October 16, 2023 – The incident happened years ago, but MaKenna Schmidt, 18, of Otsego, MN, still remembers it intimately. “We were on the bus and this girl said, 'You look pregnant,'” Schmidt recalled. “I was about 8.”
“I used to be really upset about it. It definitely stays with me.” She can easily recall other hurtful comments, including a classmate who told her she was fat and another who pointed out that her stomach was big. “In gym class we had to run the mile. I was always last. I was very embarrassed.”
Since then, Schmidt has sought medical help, learned to eat healthier and lost weight. She has now lost 30 pounds and is still trying to lose excess weight.
Today, many other children and young people are likely to be confronted with insults similar to Schmidt's. Obesity affects about 14.7 million Children and adolescents, nearly 20% of the population of this age, according to the CDC. (Children whose weight is 95Th In the United States, national childhood obesity rates rose from the 1970s to the early 2000s condition of obesity in children, Although rates have increased more slowly since then, childhood obesity is still a serious public health problem.
While medical experts have viewed the problem as an epidemic and a crisis for years, some now say it's time to pay even more attention to the situation, sooner rather than later.
- In a recent opinion piece published in the magazine pediatrics, Three obesity medicine experts suggest the U.S. should carefully weigh the pros and cons of obesity Explanation of childhood obesity a public health emergency.
- Earlier this year, the American Academy of Pediatrics released its first-ever study comprehensive guidelines for the assessment and treatment of children and adolescents with obesity. It says pediatricians should not “watch and wait,” but rather intervene earlier and use options like newly approved anti-obesity drugs when necessary. It is also emphasized that family treatment works best.
Overweight children, overweight adults
Research shows that letting children with obesity “grow out of it” probably won’t work. A review of published studies involving more than 200,000 people focused on obese children and adolescents five times are more likely to be obese in adulthood than those who were not obese as children and adolescents.
Faster and more intensive intervention, experts say, could save children from lifelong obesity and, in turn, reduce the risk of obesity Risks associated with obesity such as high blood pressure, high cholesterol, type 2 diabetes, coronary heart disease, stroke, sleep apnea and osteoporosis.
Childhood obesity as a public health emergency
Declaring childhood obesity a public health emergency has never been proposed to his knowledge, said Eric Bomberg, MD, assistant professor of pediatrics at the University of Minnesota and associate director for research informatics at the university's Center for Pediatric Obesity Medicine. He was co-author of the Pediatrics Opinion piece. He stressed that for now, he suggests that experts consider the pros and cons of the idea before moving forward.
Under the Public Health Service Act, the Secretary of the U.S. Department of Health and Human Services may declare: health emergency if an illness or disorder warrants it. “There are definitely arguments for and against,” Bomberg said. “We know this disease is rampant.”
Among the arguments for this:
- Public health emergencies have been declared for diseases that affect far fewer people, such as the opioid addiction epidemic.
- Emergency declarations have helped with many illnesses in the past, including COVID-19.
The counterarguments include:
- Resources would be necessary and could distract from other efforts such as opioid addiction.
- Calling the obesity epidemic an emergency could stigmatize weight even more.
- The public may view another health emergency as “one too many” and not pay much attention to it.
Bomberg's conclusion: “I feel it needs to be considered,” but it wouldn't be helpful to declare it a public emergency without first suggesting what to do about it and thinking it through thoroughly. “I think it needs further investigation,” he said.
While the idea is becoming more discussed, new guidelines from the American Academy of Pediatrics have “absolutely moved things in the suitable direction,” Bomberg said.
Academy Guidelines: “Watchful waiting” is discouraged
These first comprehensive guidelines demonstrate that obesity treatments are safe and work well, and urge pediatricians to act sooner rather than later.
“There is not any evidence that 'watchful waiting' or delayed treatment is suitable for youngsters with obesity,” said Dr. Sandra Hassink, co-author of the guidelines and vice chair of the Academy's Clinical Practice Guidelines Subcommittee on Obesity, in a press release.
Doctors should consider prescribing weight-loss medications such as semaglutide (Wegovy) to people age 12 and older with obesity, taking into account weight, risks and benefits to complement lifestyle treatments, the guidelines say.
The suggestion of opting for weight-loss medications hasn't gone down well with some doctors, Bomberg said. But Schmidt, the freshman who remembers being insulted because of her weight, said they worked for her.
She now takes semaglutide and credits it with helping her lose 30 pounds. At her peak weight, she said, she weighed 223 pounds. Now, at 190, she is going from being classified as obese to being overweight.
Bomberg recalled another patient who had followed diet and exercise plans without sufficient success and then added an anti-obesity drug. He lost more than 50 pounds in about 3 months. “When I saw him yesterday, his mother was literally crying,” he said.
Family centered approach
The guidelines say a long-recommended, family-focused approach to weight loss remains important. One such program that involves families is the Healthy Weight Clinic at Children's Hospital Los Angeles, which sees children as young as 2 years old.
The approach is compassionate. “We want parents to know that it is not their fault that their child lives in a larger body,” said Dr. Alaina Vidmar, pediatric endocrinologist and obesity physician and medical director of the Healthy Weight Clinic. “This is a disease and we are here to support you and give your child all the tools they need to live a long and healthy life.”
“We give tips around nutrition and really look at food as medicine,” she said. Advice on activities, anti-obesity medications and referrals for obesity surgery are also part of the program, Vidmar said. “We must remember that there is no cure for childhood obesity. The goal of treatment is not the number on the scale or body size. The goal is to enable these young people to live long, healthy lives and prevent life-limiting complications.”
The nutrition tips are often needed by working parents who find it impossible to get a healthy dinner on the table every night. Schmidt said she grew up with her sister and single mother, and her grandmother often looked after her.
The schedules were full. “We often ate fast food for dinner or had my grandmother prepare something simple and cheap.” Both her mother and grandmother struggled with weight problems, she said, and now her younger sister has, too. Now that she's in college, Schmidt said she has more control over her food choices and has learned to choose healthier options.
Experts weigh in
Neither the American Academy of Pediatrics nor the Obesity Society support the question of whether childhood obesity should be declared a public health emergency.
The main goal for now is to “increase the conversation about childhood obesity and frame it in a way that individuals aren't used to,” said Aaron Kelly, PhD, co-chair of the Obesity Society's Pediatric Obesity Task Force, a Professor of Pediatrics and Co-Director of the University of Minnesota Center for Pediatric Obesity Medicine. There needs to be more awareness and conversations, he said.
Lifelong effort
After educating herself about obesity as a disease, Schmidt said she knew her weight control efforts must continue. “I feel prefer it's still a piece in progress,” she said of her weight loss, “but I'm definitely attending to a greater place.”
Her determination is clear. “I will always have to work at it,” she said.