Adolescent Obesity and Overweight
“That was awesome!” OK, admittedly that is not a phrase that is usually uttered as a patient exits one of my exam rooms. This was an 11 year old boy, Sam, who had just heard some very encouraging news. Some five months earlier he had come in with abdominal pain and frequent episodes of diarrhea. In the midst of examining him and working this up, several additional facts came to light. Sam was obese, being well above the 95% for BMI (body mass index) for his age. Connected to his obesity were several common complications:
- High blood pressure
- High cholesterol
- High triglycerides (a fatty substance that also increases risk for heart disease)
- Fatty liver with elevated liver enzymes in the blood indicating damage
- A low HDL (the “good cholesterol” that helps protect against the plaque in the arteries that can lead to eventual heart attack or stroke)
- He was not yet diabetic or pre-diabetic but certainly was at risk for this
As we reviewed this with his mom and him, they (especially his mom) registered concern.
She was well aware that Sam’s family history, besides obesity, included heart disease, stroke, diabetes, high cholesterol, high blood pressure, and several kinds of cancer. These are the very things that Sam’s obesity put him at risk for, and they were already beginning to emerge.
Childhood obesity has more than tripled in adolescents in the past 30 years, increasing from 5% to 18%. In 2010, more than one third of children and adolescents were overweight or obese. Besides the major diseases that rise with obesity, there are the stigmas and teasing and lack of energy and involvement in physically demanding activities that often are the further unwanted baggage of obesity and overweight.
We got Sam and his mom scheduled with one of our nutritional counselors as well as our wellness nurse who helps put together a lifestyle of movement and exercise that will work for a given person. Sam and his mom both got on board with a number of healthy changes. Sam had begun to get in some walking and then running, partly through school activities. He had gone from frequent giant sweet teas to less frequent small ones. He halved the portions of a lot of the carb-heavy snacks he was having. All in all he didn’t feel deprived but was learning to make better choices, and his mom was making sure that his available choices at home and in his lunch were healthy.
The result was that Sam, in four months had dropped about 18 pounds (roughly a pound a week). His liver enzymes had gone back to normal along with his triglycerides. Sam’s total cholesterol had dropped, his good cholesterol went up and his bad cholesterol went down. Blood pressure had completely normalized. Beyond that, Sam’s digestive problems had nearly resolved, his energy was back, and he felt great about it all. What’s more, he was putting in place habits that would serve him well for a lifetime.
These are some of the most satisfying visits for me as well – to identify habits that are feeding into several disease processes, especially when this can be done early on, and to then help to effect real change. We can only put tools in people’s hands; it is the Sam’s and Sam’s moms (and dads!) who do the real work of using those tools to make things happen. And of course that doesn’t always happen. But every time that it does, to quote Sam, it’s “awesome!”
Andrew Smith, MD is board-certified in Family Medicine and practices at 1503 East Lamar Alexander Parkway, Maryville. Contact him at 982-0835