Ask the Pediatrician: What is obesity and when do children need medical treatment?

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As a parent, you want the best possible health for your child. So does your pediatrician. When your child comes to see a pediatrician, for either a well visit or a sick one, we are always asking ourselves what we can do to keep your child healthy. An important step in understanding your child’s health is checking if they have excess weight. That’s because excess weight—overweight or obesity—can impact their overall health.

In fact, we call obesity a chronic disease because it can affect every part of the body. It can even interfere with the way we feel hunger and fullness and process energy.

Obesity is a disease that can be treated, much like asthma and other chronic conditions.

Childhood obesity often lasts into adulthood if it is not treated. It can result in other diseases such as Type 2 diabetes, nonalcoholic fatty liver disease, high cholesterol, high blood pressure, sleep apnea and orthopedic (bone and joint) problems, to name a few.

The causes of obesity are not limited to just individual or family factors, such as genetics, nutrition and physical activity. They also involve multiple, complex situations in the wider environment that can lead to obesity. Examples include:

  • Unjust food systems and economic factors, which can make it hard for some families to access or afford healthy food choices.
  • Unsafe physical environments, which can limit opportunities for physical activity, exercise and active play.
  • Sources of toxic stress such as exposure to racism. Toxic stress can affect the hormones that regulate weight, among other health effects.

One of the measures we use to check for excess weight is the body-mass index, or BMI. The BMI is a calculation that compares your child’s height and weight and lets us know if they are in a healthy range for their age and gender. The BMI itself does not tell us about their health inside their body. However, it is an outward sign of what can be happening inside their body.

If your child’s BMI is outside their healthy range, this is referred to as overweight or obesity. Your doctor will want to explore and learn more. This is because excess weight can take a toll on the body. It can affect internal organs, causing inflammation and problems with the immune system and body chemistry, for example. Obesity also impacts mental health. These effects are not visible from the outside.

This is why your doctor will be asking you and your child questions about the way their body is functioning. They’ll also gauge the body’s health by ordering lab work and other tests. The goal of this evaluation is to make sure that your child is healthy inside.

We know that excess weight or high BMI is just a part of the puzzle. In some cases, children and adolescents with excess weight or higher BMIs are healthy on the inside. But the effects of excess weight or high BMI can progress, so your doctor will want to monitor these tests over time.

We need to work toward a better environment where all children and families can grow up healthy. However, until we are able to create healthier environments, keep in mind that treatment for overweight and obesity can work despite unhealthy environments.

Treatment of obesity and obesity-related diseases may be needed for many years. It requires an ongoing partnership with your child’s doctor and attention to the disease through intensive health behavior and lifestyle treatment. These can bolster your family’s ability to stay healthy on the inside and address excess weight. In some cases, medication and metabolic and bariatric surgery may be recommended as the treatment.

It is important to acknowledge the harmful effects of weight bias and stigma. There is no place for blame or guilt about body shape or size. What is important is that our bodies function in a healthy way. Blaming someone for obesity is like blaming someone for having asthma. It is not helpful, frequently harmful and gets in the way of effective treatment.

Similar to other chronic diseases, the focus of treatment for obesity should be on the overall health and quality-of-life factors important to your child and family. For example, treatment goals may include missing less school, participating in events such as walkathons and improved self-esteem.

Your child’s health is important to you as parents and to your child’s pediatrician. Measuring BMI and evaluating for the health effects of obesity is part of keeping your child healthy.

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