The Complexities of Nipping Obesity in the Bud

Later today, I will have the pleasure of moderating a live-streamed educational panel (Fokus Adipositas), with my German colleagues Martin Wabitsch, Johannes Hebebrand and Mattias Blueher,  on the issue of managing obesity in kids and adolescents. 

Given the topic, I have no doubt that the issue of nipping the obesity epidemic  in the bud by focusing our attention on kids will come up. While in theory, this is certainly a good idea, in reality, this is much easier said than done. 

As in adults, the root causes of weight gain in kids is just as complex with a wide range of environmental, socio-economic, psychological, and biological factors often working together to promote excessive weight gain. 

As in adults, childhood obesity is associated with clear health risks ranging from the psychological impact of bullying to the cardiometabolic and other pathophysiological consequences of excess weight. 

As in adults, by the time the kids get to be seen by an obesity specialist, their condition has generally progressed to a point where there is little doubt for the need of treatment. 

However, in contrast to adults, treating obesity in kids is a whole lot more delicate and challenging. 

For one, if anyone believes that behavioural modification in an adult is already difficult enough, trying to implement such modifications in kids, especially teens, is a whole order of magnitude harder. 

Indeed, trying to change health behaviours without precipitating unhealthy weight-obsession, inducing harmful weight-control behaviours, or reinforcing body-dissatisfaction, is even more challenging in kids than in adults. 

Furthermore, while we have now largely accepted that effective obesity treatment in adults will likely require medical or even surgical treatment – both options are limited when it comes to kids. 

Although there are now a couple of anti-obesity medications approved for use in kids (such as liraglutide and setmelanotide), and despite the fact that bariatric surgery in adolescents is a lot more common today than ever before, these options are generally reserved for the most severe cases and the vast majority of kids (or their parents and most doctors) would not even remotely consider these as options. 

Thus, I certainly do not envy my pediatric colleagues when it comes to their ability to manage childhood obesity. 

Clearly, when people talk about nipping the obesity epidemic in the bud by focusing our attention on childhood obesity, they are apparently unaware of just how limited our ability to provide effective obesity treatments to kids actually are. 

Nevermind that we currently have no evidence whatsoever that effective obesity management in kids or adolescents does indeed translate into less obesity in adulthood. Indeed, adult obesity programs are chock full of patients, who never struggled with excess weight in younger years. 

Statistically, adult-onset obesity remains by far the most common form of obesity and by an order of magnitude the most important driver of the obesity epidemic. 

None of this means we need to give up on our kids – rather, we need to double down on our efforts of bringing even more attention to this topic and ensure that treatments proven safe and effective in adults are urgently explored for their potential use in treating childhood obesity – the sooner the better. 

@DrSharma
Berlin, D