Cleveland_Clinic_Host: Today's live chat with Dr. Ellen Rome is about pediatric obesity. Almost one out of every five children in the United States is overweight, and this number is continuing to grow.
The percentage of overweight children has more than doubled in the last 30 years. Children have fewer weight-related health and medical problems than adults; however, overweight children are at high risk of becoming overweight adolescents and adults, placing them at risk of developing chronic diseases such as heart disease and diabetes later in life. Children become overweight for a variety of reasons. The most common causes are genetic factors, lack of physical activity, unhealthy eating patterns, or a combination of these factors. During today’s chat, Dr. Ellen Rome will discuss Treating and Preventing Adolescent Obesity.
Cleveland_Clinic_Host: Ellen Rome, MD, MPH, currently serves as Head of the Section of Adolescent Medicine at Cleveland Clinic. She is a board-certified Pediatrician who was also among the first in the United States to be board-certified in adolescent medicine. Dr. Rome received her undergraduate degree in psychology, magna cum laude, from Yale University in 1984. She received her medical degree and was initiated into Alpha Omega Alpha in 1988 from Case Western Reserve University School of Medicine, then completed an internship and residency in pediatrics at Johns Hopkins Hospital. She next completed a three-year fellowship in adolescent medicine at Children’s Hospital, Boston, during which time she also obtained a Master's Degree in Public Health at the Harvard University School of Public Health.
Dr. Rome currently serves as an Associate Professor of Pediatrics at the Cleveland Clinic Lerner College of Medicine of Case. She helped start the first Adolescent Health track at the new School of Public Health at Case Western Reserve University, and coordinates the Adolescent Medicine rotation at Cleveland Clinic for residents and medical students.
She is active on the board of the North American Society for Pediatric and Adolescent Gynecology, as well as on the board of the Federation of International Pediatric and Adolescent Gynecology. She chaired the 2005 and 2007 national courses on Adolescent Medicine: PREP The Course, and has chaired the Media Committee for the Academy for Eating Disorders.
Dr. Rome is an advocate on the epidemic of children and obesity in today’s society, the risks associated with childhood obesity, and how we as parents, educators, and community members can help curve the scale. The effects of childhood obesity are many and varied. Obesity in childhood has been identified as an independent risk factor related to other serious health conditions.
Dr. Rome’s research interests include obesity and eating disorders, preventive medicine and reproductive health. She has been an invited speaker locally, nationally and internationally on various topics in adolescent medicine, while maintaining a commitment to ongoing teaching of house staff and students in the local and surrounding areas. She has written and published on various adolescent medicine topics, including obesity and eating disorders, the female athlete triad, nutrition for the teen athlete and adolescent sexuality.
Cleveland_Clinic_Host: For more information regarding adolescent obesity at Cleveland Clinic Pediatric Institute and Children’s Hospital, please visit us on our website clevelandclinic.org/kids or call us locally 216.444.KIDS (4-5437) or toll free 800.223.2273 ext 4-KIDS (45437).
Adolescent Obesity Overview
Cleveland_Clinic_Host: Welcome to our Online Health Chat with Ellen Rome, MD, MPH. We are thrilled to have Dr. Rome here today for this chat. Let’s begin with some general questions about adolescent obesity.
nystrom: How would you define obesity as it relates to children? Is it defined as BMI as it is in adults?
Speaker_-_Dr__Ellen_Rome: Obesity in children occurs when a number of things happen.
- Energy intake > energy expenditure
- Body Mass Index = wt (kg)/(ht in meters)2
- An ideal BMI for teens and adults is BMI 20-23
- 120% of more of ideal body weight or BMI > 95% defined as obese
- BMI > 30 = obesity in teens and adults
- BMI >95% = obesity in younger children
nystrom: What are the primary causes of obesity in this young age group?
Speaker_-_Dr__Ellen_Rome: The main cause of obesity in children & adolescents is energy intake exceeding energy expenditure. An example would be the toddler being chronically overfed starting to choose more than his energy needs. Children and adults do the same. We can train ourselves to want and eat more than we need.
Dieting in unhealthy ways actually increases risk of obesity. If you are getting, for instance, <1500 calories as a child or adolescent you are likely to slow your metabolism down and trigger a binge response which will lead to an eventual increase in weight.
Adolescent Obesity Heredity
Callie: How big a factor is hereditary in obesity? I am obese, and was as a teenager, but my children are not. They are not skinny either. What can I do to help prevent them from turning out like me?
Speaker_-_Dr__Ellen_Rome: Genetics loads the gun. The environment aims and fires.
To keep your children from becoming obese adults, you can teach them healthy eating habits. This means 2-3 servings of protein per day with the definition of one serving meaning 3 ounces of meat, fish, chicken etc or 2 tablespoons of Peanut Butter.
They also need 30-50 grams of fat per day for a low fat diet. Less than that is considered unhealthy for brain development.
They should aim for 5 a day fruits and veggies. And they should have 4 dairy servings a day or the equivalent in calcium. One 500mg calcium pill or chew is around the same as 2 dairy servings.
Adolescent Obesity & Prevention
denwallaby: As a physician, what things do you look for in a child that would indicate obesity is or will become an issue in the future? How do you counsel them? Should the parent be present – or do you meet with the teen and parent separately?
Speaker_-_Dr__Ellen_Rome: As a physician we follow growth patterns and growth charts including BMI. When BMI starts tracking above the 85th percentile, the astute clinician and parent should start engaging in wellness discussions to encourage healthy lifestyle and healthy choices.
We want each child to know that they are AWESOME and that our job is to keep them well as they move forward. Shame, guilt and negative comments impact self-esteem in ways that increase the child’s risk of ongoing weight gain and obesity.
Youth and family empowerment using simple messages that they can manage with close medical follow-up has been shown to have more success.
The simple messaging we use at Cleveland Clinic can serve as a countdown to health. 5-4-3-2-1-0-Go:
- 5-Eat five fruits and veggies a day
- 4-Consume four dairy a day
- 3-Give and get three compliments a day.
- 2-No more than two media hours a day
- 1-At least one hour of exercise a day.
- 0-NO sugar-sweetened drinks, ever.
- Go-Be well, inside and out.
felix: At what age do you need to start worrying about your child’s extra weight turning to obesity? My son is 10 and overweight, but not obese (and healthy). He is fairly active, especially during the summer.
Speaker_-_Dr__Ellen_Rome: We start worrying and watching at one year of age especially as the infant starts moving. Food is not always the right answer for a fuss.
Ginilbo: What is the best way to lose weight?
Speaker_-_Dr__Ellen_Rome: The best way to lose weight is to start with a 1500-1800 calorie diet for most adolescents or adults, one hour of exercise a day and make sure that you are getting all the necessary food groups in so that you can keep your metabolism going. A balanced approach works best.
Adolescent Obesity: Risks and Complications
nystrom: Would you talk about the risks and complications associated with obesity at such a young age?
Speaker_-_Dr__Ellen_Rome: Why do we care about the risks when the child is so young? There are a number of conditions associated with obesity.
- Hypertension (2.9 x higher in obese)
- Diabetes (2.9 x higher in obese)
- CAD (coronary artery disease)
- Hypercholesterolemia (2.1x higher)
- Other hyperlipidemias
- Mechanical stress on joints, SCFE
- Blount’s disease (tibia vara)
- Pseudotumor cerebri
- Hepatic steatosis, cholelithiasis
- Social stigma- depression, low self esteem
Speaker_-_Dr__Ellen_Rome: The risk of adult obesity also exists:
- 14% chance if obese as infant
- 25% chance if obese at preschool age
- 41% chance in obese at age 7
- 75% chance if obese at age 12
- 90% chance if obese in adolescence
sunny32: What about digestive issues causing weight retention and gain? What is recommended for a person with a slow metabolism (under active thyroid) and possible irritable bowel?
Speaker_-_Dr__Ellen_Rome: If you eat <1500 calories per day as a child or adolescent, you slow your metabolism down and make it easier to gain. Moreover, some people with IBS try to fix it with food eating way more than their energy needs would require. Working with your pediatrician and a good dietician can help you make sure your child is getting in the right amount of foods and the right balance to minimize symptoms.
jp3x2: How important is metabolism in weight loss? Is it able to be changed?
Speaker_-_Dr__Ellen_Rome: Metabolism can definitely change. For those who have been substantially restrictive of intake in an unhealthy way, the body will slow down movement through your gut to attempt to find the essential nutrients your body has been missing.
If you start eating the right balance of foods, and getting the right amount of exercise without overdoing it, your body can speed up its metabolism in response.
samantha: Can being overweight interfere with my menstrual period?
Speaker_-_Dr__Ellen_Rome: Your menstrual cycle in some cases can reflect a hormonal imbalance that can indirectly relate to weight gain.
In easy terms, if you skip lots of periods as a teen, you may not be ovulating every month. If you have lots of estrogen running around from normally stimulated egg follicles, but none of the balancing hormone that comes with ovulation (think 'stingy eggs') this estrogen can convert to male hormone or androgen. Androgens pick up the appetite and it is the extra intake that leads to the weight gain.
valery: Is over-eating an addiction? Especially an addiction to sugar?
Speaker_-_Dr__Ellen_Rome: Over-eating can feel like an addiction. So can extreme under-eating. Some people find that certain foods are triggers. Assuming the person can get the right balance of foods in without that trigger, then for some people it can be easy to avoid that specific trigger. The key most often is moderation.
One example commonly cited is sugar. Sugar itself is not a bad or evil food. But if somebody finds that certain forms of sugar lead them down a path to a binge, then it may be easier to eat sugars in the form of simple sugars such as fruits, sugar used in baking a recipe instead of processed sugars. So for that person, skipping the candy and going for the whole grain muffin made with fruit may be a better option.
The caveat is making sure that muffin does not exceed the caloric needs for the overall day. One meal or snack does not obesity make. It is a cumulative process.
Adolescent Obesity & Diet
nathaniel: I have heard a lot about eating small frequent meals being better for you than eating 2 or three. Any merit is this, especially for teenagers?
Speaker_-_Dr__Ellen_Rome: In the olden days we were hunters, gatherers and grazers. Eating small amounts 6 times per day can work well for some teens as long as you get the overall right balance of foods. For others, it is easier to get 3 square meals a day in. Both styles can work.
viv49al: Is eating after a certain time in the day still frowned on? My daughter always gets hungry around 8:00pm. What would you suggest?
Speaker_-_Dr__Ellen_Rome: It is fair game to eat after 8pm especially for college age students! Paying attention to cues of hunger and satiety as well as overall food balance is the key.
alisonk: I don’t really like to drink milk and water so I mostly drink soda pop. Is it okay to drink pop as long as it is diet?
Speaker_-_Dr__Ellen_Rome: Diet pop is better than regular pop but more than one can per day is not so useful for your body. If you do not like milk, make sure you are taking two calcium pills or chews (500mg each) per day.
You can also try coconut milk, soy milk, lactaid milk or other forms to see if you can find one that you enjoy.
percy: What are your views on using Slim Fast or other over the counter weight loss products? What about carb blockers for teenagers?
Speaker_-_Dr__Ellen_Rome: The weight loss industry is big business. Many people across the world wish to sell you a quick fix. Unfortunately, many diet aids such as diet pills, energy builders, herbal medicines, etc marketed for weight loss can contain stimulants that can trigger fatal heart attack. These are the reason Fen-fen and other products have been taken off the market.
Slim Fast does not contain sufficient fat grams so this can be part of energy intake but the person needs to then make up the fat grams somewhere else to make sure that they are getting in their proper fat grams per day.
alisonk: I was watching The Biggest Loser last week and there is a teenager on the show. One week he ate very little, and still did not lose weight. The next week he lost more weight and they said it was because he made better food choices. Something about the way the calories were burned with exercise actually burned more fat. My question is, does limiting the calories also involve the right kind of foods?
Speaker_-_Dr__Ellen_Rome: This gets back to eating on a schedule. If your body thinks it is surviving a famine, it will slow down metabolism and hang on to everything you eat. If your body expects to see regular meals in the right balance, it can start doing what it is supposed to do. If you add in the right balance of exercise and have patience, you will start to see positive change body health wise.
Adolescent Obesity & Exercise
edwardnkids: Is it safe to wear weights on ankles or wrists while walking or running? My daughter is 14. If it is safe and/or recommended, what weight would you suggest?
Speaker_-_Dr__Ellen_Rome: It would not be safe for a 14 year old to be wearing weights while walking or running. At this age it would put her tendons and ligaments at risk of overuse injury.
Weight training can be useful and would involve any muscle group no more than twice or weeks (that can mean 2 days a week arms, 2 days a week legs, etc.) that can span the week. Make sure that some sort of cardio workout ideally occurs for 20 minutes, 3-5 days per week. In a perfect world, that means 3-5 days of breaking a sweat for 20 minutes each time.
That can mean different things for different kids. One kid may walk and break a sweat while another kid may have to work out very hard to break a sweat. For kids that do not sweat, you can focus on getting their heart rate up.
edwardnkids: Is interval training better than other forms of exercise? How about circuit training? Or is it the same thing?
Speaker_-_Dr__Ellen_Rome: Interval training is considered short bouts of exercise alternated with brief periods of rest. This helps keep the exercise routine interesting and varied. Circuit training is a type of interval training that combines strengthening exercises with endurance/aerobic exercises.
Interval training does better for fitness and weight loss than does sustaining at one pace.
jayson: My 15 year old son has lost about 30 pounds and still needs to lose another 20-30. He hasn’t been able to get past his current weight for the past two months. What can we do to get him over the hump?
Speaker_-_Dr__Ellen_Rome: Get him to break a sweat during his exercise and perhaps do some interval training. He can also circle back to the pediatrician and dietician to determine what he needs to tweak.
If he is not doing the 5-4-3-2-1-0-Go type of plan, encourage him to try. That would provide the reminders and structure he needs to make simple changes.
Adolescent Obesity & Surgery
kicker: Are bypass surgeries considered for adolescents who are obese? If so, what are the criteria?
Speaker_-_Dr__Ellen_Rome: Bypass surgeries have been done in adolescents but under strict conditions. Bypass surgery is considered:
- If BMI >40 with documented weight-related comorbidities and failure of non-operative weight management
- Must be post pubertal
- Must have family involvement
- Must have some abstract thought
- No substance abuse or other major comorbidity that would interfere with adherence
- Not pregnant or breastfeeding.
josefos: Do eating disorders last years and not go away even when it is treated? What if disorder behaviors become out of control?
Speaker_-_Dr__Ellen_Rome: Eating disorders may last years. Recovery in children and adolescents goes by the rule of thirds. A third of people get better, live normal and happy lives, etc. Another third of people get better but when stressed click into abnormal eating attitudes and behaviors. The last third of people have a chronic and relapsing course with 2-25% dying prematurely from the medical consequences of their eating disorders.
The earlier an eating disorder is identified, the better. A team approach is often useful for intervention and treatment.
josefos: Only a third of people get better?
Speaker_-_Dr__Ellen_Rome: No - two thirds get better. But of that group, some when stressed experience an occasional relapse of thoughts or behaviors.
Cleveland_Clinic_Host: I'm sorry to say that our time with Dr. Ellen Rome is now over. Thank you again Dr. Rome, for taking the time to answer our questions today.
Speaker_-_Dr__Ellen_Rome: Pediatric obesity is preventable and with a team effort between parents, kids, your pediatrician and often dietician, it is also treatable. The ounces needed for prevention are definitely better than the pounds of loss needed for cure.
Thank you all for joining this chat and good luck.
- For more information regarding childhood and adolescent obesity treatment at Cleveland Clinic Pediatric Institute and Children’s Hospital, please visit us on our website clevelandclinic.org/kids or call us locally 216.444.KIDS (4-5437) or toll free 800.223.2273 ext 4-KIDS (4-5437).
- A remote second opinion may also be requested from Cleveland Clinic through the secure eCleveland Clinic MyConsult website. To request a remote second opinion, visit eclevelandclinic.org/myConsult.
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This chat occurred on February 25, 2009.
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