With Pediatrician Susan Mihm, MD
For the first time in 15 years and in response to a rise in childhood obesity, the American Academy of Pediatrics officially updated its guidelines on the treatment and prevention of childhood obesity earlier this year. Not only do the new guidelines reflect a new understanding of childhood obesity as being the result of many factors, including genetic, cultural, and environmental, but also recommend a more proactive approach to preventing obesity by building healthy habits. We spoke with First Physicians Group pediatrician Dr. Susan Mihm to learn more.
Are we seeing a rise in obesity in children?
Yes. Obesity is a complex, common, and chronic medical problem with significant health and social consequences. And we're seeing a rise in the pediatric population. In 1965, obesity affected approximately 5% of that population. In 2018, that number was 19%, which is a threefold increase in obesity. One in seven children are affected by obesity and over 14 million children have obesity, which makes it our most common chronic pediatric disease.
Why are these new guidelines from the American Academy of Pediatrics significant? What’s changed?
The most important part is identifying obesity as a chronic disease and treating it like a chronic disease. We have practice guidelines for conditions like asthma and diabetes, and practice guidelines help physicians help their patients. These new guidelines are meant to help pediatricians help families manage or deal with obesity.
What is the most concerning thing about childhood obesity? What are some of the major health consequences of childhood obesity?
Obesity really affects the whole child.
Patients with obesity can have sleep difficulties or sleep apnea, joint difficulties, knee pain and back pain that then further limit activity, which only increases risk of obesity. Chronic health concerns include hypertension, heart disease, elevated cholesterol, and lipids. For our teenage adolescent females, there can be irregular menstrual cycles.
And in our developing children and adolescents, there can be social and emotional impacts through bullying, depression, and self-esteem issues.
How do we measure obesity in a child?
There’s BMI, or body mass index, which is a measure of your weight relative to your height. The difference with pediatrics is we assess the BMI as a percentile, not just a number. Children are growing and changing all the time, so at different ages or developmental levels, a particular BMI may have a different percentile, and we recognize a normal range. Obese is classified as greater than 95th percentile. Severe obesity would be even greater than that, 120% of the 95th percentile.
At what age are numbers like BMI being monitored?
We monitor health, weight, and length in our infants, and look at proportions, and start assessing the BMI percentiles at age two.
We plot BMI on growth charts or percentile charts, and we follow those. A child is growing and developing, so we're looking to see if there are concerning trends that we need to address. And we can have that discussion about a healthy lifestyle and the prevention of a chronic disease, just like we do other diseases.
What do parents need to know to help prevent childhood obesity before it even becomes a problem?
Focus on a healthy lifestyle. In our busy lives, it's important to take time for some of those things that really improve our quality of life. And you can start at a young age.
Healthy Sleep: Build a healthy sleep routine, avoiding cups and bottles at bedtime and removing TVs from bedrooms. We know those can all be risk factors for poor sleep, and poor sleep habits is a risk factor for obesity.
Screen time: Screen time is very difficult for parents these days to manage with their kids. Try creating screen-free zones in your house. Maybe the kitchen or the dining room table. And modeling good behavior. We must put our own phones away and pay attention to our kids.
Activity: Children should have at least one hour of activity per day, and that doesn't have to be sports or PE at school. It can be going for a walk with the family or the dog. Throw or kick a ball around. Go to the park or ride a bike. Swim. Dance. Anything that involves movement and make it fun!
And engage with your child. These are opportunities to spend quality time with your child. Have fun. When we turn off our electronics and we engage with the children, we benefit immensely as well. And if we do it as a family, we all benefit.
How can parents help their children have a healthy relationship with food?
Food should not be punishment. Food should not be reward. Food should be nutrition and health and fun. I really encourage families to get the kids in the kitchen with them. Let it be a family endeavor, just like you go out and play together or do other things together. See how many colors of the rainbow they have on their plate. Let them measure, stir, mix, chop. Get in the kitchen together and see what you can create.
For parents of children with obesity, how do you recommend they approach this very sensitive topic?
Obesity and being overweight can be stigmatizing. It can be that they've been bullied. So having a safe place to have this discussion is very important. Families have to realize that this is a chronic problem. It is multifactorial. It should not be shameful. We just want to help them be their healthiest selves. So it's teamwork. And you need to approach it from that standpoint.
I try not to use the word diet with kids, and I try not to use weight as a number. What I focus on is a healthy lifestyle. If they work on balancing energy in and energy out, I tell them their body will take care of the rest. All we want to do is tweak their habits to maybe a little more health, a little more quality nutrition, maybe a little more exercise and energy output. Small changes can pave the road to lifetime results.
I keep the focus on maintaining a positive healthy lifestyle and empowering them to do so. They must figure out what works for them because, ultimately, they're the ones doing it.
If home remedies aren’t working, what professional treatment options are available?
We have a program called Intensive Health Behavior and Lifestyle Treatment. These are programs set up to help families or adolescents who need a multi-team approach. There will be a nutritionist to help with meal planning, someone following the results to give feedback and provide emotional support and possibly therapy, as well as medical evaluation to evaluate any medical problems that could be contributing, such as thyroid issues. They will also evaluate and manage comorbidities such as elevated lipids or elevated blood sugars or prediabetes.
If team management and conservative treatment are not enough and we have medical problems, such as pre-diabetes or elevated lipids, there are now FDA-approved medications for adolescents, as well as approved surgeries for adolescents who are significantly overweight.
What’s the best way for parents to instill healthy habits in their children?
Model good behavior. We can all strive to be our healthiest selves. Parents have an opportunity, when their children are young, to teach them life skills that they will carry for the rest of their lives. So if we, as parents, value a healthy lifestyle and model healthy meals and snacks—including our children in this activity—then they'll continue to value those as well. Play with your kids and spend quality active time with them. You can't go back and get that, but you can start today. There are long-term life benefits for you and your children. So enjoy your kids.
Need A Pediatrician?
To hear more from Dr. Mihm about childhood obesity, catch her on episode 15 of the SMH podcast: SMH HealthCasts.
To learn more about Pediatric Services at First Physicians Group, including locations in Lakewood Ranch, Sarasota, Osprey and Venice, click here.
To schedule an appointment with Dr. Mihm, click here.
Written by Sarasota Memorial copywriter Philip Lederer, MA, who crafts a variety of external communications for the healthcare system. SMH’s in-house wordsmith, Lederer earned his Master’s degree in Public Administration and Political Philosophy from Morehead State University, KY, and has a real weakness for donuts.