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Child obesity, rampant in U.S., now global issue

Margarita Persico and Howard Manly

When it comes to childhood obesity, Dr. Abhinash Srivatsa, a pediatric endocrinologist at Children’s Hospital Boston, doesn’t mince words.

Overweight children and teens are caught in a “tsunami of all these terrible things,” Srivatsa said, before rattling off several major medical conditions associated with extreme weight problems, including heart and cardiovascular complications, type 2 diabetes and kidney failure.

Other conditions include increased cholesterol, slow- or non-healing wounds, liver inflammation, blindness, high blood pressure, heart attacks and strokes.

And the problem is not just limited to American youth.

Srivatsa grew up in India and has seen the problems spread there and in other developing nations. In addition to genetics, he said several factors are causing what is quickly becoming an international phenomenon: lack of awareness, poor health education and more access to inexpensive, high-calorie foods.

But whether the children live in Mission Hill or Costa Rica, Srivatsa said he is concerned about the long-term effects of often fatal medical conditions that are a direct result of obesity.

“Can you imagine the quality of life when you’re 25 or 30?” asked Srivatsa. “When you have your first heart attack or a stroke, [your] kidneys are all set to be replaced by someone else’s, and you’re starting to have eye disease and wounds that don’t heal. You can’t do anything then. That’s why we tell the teens: [Now] is the time to do something about your future, because by the time you get it, it’s too late.”

The problem is not going away any time soon. Childhood obesity has become one of the top 10 health concerns in the United States, according to the National Health and Nutrition Examination Surveys (NHANES).

In the United States, the government has established a national health goal of reducing the occurrence of children becoming overweight by 2010, but NHANES findings suggest that obesity and overweight rates will still be prevalent for at least another generation, according to the U.S. Centers for Disease Control and Prevention (CDC).

Of particular concern is type 2 diabetes — a condition in which the body either does not produce enough of the hormone insulin, needed to convert sugar into energy, or cannot properly use the insulin that it does produce.

According to CDC data, diabetes is linked in part to genetics in certain groups: African Americans, Asian Americans, Hispanic Americans, American Indians and Alaskan Natives.

Now, obesity in children is becoming more prominent in countries like Costa Rica, where the problem was practically unknown until five years ago, according to Dr. Erick Richmond-Padilla, director of pediatric endocrinology at Hospital Nacional de Niños, the only hospital treating this condition in the country.

That hospital now has 30 type 2 diabetic kids — the youngest is a 7-year-old boy.

This phenomenon frustrates Richmond-Padilla, because some of his type 2 diabetics had been pre-diabetes patients, which he said means parents are letting the disease evolve.

“We had done interventions with nutritionists [and] psychologists, and it was not effective,” said Richmond-Padilla, whose government-run pediatric practice sees patients 15 years old and under. “Now, we see them as diabetics in a more advanced stage.”

Srivatsa frequently sees patients at Children’s Hospital Boston’s Optimal Weight for Life (OWL) program, a clinic for “children who are overweight or obese and/or those with type 2 diabetes,” according to its Web site. Its youngest patient is 8 years old.

“Studies of patients with cancer and patients with type 2 diabetes … have shown that patients with type 2 [diabetes] have a much poorer quality of life than those who survive cancer,” Srivatsa said. “Each year or each decade you live with a history of diabetes, the risk of getting these complications is higher and higher.”

Srivatsa also often sees overweight girls and young women with a condition known as polycystic ovaries, in which overweight girls tend to have extra male hormones. This causes facial and body hair growth, as well as irregular menstrual periods.

“The ovaries aren’t working properly because the hormones aren’t working properly, [which] can lead to … infertility,” said Dr. Sara Nelson, a pediatrician at Massachusetts General Hospital (MGH) Chelsea HealthCare Center.

But obesity in children is not an easy problem to tackle. Anne B. Minichino, a nurse at English High School in Jamaica Plain, cited the bombardment of television ads selling junk food, which may be worsening the problem of eating high-fat fare. Nelson agreed.

“The worst part of TV isn’t the two hours that you are sitting watching TV,” said Nelson. “It’s probably the … advertising, because it encourages kids to drink the soda and eat the junk food. People are constantly surrounded by inexpensive, low-nutrition, high-fat food, and there [are] not a lot of places to exercise.”

The results are clear.

“Thirty to 35 percent of our kids fall into the overweight and obese category … based on national percentiles,” said Nelson, who pointed out that Chelsea has an obesity rate almost twice the national average.

But researchers are not sure what exactly causes obesity and suspect numerous factors, such as poverty, eating processed food and a lack of exercise, said Barbara B. Chase, nurse practitioner at MGH Chelsea.

Dr. Enrique Caballero, director of the Latino Diabetes Initiative at Joslin Diabetes Center, said the problem worries him.

“Overweight Hispanic children, even if they don’t have diabetes and any other problems yet, already have a lot of problems in how their insulin works,” said Caballero. “And that is very sad, because these are the overweight kids that might develop diabetes and heart disease early in life.”

There are physical warning signs that make it easier to identify pre-diabetes. One such indicator is skin on the back of the neck getting thick and dark.

The problem is reversible, though, said Srivatsa, if quick, bold action is taken.

“I tell my patients there is a point of no return,” Srivatsa said. “Most kids recede … before they really get diabetes, and at that stage it’s still reversible. Kids … are growing tall all the time, so it’s easier for them to slim down.”