In the Soup

One Size Cannot Fit All in Childhood Obestiy

A new discussion paper from the Institute of Medicine makes a compelling case for recognizing that one size cannot fit all in addressing childhood obesity. The rate of childhood obesity has reached 17%, with about a third of those children having severe obesity. One study showed that the rate of conversion from childhood obesity to severe childhood obesity is more than 40% over a four-year period. Ihuoma Eneli, Susan Woolford, and Sandra Hassink tell us:

As a society we are compelled to make a concerted effort to identify effective medical treatment options for this vulnerable subset of children with severe obesity. Their poor response to lifestyle intervention may be due to our current approach that assumes that all children and adolescents with obesity or severe obesity are a homogenous group.

Obesity presents a complex web of molecular, pathophysiological, and epidemiological pathways that extends beyond the simple mantra of “energy in and energy out.”

Happy talk urging children to Get Moving! is not going to solve this problem. Vegetable gardens won’t do it either. Children with severe obesity and their families are mostly dispensed advice about diet and exercise that will do nothing for their condition, except to instill a sense of guilt, shame, and failure.

A few expert centers with interdisciplinary programs for treating childhood obesity can provide real, evidence-based care for severe childhood obesity. But far too few of them exist and only a fraction of the families that need the care they provide can get it.

Eneli and colleagues are calling for us to do better and we should take heed. The research necessary to understand diverse forms of severe childhood obesity and develop effective treatments needs greater focus. In the meantime, we need to provide better access to evidence-based care for the children and families. They are bearing the brunt of this complex chronic disease. But we will all pay a terrible price.

To leave four million children without access to real medical care for this severe, chronic disease is a tragic failure.

Click here for the IOM discussion paper and here for detailed review of the scientific basis for prevention and treatment of pediatric obesity.

In the Soup, photograph © Fabrizio Morroia / flickr

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