About 60 percent of overweight children have at least one heart disease risk factor by age ten, such as high cholesterol or high blood pressure. The health-related risks of obesity increase with time. The longer a child remains obese, the harder it is on his—or her—joints, on his heart, and the more likely he is to develop childhood obesity related disease such as diabetes. There is more “adult onset” diabetes, or diabetes type II, being seen in adolescents than ever before.

The physical toll on kids is obvious, but the sad thing is that obese kids also have a lower quality of life. When a study was done looking at indicators of quality of life (QOL), researchers found that children and adolescents who are obese have a quality of life similar to those who are diagnosed with cancer. Simply put, obesity in adolescents is devastating—not only because of the long-range health implications, but because of the low self esteem that it causes.

Fatties – childhood obesity can devastate health, self esteem and social life

Children can be cruel, often without intending to be, when they call an obese child by nicknames like “chubby,” “tubby,” “fatty,” or tease him about his size and weight. Parents can also unintentionally cause low self-esteem in a child by constantly pointing out to the child that he needs to eat less, or by comparing him to his “normal” siblings or to themselves, especially if the parents themselves don’t have a obesity problem.

The child’s distress may not be obvious as he often covers it up with laughter and joking. The obese child often becomes the class clown in an effort to hide his unhappiness. Some, like Al Roker, turn this around and make this a positive effect, but they are the exception, and even Al Roker had to finally realize that health is important and has undergone gastric bypass surgery.

Exercise is the key to preventing childhood obesity and related health problems

The key to preventing early childhood obesity is physical activity. The Zuni Nation (a Native American group found in New Mexico) has instituted a program of physical activity, such as running, in their school system. This is early intervention to prevent diabetes when they become adults. The results have been spectacular. Physical education classes increase activity during school days, and there are more organized activities for after school programs. However, often we see kids who are not enrolled in these programs hanging out at fast food outlets instead.

There are a growing number of “activity” camps for overweight adolescents. These camps have rigorous exercise programs and fun activities for children. They also serve healthy meals with proper portions, and in a gentle way, teach proper nutrition. There are also “boot camps” for kids, and a wide variety of other programs. While these are good for a summer, or a few weeks, the key to preventing childhood obesity is probably parent involvement in school and school activities. Preventing childhood obesity means developing good habits and following a program of activities all during the year, not just for a couple of weeks.

Motivating a child to exercise every day can be difficult. Some sports can be hard on an overweight child’s knees, such as track, football, or basketball. You can’t expect an overweight child to succeed at pole vaulting or the high jump. Insisting that a child participate in sports that he is neither interested in nor suited for physically is setting him up for failure, which further reduces his self-esteem. Swimming may be more his style and is gentler on the kid’s joints. Dance is an excellent form of aerobic exercise for both boys and girls. The key to keeping the child in the exercise program is in finding one he enjoys. He may soon forget that it is an exercise program and begin to excel in the sport or activity. As he excels, he will begin to lose weight and gain self-esteem. Marathon television watching is not a sport, because if it were I would be an athlete.

When diet and exercise don’t work – genetic predisposition for childhood obesity

Now comes the controversy—should weight loss surgery be performed on children and teenagers? If so, at what age? Teenagers have clearly benefited from weight loss surgery, but the long-term outlook is unknown. The same arguments that are made for adults are made for teens; that weight loss surgery is effective, and that diets and exercise, once a certain point is reached, are not enough. The real question is, at what time, and at what level, do you go for weight loss surgery? A number of weight loss surgeons have lowered their age requirements for adolescents. Some have performed surgery on 12 year olds, but most weight loss surgeons limit bariatric surgery to teens 16 years old or older. Again, as with adult patients, prior to entering a weight loss surgery program these patients have to demonstrate that they have participated in attempts at losing pounds through diet and exercise.

Some believe that lap-band surgery is well suited to adolescents as it forces them to eat small portions, and it is quite reversible. Others will advocate that the duodenal switch is a better option as it allows one to eat a more normal diet. Still others will point to the RNY-Gastric bypass as the obvious choice since it has been studied for so many years. The pros and cons of which weight loss surgery is best for an adolescent probably will be debated for years, so let us start the debate here. There are chapters in this book about each of the major weight loss surgeries, but all the information related to bariatric surgery on kids is right here.