SAN ANTONIO — Recommend only one or two changes at a time in diet and physical activity to help severely obese adolescents improve their health and quality of life, Dr. Mary L. Brandt advised.
Incremental increases in physical activity and small but consistent changes in diet, including smarter fast-food choices, are good starting points, she said at the annual meeting of the North American Society for Pediatric and Adolescent Gynecology.
In assessing the teen's degree of obesity, BMI is important. “I strongly feel all physicians should know the BMI of every patient in their practice. BMI is a way to understand the degree of obesity. The concept is that 200 pounds is okay if you are 6 feet 6 inches, but not if you are 5-feet tall,” Dr. Brandt said.
The adverse health effects of obesity can be considerable. For example, approximately 50% of overweight adolescents have at least one risk factor for cardiovascular disease, and about 20% have two risk factors (Circulation 2009;119:628-47; Am. Fam. Physician 2008;78:1052-8). These patients are at higher risk for insulin resistance, hyperlipidemia, hypertension, and sleep apnea, said Dr. Brandt, professor of surgery at Baylor College of Medicine in Houston.
The unfavorable health effects of obesity can also shorten life expectancy (JAMA 2003;289:187-93). If an individual is morbidly obese (a BMI of 45 kg/m
Obese adolescent patients are heartened to learn that their ancestors are partly to blame. It helps alleviate some of their guilt and shame. “I tell all my obese patients that what they are doing is what human beings are supposed to do. We are genetically programmed to store fat,” she said. About 40%-70% of BMI can be attributed to genetics.
Sex differences also play a role in obesity. The health risk at any level of obesity is higher for boys than for girls. “This has to do with where the fat is, not how much [there is],” Dr. Brandt said. The sex difference in fat distribution starts before puberty.
Another way to deal with obese adolescent patients is to address the 30%-60% of BMI that is caused by factors other than genetics, she said.
Start with the “low-hanging fruit” when counseling teen patients and families about diet and physical activity. For example, begin with what the patient drinks every day. “If you tell a kid they cannot have something, it will not work. If they drink four Cokes a day, see if they will commit to drinking only two or three instead,” she said.
Ask about the patient's diet in a nonjudgmental way, she recommended. Talk to a child or adolescent who eats a lot of fast food about smart choices. For example, the difference between a Double Whopper with cheese (1,010 calories) and a hamburger (290 calories) at Burger King is 720 calories, according to the company's Web site.
Also, “the traffic light diet” works well with kids. Tell them there are “foods that are good [green light], things you need to watch [yellow light], and things you should never have [red light]. I have them pick one change for each of the three categories that they will commit to,” Dr. Brandt said. This diet plan is feasible and significantly decreased BMI in pediatric patients compared with treatment as usual in one study, she added (J. Pediatr. Psychol. 2007;32:106-10).
Decreased teenage physical activity also plays a major role in obesity, with the effect more pronounced in girls than boys, Dr. Brandt said. “We see more overweight girls than boys. What they are eating is about the same, but what they are burning is different.”
“We have to figure out ways to encourage girls to play sports, including safe venues outside the home,” said Dr. Brandt, who is also director of the Texas Children's Hospital adolescent bariatric surgery program in Houston.
'If they drink four Cokes a day, see if they will commit to drinking only two or three instead.'
Source DR. BRANDT