Last year in our November/December issue (click here to see article: www.parkhurstexchange.com/columns/pediatrics/nov10_diabetes-in-children) I discussed the alarming increase in type 2 diabetes in the pediatric population and its strong link to the epidemic of obesity. This month’s issue is again partly devoted to the important theme of diabetes, so I’ve decided to discuss an approach to childhood obesity that hopefully will impact on the incidence of diabetes in kids, adolescents and adults. Because obesity is associated with diabetes, cardiovascular disease and the metabolic syndrome, any advancement primary care physicians can make on obesity will have a profound impact on the future health of pediatric patients. The graph from The Economist on the facing page shows the world-wide extent of the obesity problem.
All is not lost
Although this chart is for adults, it can be extrapolated to the pediatric population. The prevalence of obesity has tripled for children 2-5 and 12-19 years and quadrupled for those 6-11.1 I won’t “flog a dead horse” as we’re all aware of the enormity of the issue. We’re also quite familiar with the abysmal failure the medical profession has had in dealing with this problem. However, we must not give up.
A recent Cochrane review2 examined 64 RCTs (5,230 subjects) examining lifestyle, drug and surgical interventions. There were no RCTs of surgical interventions found. Twelve studies looked at physical activity vs sedentary, six diet, and 36 accounted for behavioural oriented studies. Ten of the trials looked at pharmacological interventions (metformin, orlistat and silbutramine). The authors concluded that “combined behavioural lifestyle interventions compared to standard care or self-help produce a significant and clinically meaningful reduction in overweight in children and adolescents.”2 Clearly, a research project providing an intensive program of behavioural and dietary interventions isn’t possible for the large number of obese children but I believe primary care physicians can make a difference using some simple behavioural modification techniques. What follows is my own idiosyncratic approach, being neither an obesity expert nor a diabetologist. I admit at the outset that my success rate is low but there have been occasional surprises.
Physicians need to spur on policy makers and governments to take action to reduce the sodium, trans fat and other fat content of many foods in the food chain. Perhaps a higher tax on snack foods and soft drinks would help. Advocate for healthy eating choices in school cafeterias and hospitals. Obesity is a problem for all of us, not just the obese patient.
Finally, use the occasion of the periodic health exam to review all aspects of healthy, active living by going to the Canadian Paediatric Society’s web page (www.cps.ca) and clicking on Children’s Health Topics.