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Ep. 22 – The New Childhood Obesity Guidelines

The American Association of Pediatrics has new guidelines for treating childhood obesity. Today Dr. Chet Zelasko looks at what the guidelines really say on this episode of Straight Talk on Health

Welcome Straight Talk on Health, I’m your host, Dr. Chet Zelasko. Together with WGVU in Grand Rapids, Michigan. I examine the world of health research in news. Whether it's research that makes the news, another miracle diet, new food fad, or an exercise trend, I look at the science behind them and let you know whether it's real or not. You can check out other things that I do on my website, drchet.com, and sign up for my free emails.

If you have paid any attention to the health news at all in the last month or so, you know that the American Association of Pediatrics has issued new guidelines on how to treat childhood obesity. Now, depending on where you read or listen to how those guidelines were presented, all you may have heard is that kids over 12 can now get medications to help with weight loss and teens over 14 can have gastric bypass surgery. Now Let me be clear, those are too severe types of approaches to childhood obesity.

First, let's make sure we understand what's considered a child. Anyone from birth all the way up to the age of 18 falls into that category. And one thing that you should know from the beginning, I don't recommend that you do anything before 2 years of age. Along with what those headlines that you may have heard were, the experts weighed in, no pun intended. One was a pediatric, very well-known, pediatric physician who predicted that doctors would just pull out the prescription pad and not address the root cause of obesity. So that's a pretty bold statement. And again, this is one of the leading researchers in the country on obesity and specifically childhood obesity. Then, the psychological experts said that this is going to increase disordered eating, which means that also includes eating disorders, such as anorexia and bulimia. Why? Because distorted body image is prevalent in our society.

Let me be clear about something. I have written about anorexia and bulimia 30 years ago when I was a college professor and it was a big deal back then. So it hasn't gone away. But what has changed, the bullying that occurs on social media, especially for teenagers. So we now know the demographic group we’re looking at. Boys and girls who are up to 18 years of age. Now, once somebody achieves the age of 18, they are then considered an adult. Now, to some degree this story hit home for me because food was love in a Polish household like mine. I've been overweight since I was about 8 years old. It's been a lifelong struggle to get to a normal BMI, not there. But I'm nowhere near where I used to be. And, you know, even at my age of 71, it isn't a struggle because I understand the issue and using a step-wise approach, a very methodical approach. What has happened to me is that my weight over the years has come down in a very methodical way. But that's not our society, Is it folks? Our society is we want to get it done and we want to get it done now. We want the fastest. We want the quickest approach and don't tell me that it can't be done.

So let's go back to these childhood obesity guidelines. Is that all the things that we talked about? The surgery and the medications, is that all that was in the guidelines? Of course not. So let's separate it out and let me give you the background information. Pediatricians and primary care physician screening. Where the emphasis is on this approach to childhood obesity is that it should begin with the pediatrician and the primary care physician doing a better job of screening. Understand this, that the focus of the guidelines was to assess risk factors for degenerative diseases such as heart disease and diabetes in children who exceed the 85th percentile of the normal growth charts, not body mass index because body mass index doesn't apply to children that young. They've tried to create some like we have for adults, but it doesn't necessarily work as well. So, 85th percentile which indicates overweight and 95th percentile of the height and weight growth charts which indicates obesity.

The guidelines recommend, begin at about 2 years of age and continue through 18 years. Were there recommendations for the use of medications and bariatric surgery in children over 12 and 14 years old respectively? Yes, but they were referrals to specialists for evaluations, not a blank invitation to write prescriptions. My opinion is that what they want to do is not only treat the obesity, but really focus on excess body weight when children are even much younger. Remember, it starts at 2 and certainly kids grow in different patterns.

My grandson, Riley, he's 7 years old. He is just past 48 inches tall and he’s just approaching 50 pounds. He is lean and sometimes mean fighting machine. He loves basketball. Point guard. Brings the ball up. Excellent dribbler, But would he be considered underweight? Well, he just makes it into a normal range for his age. But there you know what? There are many kids that exceed those height and weight growth charts. And so what they want to do is train pediatricians and primary care physicians to start addressing any issues related to that. Now, is this just lets rip off a sheet from this little form here and here's the diet I want you to give to your kid? No.

I would say that the way that I would describe it, it's a family thing without exception. The guidelines recommend intensive health behavior and lifestyle treatment. Regardless of where people are on the charts. If it's warranted, health behavior and lifestyle treatment is more effective with greater contact hours, the most effective treatment includes 26 or more hours of face to face family base multi-component treatment over 3 to 12 month period. That doesn't sound like here's a diet. Follow it, kid.

This is having a whole family approach. Is that an approach that I would follow? Yeah. It's certainly not giving mom or dad a diet for the kid in sending him on their way. Family based programs have demonstrated great success but it has to be a family thing. That's what we tried to do with Riley. Riley is one of the pickiest eaters. Now, he's sort of on the underweight side. You know, we sit down as a family. We started doing it again. Now that he’s not over booked with activities and he's eating more diverse foods.

What does it all really come down to here? Because the guidelines are extensive. It's all about the money, folks. The summary of the report also talked about obstacles to the family based treatment approach.

The major obstacle is money. Money to train the pediatricians and family practice physicians on how to assess childhood obesity. Now maybe it's going to be a nurse practitioner or physician assistant that may do that, but they still need to be trained on what to look for and what to do. Money for developing more health care providers to teach and work with families as it is labor intensive. You heard 26 sessions face-to-face over 3 to 12 months and money for public health and community programs that can support this family based approach. But you know what? This is classic. Everyone knows how important preventive health care and early treatment is. No one wants to pay for it. That's a problem.

So in my opinion, new childhood obesity guidelines introduce a couple of new approaches for those with the most severe weight problems. They're not for everybody, but those are the most severe. The focus is on intensive nutrition and behavior change training for the entire family. That's a win win win. Such is the diet and exercise program. And I'll see you next year. The guidelines give a reasonable approach to help the future health of the nation.

The approach is simple. Eat less, eat better, move more. What they are saying is that health care professionals and people in the health field need training to be able to do that effectively as a teen in a reasonable family based approach. And that's the exact right approach as I see it.

That's all the time we have for this show. Until next time, this is Dr. Chet Zelasko saying health is a choice people, so choose wisely today and every day.

Straight talk on health with Dr. Chet Zelasko was recorded in the studios of WGVU public radio in Grand Rapids, Michigan. The views and opinions expressed on straight talk on health are not necessarily those of WGVU its underwriters or Grand Valley State University episodes are found at WGVU News Dot Org. And wherever you get your podcast, please rate and subscribe.

Dr. Chet Zelasko is a scientist, speaker, and author. Dr. Chet has a Ph.D. and MA in Exercise Physiology and Health Education from Michigan State University and a BS in Physical Education from Canisius College. He’s certified by the American College of Sports Medicine as a Health and Fitness Specialist, belongs to the American Society of Nutrition, and has conducted research and been published in peer-reviewed journals. You can find him online at drchet.com.
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