Docs Need to Focus on Kids' Obesity, Hypertension

Researchers urge pediatricians to recognize, treat growing problem

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By
HealthDay Reporter

MONDAY, Aug. 2, 2004 (HealthDayNews) -- Obesity and high blood pressure in children -- two major, often related health hazards that were rare in this age group not so long ago -- need more attention and treatment from pediatricians.

That's the conclusion of two articles in the August issue of Pediatrics, which recommend that children be screened for hypertension before many of them are out of diapers and that doctors work harder to identify obese kids -- and discourage behavior that promotes pounds.

Although obesity in children is reaching epidemic proportions, pediatricians are under-recognizing and under-treating this problem, concludes one study.

According to the U.S. Centers for Disease Control and Prevention, 15 percent of American children and teens are overweight. Overweight youngsters are more likely to grow up to be overweight or obese adults, and being overweight increases their risk of heart disease, high blood pressure and diabetes.

"Kids are not only overweight and obese, but they're having co-morbidities that adults do," said Barrie Wolfe, a registered dietician at the New York University Program for Weight Loss.

In the study, researchers from Children's Hospital of Pittsburgh reviewed the records from 2,515 well-child visits that occurred between December 2001 and February 2002.

"I was frustrated with trying to help kids with obesity and wanted to see what others were doing," said study author Dr. Sarah Harvey O'Brien, who was a pediatric resident at the time of the study.

The children studied were mostly from urban areas, and 70 percent were black.

The researchers found that 244 children met the definition of obesity, yet obesity was listed in only 53 percent of their charts. In those who were identified as being obese, 81 percent of the charts listed adequate information on the child's diet, while only 27 percent contained detailed notes about the child's activity level or television viewing habits.

"In half of the cases, an obese child would come for a well visit and it wouldn't be identified," said O'Brien. She added it's important for physicians to measure a child's body mass index (BMI) because sometimes you can't tell from looking at a child that they're overweight. She said parents should ask their pediatricians what their child's BMI is.

"Obesity can be tough to talk about, but if a parent asks about BMI, it can open the door to talk about weight," she explained.

Along with under-identification, O'Brien said, "the other thing that really surprised me was that clinicians weren't talking about TV habits. If children are sitting in front of the TV, they aren't moving and they're more likely to be eating high-fat foods." Pediatricians, she said, should be reminding parents to limit TV time, yet in this study only 5 percent did.

Wolfe said that doctors can provide an objective view and help parents and children catch weight problems early, which she said could help prevent the "social problems and isolation that can come from being an overweight teen."

Wolfe said that physical activity is crucial to helping kids maintain a healthy weight because it's very hard to restrict youngsters' eating. She recommends parents make exercise fun. Take family walks or bike rides or go swimming together, she said.

One of the reasons it's so important to control your child's weight is because excess weight makes serious medical conditions, such as high blood pressure, more likely.

Because of the growing problem of childhood obesity, childhood hypertension is also on the rise. According to a new report on high blood pressure in children, also in Pediatrics, many children with high blood pressure are also overweight.

The report includes new guidelines for pediatricians and recommends that blood pressure screening begin when a child is 3 years old. Ideal blood pressure levels change with a child's age, sex, weight and height. For example, average blood pressure for a 5-year-old boy who's in the 50th percentile for height would be 95/53 millimeters of mercury (mm/Hg), while for a girl the same age, also in the 50th percentile for height, average blood pressure would be 93/54 mm/Hg.

If a child is identified with high blood pressure, the guidelines recommend lifestyle changes, such as those suggested for adults. These include losing weight and increasing physical activity. This report also recommends that any changes be family-based, rather than just targeting the child.

The role of anti-hypertensive medications in treating children isn't as clear as it is for adults, said the report. That's because few drugs used in treating high blood pressure have been adequately tested in children. Still, the report said if other cardiovascular risk factors, such as high cholesterol, are present, and if lifestyle changes don't lower blood pressure, then medications may be helpful.

More information

To learn more about obesity in youngsters and what you can do about it, visit the American Academy of Child and Adolescent Psychiatry.

SOURCES: Sarah Harvey O'Brien, fellow, hematology/oncology, Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh; Barrie Wolfe, M.S., R.D., nutritionist, New York University Medical Center Program for Weight Loss, New York City; August 2004 Pediatrics

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