Overall obesity rates for American kids may have leveled off, but a new report finds that children and teens at the far end of the spectrum are getting heavier, faster -- with about 5 percent now classified as “severely obese.”
That means nearly 4 million U.S. youth fall into a new category of obesity risk, one that carries dangers of serious disease and early death, even beyond expected harms, according to a scientific statement published Monday by the American Heart Association.
“It appears that severe obesity is the fastest-growing subcategory of obesity in youth,” write the authors in the report published in the journal Circulation.
Worse, when children get that big, it’s difficult to help them lose weight with traditional tools of diet and exercise, or even with drugs and surgery.
“Once this problem gets so severe, there’s no turning back, or there’s no turning back easily,” said Dr. Thomas Inge, a co-author of the paper and director of the Center for Bariatric Research and Innovation at Cincinnati Children’s Hospital Medical Center. “People don’t like to hear that and they don’t like to know that.”
Severely obese kids have higher rates of weight-related disease, including type 2 diabetes and cardiovascular disease, with complications such as high blood pressure and hardening of the arteries. Previous research has shown that obese kids as young as age 10 can have the arteries of middle-aged adults.
The new class encompasses kids ages 2 to 19 who have a body-mass index, or BMI, that’s 20 percent higher than the 95th percentile for their gender and age, or a BMI score of 35 or higher. A child or teen in the 95th percentile weighs more than 95 percent of others his or her age.
For example, a 7-year-old girl of normal height who weighs 75 pounds, or a 13-year-old boy of average height who weighs 160 pounds would be defined as severely obese, the AHA said.
The new category was “born out of necessity” as doctors and health workers have seen more kids with weights literally off the charts used to measure the ratio of height to weight, said Inge. About 45,000 12- to 19-year-olds in the U.S. have BMIs of 50 or higher, the data showed. That translates to a 5-foot-4 person who weighs 291 pounds.
(BMI is a measurement based on weight and height. For adults, a BMI of 18.5 to 24.9 is considered normal. A BMI of 25 to 29.9 is considered overweight and a BMI of 30 or greater is considered obese. For kids, doctors use growth charts based on age and gender to calculate BMI. Children between the 85th and 95th percentiles are overweight; those at the 95th percentile and above are obese.)
The new report comes amid ongoing evidence that overall obesity rates among U.S. adults and kids have held steady for several years, with about 36 percent of adults and 17 percent of youngsters classified as obese.
“Severe obesity is an emerging problem with enormous medical, public health and economic consequences,” said Dr. Geetha Raghuveer, a pediatric cardiologist at Children’s Mercy Hospital in Kansas City, who has studied hardening of the arteries in kids and teens. “We should not be lulled into ignoring this due to the recent flattening of the obesity prevalence.”
Researchers reviewed data from several cycles of the federal National Health and Nutrition Examination Survey, or NHANES, and from more than 700,000 kids in a Kaiser Permanente database in Southern California. The numbers show a steady rise in severe obesity among kids, climbing from 1.2 percent in 1976-1980, to 3.0 percent in 1988-1994, to 4.9 percent in 1999-2004.
It’s risen beyond that, too, with some studies suggesting that the range of severely obese children and teens varies from 4 percent to 8 percent, Inge added.
“We need to look at these new metrics and realize that it really does have to be something that is taken seriously,” he said.
That’s exactly what Joe Hattery, a 17-year-old high school senior from Strongsville, Ohio, has done. He posted a BMI of 37.8 last year when he entered a program overseen by Dr. Naim Alkhouri, director of the Pediatric Preventive Cardiology and Metabolic Clinic at Cleveland Clinic’s Children’s Hospital.
"He's not the heaviest I have," said Alkhouri, who said he worries that his young patients have higher risk of disease and death. "I have one kid with a BMI of 65."
Joe had been heavy since he was a toddler, said his mom, Martha Hattery, who blamed a family diet of fast food, fried chicken and cookies and milk every night before bed. They’ve now changed their habits. Dad John Hattery, who suffered a heart attack, has lost 50 pounds and Martha Hattery has shed about 100 pounds.
Since joining the Cleveland program, thanks to a strict high-protein diet and medical oversight, Joe has dropped to a BMI of about 36 -- and it’s going lower.
“I’d never really just buckled down and said I have to fix this,” Joe said. “Being fat sucks. Stopping being fat sucks almost as much, but it’s not as hard as you think.”
Such interventions can work with kids of BMIs of 35, even 40, Inge said. But once youngsters get much heavier than that, it becomes very difficult to get them down to normal weight. The new statement calls for increased research into behavior modification, drugs and surgeries targeted to the heaviest kids.
Even better, health officials agree, would be to start early, limiting fast-food, sugary soft drinks and too little exercise, all habits that contribute to the 2.2 percent of preschoolers who already fall into the new category of severe obesity. Many parents are in denial about their children's weight, studies have shown, but they need to act early, well before kids reach adolescence.
“By the end of the first decade of life, kids are set in their environment and practices and what they eat," Raghuveer said. "There’s really no firm way to handle this problem, except to prevent it in the first place."