outlook: OBESITY epidemic

APRIL 01, 2007
Susan Farley

Surgery May Be Complicated for Overweight, Obese Kids

Just as obese adults face potential complications when they undergo surgery, obese and overweight children are facing the same problems when they have surgery. According to a recent study, nearly one third of children undergoing surgery are overweight or obese, making them high-risk surgical candidates.

To investigate this trend further, Olubukola O. Nafiu, MD, FRCA, and colleagues at the University of Michigan Medical Center reviewed the cases of 6017 children who had surgery at the University of Michigan Hospital between 2000 and 2004. In those kids, the overall prevalence of overweight and obesity was 31.5%; 10% were obese, and 4.5% were morbidly obese. The researchers were surprised to find that many of the obese and morbidly obese children were classified as healthy patients with no increased surgical risk, which is contrary to reports that show that certain surgical complications occur more often in obese people than in normal-weight people. These surgical complications that obese children face may include breathing difficulties, postsurgical upper airway obstruction, and the need for more antiemetic medication. Complete results of their data review appear in the Journal of the National Medical Association.

Extra Weight May Lead to Foot Problems for Kids

Children who are carrying extra weight may be vulnerable to foot problems that could cause permanent damage. Foot and ankle surgeon Darryl Haycock, DPM, noted that children's feet are not fully developed until "age 14 or 15 for girls, 15 to 17 for boys," meaning that their bones are "easily moldable." According to Dr. Haycock, "When there is an increased amount of weight and stress being placed on the foot, it can cause some significant changes in foot structure.

He further noted that as few as 15 to 20 extra pounds can lead to fallen arches and inflammation of the growth plate in the heel. Treatment for these foot problems generally starts with the use of orthotics and physical therapy, and if those approaches do not work, then surgery is recommended. Dr. Haycock's remarks appeared in a January 17, 2007, press release from the American College of Foot and Ankle Surrgeons.

Researchers Examine Weight-loss Surgery in Children

As more obese adults are turning to weight-loss surgeries to help combat obesity, obese children are also undergoing surgery to remedy excessive weight.

In response to increasing interest in weight-loss surgeries for this young patient population, 4 hospitals will begin a large-scale study this spring to examine how children respond to the different procedures, such as gastric bypass and gastric banding. Three other hospitals recently received FDA approval to determine outcomes for teenagers who undergo laparoscopic gastric banding.

To demonstrate the potential that gastric banding has for young patients, New York University Medical Center conducted a study of 53 boys and girls, aged 13 to 17, who underwent the surgery and lost nearly half their extra body weight with relatively minor complications. A similar study is being conducted at the Morgan Stanley Children's Hospital of New York, which houses a weight-loss surgery center for teens and anticipates performing about 50 such operations this year. Critics of weight-loss surgery for children are concerned about the long-term effects,which are not yet known, as well as the effects of altering the digestive tract of young people.

The Associated Press ran the complete article on February 5, 2007.

Low-income Hispanic Children More Likely to Be Obese

New research on childhood obesity, focusing on poverty and its correlation with kids at risk for obesity, has found that Hispanic children are at the highest risk for obesity (see Table). While researchers could not explain why more Hispanic children were overweight, compared with white and black children, they did find an important predictor: if a child was still using a bottle at the age of 3, the child had a greater likelihood of being overweight in preschool.

Lead researcher Rachel Kimbro of the University of Wisconsin at Madison used study data on more than 2000 3-year-olds from low-income families in 20 large US cities. Data showed that 32% of the white and black children were either overweight or obese, compared with 44% of Hispanic children. After reviewing factors such as television habits and mothers'access to grocery stores, researchers were unable to account for the discrepancy.

Study results were published in the online version of the American Journal of Public Health.

Ms. Farley is a freelance medical writer based in Wakefield, RI.