommendations they
agreed upon are designed to help health care professionals provide
obesity care to the children in their practices.
The following are some of the committee’s recommendations for the
assessment of children who are overweight or obese:
1. Yearly assessment of weight status in all children, to include height,
weight and body mass index (BMI) measurements for age. The
measures should then be plotted on standard growth charts.
2. Classification of children into two groups:
• Obese: Children aged 2-18 years, with a BMI greater than or equal
to the 95th percentile for age and sex and those with a BMI over 30
• Overweight: children with a BMI equal to or greater than the 85th
percentile, but less than the 95th percentile for age and sex
3. Skin-fold thickness assessment for obesity is no longer recommended
4. Waist circumference measurements are not recommended
5. Qualitative assessments of dietary patterns in all pediatric patients
at each visit, including assessment of dietary practices outside
the home (at restaurants or fast-food establishments, excessive
consumption of sweetened beverages, excessive portion sizes)
6. Assessment of child’s level of physical activity and sedentary activity
7. A focused family history for obesity, type 2 diabetes, cardiovascular
disease and early death due to heart disease or stroke
8. A thorough physical examination
In children who are classified as overweight or obese, the guidelines
recommend laboratory testing to include fasting lipid profiles (85th
to 94th percentile with no risk factors), aspartate aminotransferase
(AST) and alanine aminotransferase (ALT), fasting glucose (85th to
94th percentile with risk factors in history or upon physical exam), and
all of these test plus blood urea nitrogen (BUN) and creatinine (greater
than the 95th percentile).
“Our committee worked diligently to identify new treatment and
prevention options to address the growing problem of overweight and
obese children,” said Reginald Washington, M.D., spokesperson for the
Expert committee. “We hope that health care professionals will apply
these recommendations to their practice, so we can continue working to
preserve the health of our children.”
the ASMBS. Yet of the approximately 15 million Americans who are
morbidly obese, only 1% of those who are clinically eligible are treated
with bariatric surgery.
These procedures, which include gastric bypass surgery, vertical-banded
gastroplasty and gastric banding, are recommended by
physicians for patients with a body mass index (BMI) of 40 or greater,
or for those patients who have a BMI of 35 or more who have serious,
obesity-related medical conditions including type 2 diabetes or severe
sleep apnea.
Much research has been directed at assessing the factors, outcomes
and efficacy of bariatric surgery in obese patients. For example, the
entire October issue of the Archives of Surgery was dedicated to bariatric
surgery.
Researchers of one of the studies in that issue found that a loss of 5%
to 10% of excess body weight before gastric bypass surgery in highrisk,
morbidly obese patients may make for a shorter hospital stay and
quicker postoperative weight loss.
For this study, researchers at the Geisinger Health System in Danville,
PA, studied 884 patients (average age: 45 years) who underwent open
or laparoscopic gastric bypass surgery from 2002 to 2006. 2
In all, 19% of these patients lost 5% to 10% of their excess body
weight prior to the procedure, and 48% lost 10% or more. Patients
who lost more than 5% were less likely to stay in the hospital for more
than four days. Patient who lost more than 10% of their excess weight
before the surgery were twice as likely to have lost 70% of their excess
weight one year after the procedure, compared with those who lost no
weight or only 5% of their excess weight preoperatively.
Researchers of yet another study in the same issue of the Archives
of Surgery found that obese patients on Medicaid who had Roux-en-Y
gastric bypass surgery may return to work earlier than obese patients
on Medicaid who do not undergo this procedure. 3
For this study, conducted by researchers at the Virginia Mason
Medical Center in Seattle, WA, 38 medically disabled patients who
receive Medicaid and underwent Roux-en-Y gastric bypass (average
age: 48 years; average BMI: 58) were compared with 16 Medicaid
patients (average age: 51 years; average BMI: 54) who did not have
the procedure.
“The patients who underwent Roux-en-Y gastric bypass were more
likely to return to work, with 14 (37%) working, compared with 1
(6%) of the nonoperative control patients,” the authors wrote. “Return
to work was more likely in patients who had resolution of comorbid
conditions [co-occurring illnesses] after surgery.” Those who returned
to work no longer required Medicaid funding.
“Surgical treatment of morbid obesity has a profound effect on patients’
quality of life, as evidenced by the sustained long-term weight
loss, reversal of comorbidities, improved rating of quality of life and the
patients’ ability to return to the workforce,” they concluded. ■
References:
1. Bardia A, Holtan SG, Slezak JM, Thompson WG. “Diagnosis of Obesity by
Primary Care Physicians and Impact on Obesity Management.” Mayo Clin Proc 2007
Aug;82(8):927-32
2. Still CD, Benotti P, Wood GC, Gerhard GS, Petrick A, Reed M, Strodel W.
“Outcomes of Preoperative Weight Loss in High-Risk Patients Undergoing Gastric
Bypass Surgery.” Arch Surg 2007 Oct;142(10):994-8
3. Wagner AJ, Fabry JM Jr, Thirlby RC. “Return to Work after Gastric Bypass in
Medicaid-Funded Morbidly Obese Patients.” Arch Surg 2007 Oct;142(10):935-40
1 8 | GREATER AKRON/CANTON M.D. NEWS JANUARY-FEBRUARY 2008