A BATTLE FOR BOYS

Robert Denny’s son was just 9 years old when his pediatrician first expressed concern about his weight. “They were worried about his blood pressure and heart condition,” recalls Denny of San Diego, Calif. “He had dark rings around his neck and arms that doctors said were because of his obesity.”

At his heaviest, Justin tipped the scale at 250 pounds and was once deemed ineligible to play football at his position due to his weight. After years of visits with doctors and nutritionists, Justin is now battling against his obesity. Now 16 years old and 5’7” tall, his weight is down to 216 and he’s committed to lose more, says Denny.

Justin is just one of the country’s children who make up the generation’s alarming epidemic of obesity. Recent estimates from the Centers for Disease Control and Prevention (CDC) put the number of overweight or obese children between ages 2 and 19 at 12.5 million or 17%. A number almost tripled from 1980.

The Gender Role

A child’s weight status is determined using an age- and sexspecific percentile for body mass index (BMI) rather than the BMI categories used for adults. Overweight is considered a BMI greater than the 85th percentile on the growth chart and obesity is greater than the 95th percentile.

Research has shown obese children are at higher risk for a host of serious health complications, including high blood pressure and cholesterol, sleep apnea, asthma, type 2 diabetes, and joint problems. But recent headlines suggest obesity may be impacting boys more significantly than their peers.

For starters, the CDC reports that between 1999–2000 and 2009–2010, there was a significant increase in the prevalence of obesity among boys, but not girls. In 2010, 18.6% of all boys were obese compared with 15% of girls.

In the November 2012 issue of Obesity Review, a review of six studies including more than 18,000 children found obese boys were significantly more likely than obese girls to develop asthma.

Another study in the Archives of Pediatric and Adolescent Health reported that obese boys are also twice as likely as boys of normal weight to have puberty delayed beyond the age of 11½.

So are parents of obese boys aware of these potential health risks?

Elizabeth Parks Prout, MD, of Children’s Hospital of Philadelphia’s (CHOP) Healthy Weight Program, says parents understand the risks but not all take action right away.

“I think what tends to happen is that it’s more socially acceptable to have a boy who is larger than a girl who’s larger,” Parks Prout says. “For some boys, there’s even some resistance to lose weight because it provides them a sense of safety in terms of being heavier allows them not to be pick on or bullied.”

Bullying, however, is a serious issue for many overweight boys, and researchers are beginning to look at the emotional toll it has on teen boys.

A recent study in the Journal of Adolescent Health revealed teenage boys who are overweight or obese scored lower than obese teenage girls on quality of life questionnaires about their emotional, social, and school functioning.

Bamini Gopinath, PhD, lead author of the study from University of Sydney, Australia, says the reasons for the difference are unknown, but she speculates it might be because of the importance of sport in boys’ social lives. “If obesity is limiting their participation in sports, it might negatively affect their social functioning and/or physical functioning, both of which are measured as part of the total quality of life score,” Gopinath says.

Chrystal Wittcopp, MD, director of Baystate Children’s Hospital Pediatric Weight Management Program, Springfield, Mass., says, however, she doesn’t see a noticeable difference between her boy and girl patients. Both have body image issues and tend to be bullied about their weight.

“Boys don’t talk about their weight as much and may internalize their feelings more than girls,” Wittcopp says. “But for all obese adolescents, there is a significant impact on mental health as long as their obesity continues.”

An Encompassing Approach

Mental health counseling is a vital component of the weight management programs at both Baystate Children’s Hospital and CHOP. Both programs include sessions with physicians, psychologists, nutritionists, and a physical activity coordinator. And both make treatment a family affair.

“One of the biggest risk factors of obese children is having one or both obese parents,” explains Bay-state’s Wittcopp. “Some of it has to do with lifestyle within the family so any changes we recommend for young kids involves the parents.”

“We want the entire family to get more activity, change their intake, get rid of sugar-sweetened beverages, and drink 1% or skim milk,” she adds.

Parks Prout agrees. “At CHOP, our program never includes just changes for the child, it’s changes for the entire family,” she says. “In the initial visits, parents are also asked to track their food intake as well as the child’s so they understand they are a partner in the process.”

Children treated at Baystate typically spend two years in the program, with the intensive first phase lasting six months. After that, patients attend monthly maintenance group sessions, which they are welcome to attend for the rest of their lives.

“Patients’ weight loss goals depend on their starting weight, age, and their motivation,” Wittcopp says. “Of course, we’d like everyone to get less than the 95th percentile, but we know that with a 7–10% decline in BMI, they’ll have significantly improved health benefits, so that’s a good achievement of success.”

The Surgical Solution

For some teens with BMIs over 35, bariatric surgery has become a necessary option to treat substantial obesityrelated health problems. As the first and largest bariatric surgery program facility for adolescents, Cincinnati Children’s Hospital has performed laparoscopic gastric bypasses and sleeve gastrectomies on 205 teens since 2001, according to Thomas Inge, MD, PhD, surgical director of the Surgical Weight Loss Program for Teens.

Sleeve gastrectomy is the latest surgical technique used to treat obesity, in which about 85% of the stomach is removed, leaving just a narrow tubular stomach that becomes full with only a one-half to a cup of food, says Inge.

And while national statistics show obesity rates higher in boys, at Cincinnati’s Children’s, there is a significant difference in which gender seeks help through surgery. Girls make up 75% of the patients—just 53 of the 205 teens operated on since 2001 have been boys.

Before surgery, there is a six-month program during which teens must adhere to lifestyle modifications such as taking vitamins, controlling calorie intake, and increasing physical activity. And while teens are not instructed to lose weight during the pre-op period, one rule is firm—they cannot gain any weight.

“We look for signs that they can adhere to a different lifestyle and we don’t proceed with surgery if the family and child cannot put the basics of the healthy lifestyle into action in the six-month period,” says Inge.

Th e average weight of patients at time of surgery is 382 pounds with an average BMI of 59.5. At three months postsurgery, patients have an average weight loss of 75 pounds. Within 12 months, the average loss is 141 pounds. Inge says, however, that there is still more to learn about bariatric surgery for teens.

“There are a lot of unanswered questions. For instance, what procedure, bypass, sleeve, or band should we be recommending and why? On balance, is one superior from the standpoint of treating obesity-related health conditions, nutritional risks, weight loss, and durability of weight loss?”

Inge believes that several long-term clinical studies now being conducted will help provide answers to these questions. He is the principal investigator for Teen-LABS (Teen-Longitudinal Assessment of Bariatric Surgery), a study that follows 250 teens for up to five years who had weight loss surgery at five participating hospitals.

On Track

Back in San Diego, Justin Denny is banking on the old adage of “eat less, move more” to achieve his normal weight. He exercises at the gym with his father or personal trainer four days a week and follows a healthy diet suggested by a nutritionist.

“What changed is that Justin became concerned about his own weight,” says his father Robert. “It all turned around when he took control and wanted a better lifestyle.”

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