Pediatric Obesity

The patient (let’s call him Jake) had been referred to me by his local pediatrician. He was 17 years old and weighs 497 pounds. He came with his father who must have weighed at least 400 pounds.

There was a lot going on here and the family dynamics could be the subject of another blog entry. However, after they left, I couldn’t help reflecting. I’m 50 years old; did I ever know families like this when I grew up?

I remember the heaviest kid in our class when I was growing up. He was the target of endless abuse. His last name started with the same first five letters as mine; I tended to sit next to him because we were frequently assigned seating alphabetically. This included gym class, which meant that I had to sit next to him in the locker room. He was terribly ashamed of his body. I felt sorry for Larry, who was a gentle soul, and tried to act as if his corpulence didn’t exist, while many others would taunt him. I remember trying to avoid looking at his body while we undressed or showered in gym, both to save him further embarrassment but also because I was repelled by his rolls of fat.

For some reason, they once weighed us all in gym--publicly. I was 6’3” and 155 lbs., and Larry was 5’8” and 240 lbs. He was devastated because he hadn’t known how much he weighed.

Yet for all his corpulence, I believe Larry wouldn’t even stand out compared to what I see in adolescents today. 17% of our teenagers are obese. And to be considered an obese teenager you have to be pretty big. A child isn’t considered obese until he or she is above the 95th percentile for height and weight. Between the 85th and 95th percentile considers are classified as “overweight” and “at risk” for Obesity. Even by this incredibly lax standard, about 1 in 6 kids today is obese.

Furthermore, these kids already have the adult illnesses that accompany obesity. The rates of diabetes in children are at alarming levels. 10% of the kids in our country already have liver disease. Hypertension in kids is skyrocketing. It isn’t unusual for kids under 20 to be having heart attacks and strokes.

Despite all these health issues, the biggest issue still troubling these kids is what most bothered Larry--peer rejection. Despite the fact that they are now much more numerous, they still feel ostracized and very self conscious of their body image.

The biggest predictor of whether a child will become obese is if they have obese parents. Think of that the next time you evaluate your weight and health. Parents that make the time and effort to control their weight are the best role models for these children.

I last saw Larry over 10 years ago, at our 20th High School reunion. While he was still struggling with his weight he probably hadn’t gained more than 20 pounds since then. Meanwhile it was shocking to see how many of our classmates had overtaken him. I remember one of his worst tormentors, who was a small wiry kid. He now was a policeman somewhere in Florida and must have weighed 300 pounds. I remember the look on both of their faces when they greeted each other. Larry was too polite to say anything but one didn’t need to be psychic to know what he must have been thinking.