Obesity is rising among children and needs a more aggressive multi-pronged approach

The American Health Association (AHA) recent held their annual scientific meeting where leaders and scholars in cardiology shared their knowledge and discussed how to tackle future cardiovascular health problems for both adults and children.

Important on the agenda was how close or not close they are to the AHA 2020 goal to improve the cardiovascular health of all Americans by 20 percent while reducing deaths from cardiovascular diseases and stroke by 20 percent.

{mosads}In the meantime, a recent report by WalletHub quantified the fattest cities in America. It is common and true stereotype that 37 percent of the American adult population is obese.

And, as a pediatric cardiologist, I am particularly cognizant of the negative health consequences of obesity in children.

The epidemic of obesity is rising in children and rising fast. Based on records from the National Health and Nutrition Examination Survey, obesity rates in children aged 2-19 was 10 percent in 1998-1994 and has risen to 17.2 percent for 2013-14. The Physical Activity Council report showed that only 42 percent of the population ages 6 and over participating at least once a week in a high calorie burning activity.  

I see this pattern in my own clinic patients. My primary role as a pediatric cardiologist is to diagnose and care for infants who are born with a structurally abnormal heart that often needs surgical intervention. But, I am now evaluating more children who are obese and have the consequences from it (such as high blood pressure and high cholesterol). Pediatricians refer these patients to be because they want to make sure there is not an underlying more serious heart problem.   

At these visits, I start by obtaining a medical and social history. I perform a physician exam and obtain an electrocardiogram.  Sometimes, I order an ultrasound of the heart. In the majority of cases, I counsel the family and the patient that there is no primary heart problem. I have given the best news possible. And this is when the room becomes quiet. Families often express relief but are left wondering, “What next?  What do we do with the obesity and hypertension and high cholesterol?”

Families and pediatricians are looking for help from experts. This is a new and critical area in health care that needs a more aggressive multi-pronged approach including research, training experts, and creating multidisciplinary clinical approach.

The AHA is acutely aware of this and has developed Strategically Focused Research Networks for children that focus on obesity and prevention. The goal of this $15 million initiative is to bridge the gap in heart-health knowledge between birth and early adulthood and to tackle childhood obesity by understanding its genetic influences and developing effective interventions.

However, in addition to research, we must train pediatricians, pediatric cardiologists, and other health care providers in preventive medicine.  These trained experts can focus on providing care for children who are at risk for obesity or are already obese and have sequelae such as hypertension, hyperlipidemia, early coronary artery disease, and diabetes mellitus. One way to do achieve this is through engaging and encouraging pediatric trainees to pursue Preventive Medicine training.

In the actual clinical practice setting, we need to develop comprehensive, multidisciplinary, clinics that address childhood obesity. A family and a patient needs a physician, but they also need a social worker, a nutritionist, and a physical education prescription to approach obesity through a holistic approach.

To be sure, obesity prevention is not easy. To make meaningful change requires a great deal of resources. However, we have data that states that better cardiovascular health is associated with lower health care expenditures.  

There is a well-known quote by Benjamin Franklin that I was indoctrinated to when I studied public health: “An ounce of prevention is worth a pound of cure.” We must invest right now in preventing obesity-related negative health consequences in children.

Angira Patel, MD, MPH, is assistant professor of pediatrics and medical education and a member of the Center for Bioethics and Medical Humanities, both at Northwestern University Feinberg School of Medicine, a pediatric cardiologist at Ann & Robert H. Lurie Children’s Hospital of Chicago, and a Public Voices Fellow.