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Center for Healthy Weight offers unique solutions

With a rise in pediatric obesity, Packard center provides comprehensive care

BY KRISTA CONGER

Overweight and obese children face an uphill battle to control weight and minimize medical consequences of their condition. Although recent reports show an alarming increase in affected children, strategies for dealing with the problem are lacking.

Lucile Packard ChildrenÂ’s Hospital is developing a new Center for Healthy Weight to provide a comprehensive program to prevent and treat obesity and the related medical fallout that comes hand-in-hand with excess pounds.

“A lot of physicians feel powerless when it comes to dealing with children and obesity,” said center director Tom Robinson, MD. “The center will focus on providing solutions by linking basic science, clinical research, medical care and community-based prevention. We’ll continue our work with community health programs and form new partnerships to create healthier environments for children while providing comprehensive care for overweight kids.”

Prevention and solutions to childhood obesity are urgently needed. Although extra pounds are not yet a leading cause of death, they do increase the risk of life-threatening problems in adolescence and adulthood. A rising prevalence of childhood obesity has led the U.S. Centers for Disease Control and Prevention to estimate that 1 in 2 African-American and Hispanic children and 1 in 3 of all children will develop type-2 diabetes in their lifetimes. Obesity-related conditions are already responsible for about 400,000 deaths annually, trailing only smoking as the leading cause of death in this country.

“Now insulin-resistance, which is a type of pre-diabetes, kidney and liver damage, and orthopedic problems are starting to affect children as well,” said Robinson, associate professor of pediatrics and of medicine. “And the morbidity seems to be much worse than in adults. Children are living with this excess fat in their organs from very early ages.”

“Obesity is the biggest epidemic we face,” said Packard chief of staff Harvey Cohen, MD. “Even those obese kids who escape medical problems during childhood will likely have problems as adults. Mortality from tobacco, alcohol and traffic accidents will pale in comparison.” Cohen is also the Arline and Pete Harman Professor for the Chair of the Department of Pediatrics.

“Packard Children’s Hospital is unique in terms of our expertise across so many disciplines,” said Robinson. “We have state-of-the-art clinical facilities in which we provide primary care management and assessment for obesity risk factors. We also conduct clinical research into different nutritional therapies and new pharmacological treatments.”

“Our mission will be to provide a comprehensive, multidisciplinary evaluation of significantly overweight patients,” said Lawrence Hammer, MD, medical director of the hospital’s ambulatory care center and professor of pediatrics.

“Some will need evaluation of co-morbidities such as type-2 diabetes or obstructive sleep apnea, and others may need ongoing monitoring. Each patient will receive a complete initial evaluation by general pediatric or adolescent medicine staff, including a review of past history and a physical exam that includes diagnostic testing, a meeting with a dietitian and the development of dietary and activity goals. We will also work closely with our colleagues in child psychiatry to address psychological impact,” said Hammer.

Cultural and ethnic differences among population groups can affect obesity prevention and treatment efforts. Understanding and working within these differences will be important goals for the center. “Ethnic and social differences need to be addressed,” said Cohen. “Unless we work within the expectations of the different communities from which these kids come, we are not going to be effective.”

Occasionally a severely obese patient may need more aggressive treatment in order to prepare for an upcoming surgery or because the patient’s condition is not responding to traditional treatment. “Aggressive low-calorie diets can be effective and safe if medically supervised,” said Hammer, “and if bariatric surgery is necessary to control weight gain, we are in the right place to evaluate, manage and standardize the procedure.”

“There is a small number of teens for whom bariatric surgery may turn out to be their best or only option,” said Robinson. “The reason we’re considering these measures is the growing number of teens with life-threatening obesity. It behooves us to evaluate the potential benefits and harms of much more intensive treatments.”

But Robinson, Cohen and Hammer would prefer to root out the problem at its source, before it has a chance to tighten its grip on affected children. “Prevention is clearly better than treatment,” said Cohen. “This effort is more of a marathon than a sprint. We’re in this for the long haul.”