Letter to the Editor: Childhood Obesity

The fundamental causes of obesity are well established as an imbalance of energy input and energy output in a given individual. The existence of this simple paradigm of eating less and exercising more is not surprising given the marketing expenditures in the promotion of food consumption favoring weight gain and of the entertainment market forces that promote a sedentary calorie-conserving lifestyle.

There are in general two approaches to the management of childhood obesity: (1) Social and environmental control by education and policy mandates, and (2) Direct patient care. The first of these deals with fundamental social issues conducive to obesity such as nutritional advice, school policies, city design, and environmental law. Modifications in these areas are aimed at changing mores and usually require generations to take effect.

The second of these approaches addresses the care of the individual patient through dietary and behavioral modifications and the care of the morbid obese patient. A literature search and review of English language studies reveal that intensive and comprehensive behavior modification results in calorie control of food intake and increasing exercise to produce weight reduction and its benefits. Unfortunately this approach is followed by a high rate of failure when dealing with the morbidly obese patient. This paper deals with the eminent need for treatment of those who are morbidly obese and that have a current or projected health risk for the development of complications during early adult life.

The national and Hawai‘i State childhood incidence for obesity is 16%. This gives Hawai‘i a significant opportunity to participate in a national effort at obesity control and to meet an obligation to its minority citizens in an effort to decrease the mortality associated with obesity and its comorbid conditions of hypertension, diabetes, cardiopulmonary disease, renal failure, and their attendant health care costs.

Surgery is currently the most effective method for achieving significant long-term weight loss in severely obese adolescents (BMI 40, or BMI >35 with obesity-related co-morbidity) and can result in significant weight loss, reduction in co-morbidities, and improvement in quality of life.¹

All the elements of a tertiary center for the care of adolescents with morbid obesity already exist in the community but there is a need to coordinate the individual community efforts. Currently there is an obesity clinic at the Kapiolani Medical Center for Women and Children for the medical control of obesity; bariatric surgery for adolescents is available through the Queen's Medical Center obesity program; expertise exists in the John A Burns School of Medicine Department of Pediatrics for dietary, psychological, behavioral, gastro-enterological, and endocrine management of the obese adolescent; and ethnic specific attention to the health problems of the State's minority population is available through the JABSOM Department of Native Hawaiian Health. It remains only to coalesce these existing components into an effective organization whose goal is to treat an obese cohort of Hawai‘i's adolescents to both improve their health and control health care costs.

Two ingredients not mentioned are money and determination. The first requires funding and making obesity a billable illness. The second requires recognizing the value of life and health, and the potential decrease in health care expenditures.