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Pediatric Update

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Pediatric Update

 
Spring 2008

UCLA Program Helps Overweight Children

As more and more American children gobble fast-food lunches, spend limited time exercising in school, consume high-calorie snacks and sit at home for hours staring at a TV, computer or video box instead of playing outside, the problem of weight gain in children increases. And with that additional weight comes, in addition to a host of psychosocial problems, an alarming rise in some health conditions once thought of as diseases of adulthood. Doctors, for example, increasingly are diagnosing adult-onset, or type 2, diabetes in overweight youngsters, along with high blood pressure and elevated cholesterol.

Testifying before a congressional committee several years ago, then-U.S. Surgeon General Richard Carmona stated that the rates of overweight children and adolescents have increased at a worrisome rate in the past 20 years, and he called the situation “a growing epidemic in our country.”

Excessive weight among children is now characterized as the most serious and prevalent nutritional disorder in the United States. An estimated 11 million children and adolescents nationwide are overweight, and some 13 million more are at risk for becoming overweight. According to UCLA Assistant Clinical Professor of Pediatrics, Wendy Slusser, M.D., an expert in childhood nutrition, with weight problems youngsters have a 70-percent risk of becoming overweight adults with increased risk factors for such weightrelated health problems as heart disease, hypertension, osteoarthritis, gallstones, kidney stones,sleep apnea, colon cancer and stroke, among others.

Increasingly, a public light is being shined on the problem through such programs as the Alliance for a Healthier Generation, a partnership of the American Heart Association and the William J. Clinton Foundation. In December 2007, the journal Pediatrics dedicated a 125-page supplement to the issue of overweight children. As part of that growing recognition, UCLA is joining a number of health centers across the country that have established multidisciplinary programs focusing on treatment of overweight children. For information about the UCLA Fit for Healthy Weight Program, go to www.fitprogram.ucla.edu or call 310-UCLA-FIT (310-825-2348).

Children are classified as overweight if their body mass index, BMI, a calculation based on height and weight, is at or above the 85th percentile but less than the 95th percentile in comparison to national statistics for children their age, and obese if their BMI is at or above the 95th percentile.

“The goal of this program is to work with the doctors in the community to serve a group of children who traditionally have been challenging for general pediatricians to take care of,” says Dr. Slusser, who is among the lead physicians for the UCLA Fit for Healthy Weight Program.

In addition to a general pediatrician whose professional focus is nutrition, the UCLA program includes an endocrinologist, gastroenterologist, psychologist, dietitian, exercise physiologist, and a pediatric bariatric surgeon. Daniel DeUgarte, M.D., surgical director of the program, notes, “Only select patients who undergo a minimum six-month evaluation will be candidates for minimally invasive weight-loss and metabolic surgery.” “We will work to find out the root of their weight problem that hasn’t responded to the less-intensive efforts in the primarycare setting,” Dr. Slusser says. “Based on our assessment, we will determine the needs for each individual child.”

Dr. Slusser notes that Pediatrics laid out a four-tier system for managing overweight children. The first two tiers can be undertaken in a community pediatrician’s office and involve identification, assessment of risk factors, nutritional guidance and structured weight management, while the third and fourth tiers require a more specialized, multidisciplinary approach such as that offered by the UCLA program. A general pediatrician might not be comfortable, for example, managing a child with metabolic syndrome; in such a case, the UCLA program offers a multidisciplinary team that addresses the range of the child’s health issues.

“Not only will we address children’s medical needs, but we can also work on their weight loss, which is very important to their overall treatment and will ultimately help to reverse their problems,” Dr. Slusser says.

“This program is part of an overall strategy to fight the epidemic,” says Edward R.B. McCabe, M.D., Ph.D., director of Mattel Children’s Hospital UCLA. “It is a problem that needs to be aggressively addressed.” Part of that strategy includes increasing children’s activity levels. Toward that end, the UCLA program has partnered with a program on campus, the Bruin Kids Club presented by Mattel Children’s Hospital UCLA, which has UCLA athletes serving as mentors and role models for youngsters. “It is a great way to try to get the kids to increase their physical activity,” Dr. McCabe says.

The cornerstone of therapy to treat weight issues in children—as with adults— remains diet and increased physical activity. Thirty to 40 minutes of sustained exercise at least five days a week is recommended for children. A diet that offers the full Recommended Daily Allowance of vitamins, minerals and proteins and is based on fruits, vegetables, whole grains, non-fat and low-fat dairy products, fish, lean meat and beans, is preferable. Changes in diet seem to be most successful when preparation of familiar foods is modified rather than new foods being substituted.

Recommended Reading

John-Sowah J, et al. Assessment of child and adolescent overweight and obesity. Pediatrics. 2007 December; 120(6) (Supplement): S163-S288.

Weiss R, Taksali SE, TamborlaneWV, Burgert TS, Savoye M, Caprio S. Predictors in changes in glucose tolerance status in obese youth. Diabetes Care. 2005 April; 8(4): 902-909.

 

The Bruin Kids Club presented by Mattel Children's Hospital UCLA is an exclusive membership club for kids ages 13 years old and younger. Members will have the opportunity to meet new friends, participate in exclusive Kids Club events, and attend sporting events to cheer on their favorite Bruins. This club provides members with a chance to become a part of the excitement of UCLA Athletics! Join online now at www.uclabruins.com





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