Treating Childhood Obesity - What Does it Take?
In one of the workshop at Uppsala Health Summit 2016, we will develop a roadmap for how childhood obesity could be addressed as a joint effort by different stakeholders in defined areas (in Ending Childhood Obesity (ECHO) Zones). The idea is born out of the realization that "it takes village" to prevent and treat this complex condition, which today affects more than 40 million children under five.
To better understand the current thinking around treatment for obesity, I sit down for a conversation with Dr. Anders Forslund, Pediatrician and Obesity Specialist at the Uppsala University Children´s Hospital, and one of the organizers of the workshop for ECHO zones.
"First of all we need an understanding that obesity in childhood is a chronic condition, and that the outlook is better if we start treatment in the early years", Dr Forslund explains when we meet in the clinic where Dr Forslund care for severely obese children and conducts research into new medications.
Why are some children more at risk than others?
There are many combinations of factors that contribute….You inherit a vulnerability to become obese, as with many other diseases. This susceptibility, in combination with the environment, causes an effect on i.e hormone levels and even the flora in the gut. When children with this heightened risk are exposed to different triggers, they start to gain weight. Triggers can often be poor diet, insufficient sleep and sedentary lifestyles. Stress, which is common in children these days, makes it worse.
Can you tell a little about the children who come for treatment here?
In many of the severe cases (defined as an age-adjusted BMI over 35) family conditions play a role. It could also be neuro-psychiatric causes such as an undiagnosed Attention Deficit Disorder (ADD) or Dyslexia. These type of conditions can lead to stress and low self-worth, which in turn can lead to unhealthy diets, habits and weight-gain.
What is your approach to treatment here in Uppsala?
Support to lifestyle changes is the first response. When a regular pattern of more daily exercise and better diet and sleep is developed and maintained, the odds are good. But telling children with severe obesity just to diet or exercise will not help. We have to dig deeper to find the real reasons for the excessive weight-gain. This is why we work as a team here in Uppsala, severely obese children and their families do not just meet with doctors and nurses, they also meet a dietitian, a psychologist and sometimes a social worker too to develop individual treatment plans.
Are the parents actively involved in the treatment?
At least one is usually present during the meetings, and the whole family is involved in treatment at home. Like their children, they are exhausted and frustrated, there is a sense that they have tried everything. When we ask how much they would like their child to lose weight on a scale from 1-10, it is always a ten, but when we ask of their perceived ability to help, they rate themselves much lower, below 5 on the same scale.…and there is sometimes denial...there still a lot of shame around obesity…so we sit with the family and listen to their story. In many cases the causes can be a real puzzle, we can have many talks before we can pin-point what actually lies behind.Often parents need support to say no and make lifestyle modifications such as eating healthier and together, install regular habits around sleep, and finding ways to build in exercise in daily life.
What are the chances of recovery - can childhood obesity be treated for good?
Generally, we need to get away from the idea that obesity is a state that you can overcome. We need to recognize that it is a chronic condition that will impact a life-time of sensitivity. And if a complication has developed, such as type 2 diabetes, then the outlook is quite somber.
What predicts success is how early the treatment starts. If you intervene when the child is 5- 8 years old, he or she has a bigger chance to be normal weight around 10-15 years old. But if the child gets into the teenage years, he or she will feel increasingly stigmatized, frustrated, and a vicious circle develops, which it is not easy to get out of.
Will some children require medication?
We see medicine as a crutch, as a support to the other interventions we do. And as long as we don’t have better medicines, that is our only option. But we are hopeful about the EU- supported research project we are involved in called Beta Judo. 44 of our patients are trying a drug, called Bydureon. It regulates the insulin in the body, but also to some extent the feeling of constant hunger. (Read more about the Beta Judo research project in the interview with Professor Peter Bergsten in the April Newsletter).
What are the biggest challenges with your work?
“Well for those of us who work with these children, we are saddened by the stigma and prejudice in that prevails in society, even from politicians and within the healthcare sector. The idea of obese people being lazy and somewhat responsible for their situation prevails and is reflected in resource allocation even for treating children. In Sweden and in much of the resource-rich world, resources are available to treat the complications, but not for obesity itself…which will also get very expensive for society in the long-run.
Can you tell about your involvement in the Uppsala Health Summit on Childhood Obesity and your expectations for the meeting?
Together with my research colleague Professor Peter Bergsten, I am involved in the planning of the workshop for the ECHO zones. It is an effort to create geographical or cultural areas in which resources are pulled from all stakeholders (school, health care, social services, industry) to bring down obesity rates within a specific area...our vision is to develop a structure and that these zones then can learn from each other… we hope to start something that can lead to something constructive after the meeting…. I am very glad that childhood obesity get some of the attention that it deserves”.