Are We Doing Enough to Help Obese Children?
Being an overweight kid is often a silent drama of negativity.
Posted Jul 17, 2019
Pediatric obesity is not going away. According to the federal Centers for Disease Control and Prevention, the percentage of children and adolescents who are obese has tripled since the l970s; one in five school-age children and adolescents today are obese. The rate is even higher in economically limited communities, where as many as two-thirds of the children may be overweight or obese. Obesity may cause physical limitations, health problems such as diabetes, and carry the psychological stress that comes with being tagged as a fat child.
A distressing account of what the obese child encounters in school, from the family, and even from health care providers, is provided in a review by Pont, Puhl et al. The teasing, bullying, and stereotyping starts in elementary school. The overweight or obese students are less likely to be chosen for group projects, they are often victimized, and teachers may assess them as underachieving socially, academically, and physically, even when performance tests show otherwise.
Not surprisingly, gym class tends to be the epicenter of teasing, both from peers and gym teachers.
Moreover, overweight or obese children often face teasing and bullying at home, according to this review. More than a third of adolescents who went to weight-loss camps reported being harassed by a parent. Adults who grew up fat in a household of thinner siblings and parents recollect how they were denied desserts, snack foods, and sometimes meal foods that the rest of the household ate because they were supposed to be on a diet. An acquaintance remembers going away to overnight camp as a young and overweight child and being sent not a box of cookies like other campers, but of celery sticks.
Two risk factors for childhood obesity are autism and treatment with psychotropic drugs. A survey of a large medical database with information on the heights and weights of children and adolescents from age 2 to 20 revealed a much higher prevalence of obesity among patients who had a diagnosis of autism and Asperger’s syndrome.
Children treated with antidepressants, mood stabilizers, and anti-psychotic drugs are also at a higher risk for obesity than the general pediatric population. These drugs are known to cause weight gain in adults, and children are just as vulnerable. Indeed, the authors of this review point out that the use of antipsychotic drugs, which have the greatest weight gain potential, is increasing among the pediatric population, contributing to an increase in obesity. Sometimes the drugs can transform a formerly lean, active child (who often is more interested in playing than eating) into a sedentary, obese child who is constantly hungry and socially isolated because of bullying and victimization. One parent whose son had gained 30 pounds on a mood stabilizer told me that she was torn between making her now obese 9-year-old eat normal amounts of food, or give into his medication-generated need to eat more. Her son, who had loved sports, refused to go back to a day camp he had enjoyed the previous summer because he did not want to be seen in a bathing suit. And he no longer played soccer because his weight made it hard to run.
Programs to help obese children lose weight are increasing around the country. Some are hospital based; others are run out of YMCAs or community centers, or may be commercial. (Weight Watchers runs programs for children and adolescents.) The programs at many YMCAs include parents in the sessions and cover healthy meal planning, shopping for food, exercise, and understanding the emotional reasons that might be causing the excessive eating. The programs run about 10 weeks. Summer camps that specialize in helping children lose weight offer a place where children can learn how to alter their eating habits and exercise without fear of being bullied. However, these programs may not fit the child or adolescent whose weight gain was not caused by eating too many snacks or by sitting rather than playing. When weight is gained as a side effect of a medication that causes persistent hunger along with fatigue, traditional recommendations to snack on carrot sticks and run around the gym are unlikely to be followed. The obesity of the autistic child is no less difficult to manage, especially when foods desirable to the child are no longer offered, or are restricted, and the reasons are neither understood nor accepted.
Where do parents go to get help for these kids? Their children are vulnerable to the social hazards confronting the typical obese child, but with the added problem of the child and the parent not wanting to share the reasons for the weight gain. What child wants to tell his playground tormentor or the facilitator at a Y program that he is fat because he is taking a drug for mental illness? A teenager who came to our weight-loss clinic at a Harvard psychiatric hospital refused to go to school when her medication for bipolar disorder caused her to gain over 50 pounds. Home schooled, she refused to see her friends and became a recluse, but never shared the reason with her former friends.
Weight-loss clinics, summer camps, and dieticians specializing in programs for children whose obesity is a consequence of their medication or autism are rare. The problem is known; the solutions are yet to be identified. The obesity and psychiatric communities must recognize the need and begin to help these children.
“Stigma Experienced by Children and Adolescents With Obesity,” Pont S, Puhl R, Cook S, Slusser W, Pediatrics 2017 140: 1-11.
“Prevalence of Overweight and Obesity in a Large Clinical Sample of Children With Autism,” Broder-Fingert S, Brazauskas K, Iannuzzi D and VanCleave J, Academic Pediatrics 2014 14: 406-414.
“An Overview of Obesity in Children with Psychiatric Disorders Taking Atypical Antipsychotics,” Shin L, Bregman H, Frazier J, Noyes N, Harvard Review of Psychiatry, 2008; 16:69-70.