Chattanooga doctors want families to know that there are underutilized options beyond diet and exercise to help treat childhood obesity -- a common and increasingly prevalent disease with serious health and social consequences.
Last week, the American Academy of Pediatrics released new guidelines calling for more proactive treatment of childhood obesity. The guidelines highlight evidence that obesity treatment, which may include intensive health behavior therapy, medication and bariatric surgery, is safe and effective in children.
"There is no evidence that 'watchful waiting' or delayed treatment is appropriate for children with obesity," Dr. Sandra Hassink, an author of the guidelines, said in a statement from the American Academy of Pediatrics. "The goal is to help patients make changes in lifestyle, behaviors or environment in a way that is sustainable and involves families in decision-making at every step of the way."
Dr. Joani Jack, medical director of the Childhood Healthy Eating and Active Living Center at Children's Hospital at Erlanger, specializes in treating childhood obesity and said the updated guidelines are intended to empower more general pediatricians and primary care providers to evaluate and treat obesity and weight gain in children. For adolescents, prescribing medications or referring them for metabolic and bariatric surgery may be appropriate.
"It's a chronic, complex disease, and that's how we need to be treating it, rather than just continuing to say, 'You need to work harder, you need to do better, you need to exercise more, you need to eat differently,'" Jack said in a phone interview. "These medicines have been out there, and this has been known as a disease for a while, but only a few little clinics around the nation are doing the bulk of the work. We've got to broaden how many people are treating it."
The prevalence of childhood obesity -- defined as a body mass index at or above the 95th percentile for a given age group and sex -- has more than tripled since the 1970s, according to the National Center for Health Statistics.
Children with obesity are more likely to have obesity as adults and face an increased risk for a range of other health issues, including cardiovascular diseases, diabetes and cancer.
Roughly 36.8% of children ages 10-17 in Tennessee are overweight or obese for their age compared to 33.5% of U.S. children as a whole, according to America's Health Rankings. Wyoming has the lowest rate of children who are overweight or have obesity (24.3%), while Mississippi has the highest (41.4%), according to the rankings.
Dr. Nita Shumaker, a pediatrician at Galen Medical Group who's board-certified in obesity medicine, said via phone that ultimately prevention is key, but it can be difficult for parents to choose nutritious options when there's an overwhelming amount of unhealthy, processed foods on the market that are designed to appear healthy.
While unhealthy foods are nothing new, Shumaker said excessive electronics use -- which reduces physical activity, interferes with sleep and harms mental health -- has exacerbated the childhood obesity crisis and made it "virtually impossible" for some people to lose weight.
"The environment is setting us up to fail, and our food sources are setting us up to fail," she said, "and therefore medications can help."
Shumaker compared treating obesity in children to treating high blood pressure in adults, which often includes medication in cases where lifestyle changes alone are unsuccessful.
"You need to exercise, you need to eat better, but we don't not treat people who have high blood pressure," she said. "We say, 'You need to keep working on this, but let's help you stay healthy while we do that.' And I think we're starting to understand that obesity is the same way, and yes, it may require lifelong treatment."
Jack said it's important to note her clinic and the vast majority of medical providers who treat this disease "strongly oppose" weight bias, and treating obesity in children is about reducing the negative impact of extra calories and weight on the body -- not a matter of appearance.
"We're not about shaming kids at all. We're totally the opposite. We're gonna wrap them up and love on them and tell them they're beautiful," she said. "This is not their fault. They didn't do anything wrong. And the kid that's skinny that's eating chips and drinking Dr Pepper actually didn't do anything right -- they just happened to get a healthy metabolism -- so let's just figure out how we can get their metabolism healthy, too."
Jack said she hopes increased awareness about obesity treatment options helps parents and children grappling with obesity feel encouraged.
"We recognize that you're working really hard and you're doing your best, and it's time to get you some more treatments, and they're out there," she said. "You don't have to just look at your child and say, 'Well, if they're overweight, they're always gonna be overweight.'"