MDNews - Cleveland-Akron-Canton

++ + ++ + ++++++++++++++++++++++++++++++++++++++++++++++  SPECIAL SECTION: DIABETES AND OBESITY ++++++++++++++++++++++++++++++++++++++++++++++ + + Obesity S Combating in Children and Adolescents By Cydney Fenton, MD INCE 1980, OBESITY prevalence among children and adolescents in the U.S. has almost tripled, now accounting for nearly 17 percent, or 12.5 million children and teens between the ages of 2 and 19. This number doesn’t include those at risk for becoming obese, marked by a Body Mass Index greater than the 95th percentile. Today, nearly 30 percent of referrals to endocrinology are obesity related. As childhood obesity becomes more prevalent, we are observing an increased incidence of obesity-related complica- tions, including Type-2 diabetes. In fact, patients with Type-2 diabetes are being seen at increasingly younger ages, including children under the age of 10. Although there are no new medications on the market to treat the growing popu- lation of diabetes patients, physicians are beginning to recognize pre-diabetic states resulting from obesity, including high insulin levels that often serve as an early warning sign for development of Type-2 diabetes. Some are using medication intervention in addition to diet and exercise, including off-label use of Metformin, shown to decrease the rate of progression of Type-2 diabetes by nearly 30 percent. To tackle excess weight, and potentially ward off obesity-related complications, some patients have experienced success with Orlistat (prescription Xenical and nonprescription Alli), a class of lipase inhibitors that works by preventing the digestion and absorption of a portion of fat in food within the intestines. The unabsorbed fat is further removed from the body through stool. Both forms have been approved for use by adolescents, but because of the social side effects, including urgent and/or increased bowel movements, fl atulence and incontinence, adherence in adolescents is low. Due to the growing epidemic, there has been an observed increase in recent years in the number of adolescents referred for bariatric procedures, which were traditionally reserved for adults. Comparatively, however, these surgeries are still relatively rare in adolescents. There are physicians who recommend a bariatric procedure if an adolescent is diagnosed with severe obesity and obesity-related complications such as hypertension and diabetes. Generally, doctors may recommend adolescent bariatric surgery if the individual’s weight poses a greater health risk than the potential risks of surgery. Many patients fi nd, however, that life- style changes are the most effective way to prevent or manage Type-2 diabetes, and obesity in general. Medication or surgery can work in conjunction with lifestyle changes, but core behavioral changes relative to diet and exercise are key. Programs are popping up across the country to address the childhood obesity epidemic and promote the importance of diet and exercise, while striving to reverse obesity trends and lower the incidence of chronic disease. A good example of a fi tness program for this population is the Kohl’s Community Youth Fitness pro- MDNEWS.COM  JULY-AUGUST 2011  MD NEWS Cleveland-Akron-Canton | 43 gram, which offers Future Fitness Clubs for children ages 8 to 13 at fi tness centers throughout northeast Ohio. During program sessions, kids learn about safe weight loss, healthy nutrition for various ages, and fun fi tness while participating in games and other noncompetitive activities. The effect these types of pro- grams can have on obese adolescents can be seen through great patient stories and will undoubtedly continue to help tackle the signifi cant increase in childhood and adolescent obesity. Dr. Cydney Fenton is a board-certifi ed pediatric endocrinologist and the director of the Akron Children’s Hospital Center for Diabetes and Endocrinology. n

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