National Childhood Obesity Awareness month is a great opportunity for parents, teachers, government officials and community leaders to promote healthy eating and physical fitness initiatives. By stressing the importance of nutrition and a healthy lifestyle now, we can increase the chance of more and more children developing proper dietary habits and growing up to be healthy adults. Remember, it is our responsibility as adults to set the children in our lives up for success. This means leading by example with a healthy lifestyle.

If you or your children are obese and struggling to lose weight, Dr. Cywes and his team at Jacksonville Weight Loss Center may be able to help you finally lose those excess pounds and begin living a healthier lifestyle.

Dr. Cywes believes that the Lap-band should be available to overweight teens that do not have an equal playing field with their peers. For this reason, Dr. Cywes is involved in a clinical trial with Allergan, the maker of the Lap-band product, and currently performs the procedure on adolescents with parental approval. Weight loss surgery is not a quick fix solution to obesity, it is a stepping stone that together with diet and exercise will provide patients with an advantage in their weight loss goals.

The Allergan clinical trials are expected to take another two years before the FDA approves the procedure in adolescents. Gastric bypass, another bariatric surgery procedure, has been proven safe for both adults and adolescents, but it is a much more invasive and dangerous procedure than Lap-band surgery is. The Lap-band procedure is adjustable and reversible, so it is not causing any permanent changes within the adolescent’s body. If the child grows up to be of a healthy weight and wants the Lap-band removed, that option is completely open to them. This is not true of the gastric bypass surgery.

Obese teenagers that are looking for weight loss surgery are not always granted their wish. Dr. Cywes does an intense screening process and only conducts the operation on adolescents that are emotionally and mentally ready to make this drastic life style change. In addition to providing teens with assistance in the form of the Lap-band, Dr. Cywes also provides guidance to his clients in the form of behavioral therapy.

“For banding, age should be less of an issue than obesity and health. The question is no longer whether banding surgery is safe or effective,” said the Robert Cywes, MD, PhD, a board-certified pediatric and general adult surgeon at the Jacksonville Weight Loss Center.

The research showed that children who underwent laparoscopic gastric banding lost more than half of their excess body weight and their complication rates were lower than those in adults.

Despite this, it is more difficult for obese teens to have access to bariatric surgery. A shortage of pediatric bariatric programs, unwillingness for insurance companies to cover these procedures, and lack of approval from the FDA combine to restrict entry into these surgical programs for obese children and teens.

Dr. Cywes’ study provides some of the strongest evidence to date showing that gastric banding is safe and effective in children. It adds to mounting evidence that gastric band surgery is a viable option for treating obese teens.

A study published recently in JAMA, showed that laparoscopic adjustable gastric banding resulted in significantly better outcomes than diet and exercise in a randomized controlled trial involving 15 teenagers. Other studies show the reluctance of medical professionals to consider bariatric surgery for young people. One survey of primary care physicians revealed that 48% would never refer an obese teenager for bariatric surgery, and 46% considered 18 as the minimum age for referral. 

However, Sandra Hassink, MD, chair of the American Academy of Pediatrics’ Obesity Leadership Workgroup and director of the weight management clinic at duPont Hospital for Children Wilmington, Delaware believes the attitude toward weight loss surgery for teens may be changing.

Increasingly, pediatricians and primary care doctors look at surgery as “one of the options” for children who have failed on long-term weight loss programs, she said. Doctors need to consider each child individually and look for a program with a proven record in all aspects of weight management.

According to Dr. Cywes, age matters less than a patient’s commitment to lifestyle modifications and the support they receive from their family.  “What we avow is that the age is less important than the particular patients’ mental capacity to understand the nature of the operation as well as the behavioral and lifestyle modifications required to be successful.”

Two recent studies analyzed the effectiveness of weight loss surgery for helping adolescents lose weight as well as the risk and complications for younger patients. In one study, presented to the American Society for Metabolic and Bariatric Surgery, Dr. Robert Cywes a bariatric surgeon from Jacksonville, Florida looked at data from over 400 adolescent patients who underwent gastric banding surgery between 2005 and 2009. The study found that the average BMI of the gastric banding patients dropped from 43 to 35.7 six months after surgery, and continued down to 31.9 a year after surgery. None of the patients died during or after surgery and all operations were successfully completed laparoscopically. Other complications were extremely rare. Dr. Cywes states that his findings suggest that adjustable gastric banding is effective with an “acceptably low complication rate” in adolescent patients. He says, “Age should be less of an issue than obesity and health when considering patients for surgery.”

Another study presented at the same meeting examined the outcome of 17 gastric banding surgeries performed on morbidly obese adolescents. This study confirmed that gastric banding produced a significant reduction in weight, waist circumference, blood pressure and insulin resistance while bearing a very low complication rate.

These studies suggest that gastric banding surgery may be a safe solution for adolescents who struggle with childhood obesity. It is recommended that these younger patients undergo extensive education and preparation before having surgery to ensure that they’ll be able to make the necessary lifestyle changes following the surgery.

4 Tips for Overcoming Childhood Obesity

1. Focus on healthy snacks: Recent studies suggest that the average child eats as many as 3 snacks per day, in addition to their 3 regular meals. This can add up to a lot of extra calories and unwanted weight. Focus on healthy snacks of fresh fruits and vegetables to ensure that the food your kids are eating are improving, rather than harming, their health.
2. Practice portion control: Our societal perception of portion sizes has been skewed by large packages and supersized portions served to us in restaurants. Practice using smaller dinner plates at home and serving portions about the size of your (or your child’s) fist. When you go out to eat, consider sharing meals, requesting a to-go container, or ordering smaller portions.
3. Drink healthy: Replace sugary sodas and fruit cocktails in your kitchen with water, milk and real fruit juices. Focus especially on making sure everyone is drinking enough water during the day.
4. Get moving as a family: Young children who have limited TV time are less likely to be obese. Replace your family TV time with a walk, bike ride, or playing catch in the yard. Find a local fitness center that caters to families, or play a sport together. Setting an example of living a healthy lifestyle is the best way to get your children moving.

Federal health officials recently reported that one out of every five U.S. teenagers has a cholesterol level that increases the risk of heart disease. A survey of blood tests showed that 20% of American teenagers have at least one abnormal level of fat, while 43% of obese teenagers had abnormal fat levels. Statistics about the effects of obesity on the health of teenagers are especially alarming in light of estimates that nearly one-third of kids are considered overweight or obese.

Linda Van Horn, a professor of preventive medicine at Northwestern University, states, “These data really confirm the seriousness of our obesity epidemic. This really is an urgent call for health-care providers and families to take this issue seriously.”

Obese children and teenagers are at increased risk for diabetes and heart disease, both at a young age and as they get older. Experts are concerned that the overall health of the American population may be at risk. “People are worried that this generation is going to grow up to have more cardiovascular disease than the current generation,” says Denise Simons-Morton of the National Heart, Lung and Blood Institute. “This problem is poised to negate all of the advances we’ve made in cardiovascular health.”

Experts urge physicians to monitor the cholesterol level of overweight and obese teenagers. They also call for parents and children to become more aware of and involved in the fight against obesity.

Talk to your teen.

The first step toward helping your teen get healthy is communication. It’s likely that your child is as concerned about the excess weight as you are, and by being supportive and understanding, you can show sympathy rather than judgment. Be willing to help them manage the problem without supporting unrealistic concepts of “fat” vs. “thin.” By reminding your teen that there is no ideal weight or perfect body and that the right weight for one person may be different for another, you can encourage healthy behaviors and realistic goals.

Promote healthy habits.

Losing weight is a lifetime commitment, and by resisting fad diets and other quick fixes, your teen can develop healthy habits that pay off well into adulthood. Additionally, most short-term solutions may rob your teen of essential nutrients without solving the underlying problems, resulting in a high risk of regaining all weight lost. Try promoting physical activity instead, because teens need about 60 minutes of physical activity a day. Team sports, walking, or even chores or video games that require physical movement can count toward this activity, and short, repeated bursts of activity are just as good as one prolonged active period.

Finally, helping your teen establish healthier eating habits can serve your child for the long term. By encouraging nutritious meals that include proteins and veggies, you can help your teen to come off the highs and lows that result from carbohydrate consumption. It’s also important to talk to your teen about focusing on quality of their intake and avoiding liquid calories. By setting a good example, adopting healthy habits as a family, and providing support and unconditional love, you can help your teen get and remain healthy.

Metabolic syndrome is a set of risk factors that can predict the risk of heart disease, stroke, and diabetes. Though there is not one definition of the metabolic syndrome, for a proper diagnosis, three of the following characteristics must be present: abdominal fat, low HDL cholesterol, high triglycerides, high blood pressure, and high blood sugar. “Doctors often do not treat obesity in children now unless they have other features of the metabolic syndrome,” said Nelly Mauras, senior author of the study. She continued, “This practice should be reconsidered.”

The recent study, accepted for publication in The Endocrine Society’s Journal of Clinical Endocrinology & Metabolism (JCEM), consisted of over 300 subjects ages 7 to 18 who had normal fasting blood sugar levels, normal blood pressure, and normal cholesterol and triglycerides. The subjects were tested for known markers that predict the development of cardiovascular disease, such as C-reactive protein (CRP) and fibrinogen, a clotting factor. The obese subjects, all otherwise relatively healthy, demonstrated significantly higher CRP and fibrinogen concentrations.

“These findings suggest that we need more aggressive interventions for weight control in obese children, even those who do not have the co-morbidities of the metabolic syndrome,” Mauras stated. She concluded that it would be wise for physicians and other healthcare providers to suggest more aggressive weight-control intervention for “healthy” overweight children.

Dr. Pooja Tandon, a graduate fellow in the department of general pediatrics at the University of Washington in Seattle, conducted a study that used McDonald’s menu items to test how parents responded to the availability of nutritional information. Researchers showed 99 parents of 3- to 6-year-olds pictures of McDonald’s menu items, including sandwiches, salads, dressings, side items, beverages, desserts, and children’s meals. Half of the parents were given menus with calorie information for each item and half of the parents received menus with no nutritional information. The parents were then asked which items they would pick for themselves and their children.

While there was no difference in which foods the parents chose for themselves, the parents who were given nutritional information picked lower-calorie meals for their children. The parents with detailed menus chose meals with an average of 102 fewer calories for their children than the parents who were given no nutritional information.

Tandon said that, “These results make me optimistic that if parents are provided nutrition information at the point they are purchasing fast food for their children they actually make lower calorie, healthier choices for their families.” She hopes that this research may help support legislative efforts designed to encourage fast food restaurants to make nutritional information regularly available to diners.

What did researchers learn about the effects of bariatric surgery in teenagers?

• The average body mass index of the teens went from 58 before surgery to 38 two years later. The BMI of a person considered of normal weight ranges between 18.5 and 24.9.
• The percentage of teen patients with structural heart abnormalities dropped from 49% before surgery to 24% two years after surgery.
• Heart rate and blood pressure improved in teens after bariatric surgery.
• The ability of the heart to relax improved within six months after surgery and persisted for two years. The inability of the heart to relax is an early precursor for heart disease.
• Before surgery, all of the teens suffered from enlarged hearts. After six months, the condition had improved in all subjects. The condition remained improved after two years.

In addition to losing weight and having improved heart health, many teens noted an increase in general happiness after undergoing weight loss surgery. Losing weight often means being able to do and experience things they were missing out on before.

Average Weight Of Children Rising

Weight loss surgery has been proven to be an effective way to treat obesity in teenagers. Recent studies also showed that bariatric surgery helped improve heart health and reduce the risk for future heart disease in young patients. This news is especially important as the rate of childhood obesity continues to rise in the United States.

Researchers found that children, on average, weigh 11 pounds more than they did a decade ago. Average body mass index has risen from 18.1 to 19.9 in the same ten years. The study also showed that boys and African-Americans were at particularly heightened risk for obesity. As the rate of obesity rises, so does the risk for heart-health problems in children and teenagers, along with the risk for future heart complications as obese children grow into adulthood.

However, not every overweight teen is a good candidate for weight loss surgery. Bariatric surgery is reserved for teens who are morbidly obese, which for most people means being at least 100 pounds overweight or having a BMI of 40. In some cases, weight loss surgery is reserved for teens who are obese and show signs of a serious obesity-related health condition like diabetes.

Childhood obesity is a serious problem facing America today. Efforts should be made to prevent or reverse obesity with proper diet and exercise before health complications arise; however, in the cases of morbid obesity, weight loss surgery has been proven to be a safe and effective treatment option.