Tag Archive for: children

Childhood Obesity: A Family Thing

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I hope you took some time to scan the Executive Summary of American Association of Pediatrics Guidelines for Physicians. If you couldn’t, here are the three things that stood out to me.

Screening by Pediatricians and Primary Care Physicians

The focus of the guidelines was to assess risk factors for degenerative disease such as heart disease and diabetes in children who exceed the 85th percentile of the normal growth charts, indicating overweight, and 95th percentile, indicating obesity. The guidelines recommend beginning at 2 years of age and continuing through 18.

Were there recommendations for the use of medications and bariatric surgery in children over 12 and 14 respectively? Yes, but they were referrals to specialists for evaluations, not a blank invitation to write prescriptions.

It Must Be a Family Thing

Without exception, the guidelines recommend intensive health behavior and lifestyle treatment. “Health behavior and lifestyle treatment is more effective with greater contact hours; the most effective treatment includes 26 or more hours of face-to-face, family-based, multicomponent treatment over a three- to twelve-month period.”

That’s not the same as giving Mom and Dad a diet for the child and sending them on their way. Family-based programs have demonstrated great success, but it has to be a family thing.

It’s All About the Money

The summary also talked about obstacles to the family-based treatment approach. The major obstacle is money:

  • Money for training pediatricians and family practice physicians on how to assess childhood obesity.
  • Money for training more people to teach and work with families—it’s labor intensive.
  • Money for public health and community programs that can support the family-based approach.

It’s a situation we’ve seen many times: Everyone knows how important preventive healthcare and early treatment is, but no one wants to pay for it. But maybe we shouldn’t always look to government to foot the bill; maybe schools, community organizations, and churches could offer programs for their members. If what we’ve always done isn’t working, let’s try something different.

The Bottom Line

The guidelines introduce a couple of new approaches for those with the most severe weight problems, but the focus is on intensive nutrition and behavior-change training for the entire family. That’s not just “Here’s a diet and exercise program, and I’ll see you next year.” The guidelines give a reasonable approach to help the future health of the nation. The approach is simple: Eat less. Eat better. Move more. What they’re saying is that healthcare professionals need training to be able to do that effectively as a team in a reasonable family-based approach. That’s the right approach as I see it.

What are you prepared to do today?

        Dr. Chet

Reference: Pediatrics e2022060641.https://doi.org/10.1542/peds.2022-060641

New Guidelines on Childhood Obesity

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If you pay attention to health news, you know the American Association of Pediatrics issued new guidelines on how to treat childhood obesity. Depending on where you read or listened to how those guidelines were presented, all you may have heard is that kids over 12 can get medications to help with weight loss and teens over 14 can have gastric by-pass surgery.

Then the experts weighed in (no pun intended). One pediatric physician predicted doctors would just pull out the prescription pad and not address the root cause of obesity. Psychological experts said this is going to cause increases in disordered eating, which includes anorexia and bulimia.

This story hits home for me because food was love in a Polish household like mine. I’ve been overweight since I was around eight years old, and it’s been a life-long struggle to get to a normal BMI. But even at my heaviest, I was nowhere near the weight many kids are today.

Is that all that was in the guidelines? You can read the summary at the link below. Then on Saturday I’ll break them down to get the bottom line.

What are you prepared to do today?

        Dr. Chet

Reference: Pediatrics e2022060641.https://doi.org/10.1542/peds.2022-06064

Did Probiotics Help Preschoolers with Gastroenteritis?

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The use of probiotics to stop diarrhea and vomiting for preschoolers with gastroenteritis (GE) was studied in two major studies published in the New England Journal of Medicine. In the U.S. study, 55 of the 468 subjects who got the probiotics had scores of nine or greater on the scale while 60 of 475 in the placebo group has scores of nine or greater for the two weeks after the study began. This was a 20-point scale and the higher the score, the worse the GE symptoms. No significant differences.

In the Canadian study, 108 of the 414 subjects in the probiotics group and 102 of the 413 subjects in the placebo group had scores of nine or greater for the two weeks after the study began. Again no significant differences were found.

This led both research groups to conclude that the probiotics used in the studies were ineffective in preventing negative GE outcomes compared to those who received the placebo.

The press releases and follow-up interviews were much harsher in their criticism of probiotics. One of the study leaders concluded that “These two probiotics did not work. They should not be used for GE.” I would emphasize “period!” was implied. But is that true? If you’re a regular Memo reader, I’ll bet you have an idea where this is going; I’ll explain on Saturday.

What are you prepared to do today?

Dr. Chet

 

References:
1. N Engl J Med 2018; 379:2015-2026. DOI: 10.1056/NEJMoa1802597.
2. N Engl J Med 2018; 379:2002-2014. DOI: 10.1056/NEJMoa1802598.

 

Preschoolers, Probiotics, and Gastroenteritis

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Estimates are that close to two million preschool children will be taken to the emergency room for vomiting and diarrhea every year; the term generally used is gastroenteritis (GE). Two research groups, one from the U.S. and one from Canada, conducted studies to see if probiotics would have any impact on the course of GE from the time of the ER visit for at least two weeks after. Here’s what they did.

Researchers in Canada recruited close to 900 children and researchers in the U.S. had close to a thousand; all the children had symptoms of GE. The subjects were randomly assigned to a placebo or experimental group. The subjects in the experimental groups were given a five-day course of probiotics; the Canadian group used two strains and the U.S. used one strain. The subjects were then tracked to see whether there was a difference in the severity of the GE between those kids getting the placebo and the ones getting probiotics. Both research groups used the same GE symptom scale to monitor the severity of the GE.

Did the probiotics have any impact on the severity of the GE? We’ll check out the results on Thursday.

What are you prepared to do today?

Dr. Chet

 

References:
1. N Engl J Med 2018; 379:2015-2026. DOI: 10.1056/NEJMoa1802597.
2. N Engl J Med 2018; 379:2002-2014. DOI: 10.1056/NEJMoa1802598.

 

Last Was First

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What was the roar I told you about in the last message? It was for the last runner of the Grand Rapids Kids Marathon. You can see him in the group picture: the kid on the far right with the walker in the cool shades. I don’t know exactly what his condition is; most likely a muscular disorder of some sort. But that didn’t stop him from participating.

His mom accompanied him the whole way. When he came through the aid station, he wanted a cup . . .

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Kids Marathon

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One of the requirements of a triathlon training group I belong to is to volunteer at a running or other event. This past weekend, the Grand Rapids Marathon held a Kids Marathon. I was in—not just to help, but experience what this type of event is like.

The idea is this: kids run or walk at least one mile, three times a week, with a friend or family member and track their progress on a training sheet that goes through mile 25. On race weekend, the children run or walk the last 1.2 miles of the marathon distance . . .

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School Daze

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Tuesday was the first day of school in Grand Rapids. I’m sure the kids were excited, at least the younger ones; I think the parents were a little excited as well. In fact, my observation was that they were a little dazed. It seems they have lost all sense of traffic and parking laws in their quest to get kids to school.

When I went out for my run, 200 yards on both sides of my street were filled with cars near the intersection with the main road. Parents were walking their children into the first day of school . . .

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Breastfeeding? Take Vitamin D

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To recap the week, breastfed infants do not appear to be getting enough vitamin D. Neither the moms nor the infants are exposed to enough sunlight to make their own vitamin D, especially in winter. Moms who breastfeed and don’t supplement their infants with vitamin D don’t have adequate amounts of vitamin D in their breast milk. That leaves a logical question: what happens if the moms supplement their diet with vitamin D? Two recent studies asked that very question.

In the first study, Australian researchers gave pregnant women either a placebo, 1,000 IU vitamin D3, or . . .

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Vitamin D for Babies

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The next logical question is this: if babies aren’t getting enough vitamin D from breast milk, will supplementing the babies’ diet with vitamin D3 increase vitamin D levels? Researchers examined data collected from the TARGet Kids! primary healthcare research network, a large cross-sectional study conducted in Canada, to answer the question.

The researchers examined data from over 2,500 breastfeeding mothers and infants who had vitamin D levels checked regularly. Those infants who were supplemented with vitamin D while breastfed had higher levels of vitamin D than those who were breastfed without taking a vitamin D supplement. The . . .

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Healthier Eating for Kids

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In the last message before Labor Day, I wanted to provide you with a few references to help your kids eat better. It’s something that I’ve never done before but frankly, I just don’t know everything and I’m not going to live long enough to learn it all. I hate that, but every man’s got to know his limitations. Yes, that’s one of my favorite movie quotes.

Two are books that I referenced in earlier webinars; the other two are books by long-time readers who are passionate about helping kids eat healthy. I . . .

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