THINKSTOCK Luck played a role in the transformation of a Manalapan teen’s life when he went to the pediatrician with his mother.
Dr. Jill Sharon, a Manalapan pediatrician, was filling in for Alec Fiallo’s regular pediatrician, and she noted his high cholesterol level and excessive body weight.
Shortly thereafter, Alec became of patient of Sharon.
“Dr. Sharon has a different approach to weight loss for kids. It’s not a diet. The kids learn how to make healthy, lifelong choices and to incorporate activity. There are no restrictions,” Alec’s mother, Susan, said.
Through a slow process of changing Alec’s eating habits and adding physical activity, he lost 50 pounds in about nine months, Susan Fiallo said.
“I ate everything, but my portions went down. I never exercised before, and then I started doing cardio and weight lifting,” Alec said.
That was more than two years ago, and Alec, 16, has maintained the weight loss and lowered his cholesterol level.
“He is so much more confident and outgoing now,” Susan Fiallo said.
Alec added that he has more energy now and has improved physically and mentally.
“I didn’t change for anyone else. I wanted to change. I feel stronger as a person now,” Alec said.
Sharon has concentrated her pediatric medical practice on obesity in children.
Because her overweight patients “didn’t have anywhere to go,” Sharon changed her focus from general pediatrics to specifically addressing challenges of obesity in children.
“A lot of programs are geared to adults, and others did not have the time to work with children,” Sharon said.
Board-certified in obesity medicine, Sharon emphasizes “small and slow changes” for her patients.
“I work with children on foods they like to eat and to get them to do more activities,” Sharon said.
Children need to learn how to make good food choices and exercise regularly, Sharon said, and cautioned against drastic measures. “If they (children) have bariatric surgery, they will certainly lose weight, but once they begin eating regular food, they might regain what they have lost. I have seen parents of patients who had bariatric surgery who lost and then regained weight because they did not change the food they were eating,” Sharon said.
However, Sharon said, “bariatric surgery may be the right choice” for patients who have tried for many years to lose weight and who have multiple medical issues.
Children who are obese face a lifetime of health risks that could shorten their lives if not addressed.
“Children with obesity are more likely to have obesity in adulthood. Adult obesity is associated with a number of serious health conditions including heart disease, diabetes and some cancers,” said Pamela B. Bryant, health communications specialist at the United States Center for Disease Control and Prevention (CDC), division of nutrition, physical activity and obesity. The prevalence of childhood obesity remains high, Bryant said.
According to the CDC, for children and adolescents ages 2-19 years, the incidence of obesity has remained fairly stable at about 17 percent and has affected about 12.7 million children and adolescents for the past decade.
There is no simple answer as to how obesity among children became so prevalent.
“It is difficult to tease out,” said Dr. Stephen Cook, associate director of the Institute for Healthy Childhood Weight at the American Academy of Pediatrics and associate professor of pediatrics at the University of Rochester’s Golisano Children’s Hospital.
Social factors, biologic factors and genetic factors all play into the causes of obesity in children, according to Cook.
“People jump to personal choice (as the cause), but it’s not that simple,” Cook said.
The body resets when one gains weight and wants to hold onto it, Cook said. Some causes of childhood obesity can be attributed to behavior (diet, physical inactivity, medication use) and genetics, as well as societal factors (food and physical activity environment, education and skills, and food marketing and promotion), Bryant said.
Society went from a “more physical to a less physical environment,” Cook said.
In addition, changes in the food and technology industry are contributing factors to the problem, Cook said. He cited larger food portion sizes and increased screen time, in addition to the “mismarketing around food and food labels.”
“Reducing childhood obesity is something we as a nation must tackle,” Bryant said.
Locally, Dr. Leo Lopez, a CentraState Medical Center pediatrician with offices throughout the area, is concerned with the increase in overweight and obese children that he encounters in his practice.
“With school physicals, when heights and weights are taken, you see the number of children who are overweight or obese,” Lopez said.
Parents seem surprised by their child’s body mass index (BMI) and often make excuses for the weight, such as saying the child is big boned, Lopez said.
“Children with obesity don’t recognize that their body is not strong due to weight. They complain of back and knee pain, being uncomfortable with exercise and breathing hard,” Cook said.
Extra weight puts stress on bones and muscles, Cook said.
A child’s BMI provides a measure that applies quantitative values to weight. Obesity is defined as a BMI at or above the 95th percentile for children and teens of the same age and sex. Overweight is defined as a BMI at or above the 85th percentile and below the 95th percentile for children and teens of the same age and sex.
(To calculate BMI, visit www.cdc.gov/ healthyweight/assessing/bmi)
Lopez encourages families with children who have elevated BMIs to reinforce some basic habits: increase activity levels; include more fruits and vegetables and less soda in their diet; and reduce screen time.
“Some kids have screen time for 10 hours per day. The American Academy of Pediatrics recommends less than two hours per day,” Lopez said.
The effects of too much weight during childhood years are evident to Lopez through blood work results and other indicators.
“Blood work markers are on the cusp for diabetes, and cholesterol levels are high. I see sleep apnea (a sleep disorder in which breathing repeatedly stops and starts) and high blood pressure,” Lopez said.
Lopez advises his patients and families to reverse the weight gain in order to avoid long-term health problems.
“They (families) already know what I am going to tell them and they tune out.” Lopez said.
Overweight younger children, Cook said, are not as much of a concern as children with obesity since there is a growth projection for the child.
“The younger the child, the more wiggle room you have. For younger children, you need to slow down weight gain,” Cook said.
The goal for young children with weight issues is not to focus on losing weight, but instead on maintaining weight as they grow taller, said Caryn Alter, registered dietician, Star and Barry Tobias Health Awareness Center, CentraState Medical Center.
“Kids grow up with only supersized portions. The main problem is portion sizes. Twenty or 30 years ago, portion sizes grew and never went back to normal size,” Alter said.
Children and adolescents with obesity also have a greater risk of social and psychological problems, such as discrimination and poor self-esteem, which can continue into adulthood according to the CDC.
Even behavior problems such as attention deficit disorder, Lopez said, can be attributed to pediatric obesity.
Cook said children who are obese are the most common targets of bullying.
“We assign assumptions to obese people: lazy, unintelligent and unmotivated,” Cook said.
The CDC reports that there are significant racial and age disparities in obesity prevalence among children and adolescents. In 2011-2012, obesity prevalence was higher among Hispanics (22.4 percent) and non-Hispanic black youth (20.2 percent) than non-Hispanic white youth (14.1 percent). The prevalence of obesity was lower in non-Hispanic Asian youth (8.6 percent) than in youth who were non-Hispanic white, non-Hispanic black or Hispanic.