Dr. Aparna Govil Bhasker
Bariatric and Laparoscopic Surgeon, Mumbai
Children are our hope for the future. One of the disturbing trends in the epidemic of obesity is that more children and adolescents are afflicted with the scourge of obesity than ever before.
The reasons for this are many. Hereditary causes, increased junk food intake, increasing amount of time spent with gadgets, decreased time to play outdoors are a few of the causes leading to weight gain in the younger population.
Obesity leads to a detrimental effect on each and every organ of the human body. The earlier a person is affected, longer they need to suffer from its afflictions. Today we are seeing children as young as 8 or 9 years old who suffer from type 2 diabetes.
Other metabolic issues related with obesity include but are not limited to, high blood pressure, high cholesterol, sleep apnea, liver disease, gout, PCOD, joint related issues and so on. Children and adolescents who suffer from obesity also tend to have low self esteem and suffer from a greater bias amongst their peers. This leads to enhanced psychosocial issues in this patient population.
When it comes to assessment of obesity in children and adolescents it is usually done with the help of BMI. If the BMI is above 85th percentile then these children are considered to be overweight and above 95th percentile is considered to be obese.
Treatment of obesity in children and adolescents can be very difficult. However, parental supervision and control is much needed. Parents are the first teachers of their children and they need to play an active role in inculcating good dietary habits in their children. Role of physical activity is paramount and children must be pushed out of the house to play outdoors. As a mother of a 6 years old, I understand the importance of physical activity. Nothing is better than just free play.
If your child is inching towards the overweight category, its important to take note of that and start making efforts to control the weight gain. If needed, take professional help from a weight loss expert. Usually with some guidance and concentrated efforts, children can be brought back to the normal BMI range.
For children and adolescents who have crossed the 95th percentile and lie in the obese category a more concentrated effort is needed. They need professional help from qualified weight loss experts and must be enrolled in a weight loss programme.
As per the Indian guidelines, bariatric surgery is recommended above the age of 16 years of age. By this age usually bone growth is complete and they are also able to understand and comply with the demands of surgery.
As for children and adolescents younger than 16 years of age, bariatric surgery must be recommended as a treatment option with extreme caution and only to those cases where life may be at risk. However, the final decision is at the discretion of the clinician and they must weigh the risk versus benefit as they advise any treatment option.
It is also extremely important to have a multidisciplinary team to take care of this patient population. Pediatric endocrinologist and a psychologist must be a part of the team for sure.
Just like any other chronic disease, the treatment of obesity is lifelong and these patients must be supported in the long term.
Dr. Aparna Govil Bhasker
Bariatric Surgeon and Laparoscopic Surgeon in Mumbai, India
