Policy and early intervention can curb obesity rates

December 18, 2017 by Leha Byrd, Virginia Commonwealth University
Policy and early intervention can curb obesity rates
Credit: Virginia Commonwealth University

More information and emphasis on dietary lifestyle changes that prevent obesity, and its comorbidities, have not reduced the rise in obesity in U.S. adults and adolescents, according to a recent study in the New England Journal of Medicine.

The study shows 57 percent of U.S. children and teens will suffer from obesity by the time they are 35. Presently, 40 percent of American adults and nearly 20 percent of adolescents are obese, according to a recent Centers for Disease Control and Prevention study.

In an effort to fall in line with media messaging that focuses on healthy options and , big-name companies known for sweets, including Mars and Nestle brands, have made recent, hefty investments in more health-centric offerings. It's a change that is targeted and thoughtful, but won't be beneficial for consumers unless they do their own research and make consistent, purposeful choices about their long-term health, said Nicholas Fischetti, a clinical dietitian at VCU Health who specializes in cardiology.

"The trend over the past few years has been the promotion of healthier snacks. As far as changing the tide of obesity, I don't really think this will have a big impact," he said. "Ultimately it's up to the consumer to choose healthy options as part of a healthy diet."

Long known to precipitate the onset of life-changing diseases like diabetes and some cancers, obesity is even more disconcerting in children. Yet, for young people, obesity is potentially preventable, according to clinicians at Children's Hospital of Richmond at VCU.

Childhood is a great time to normalize nutritious eating habits that set kids up for a healthy future, said Sonya Islam, a pediatric dietitian at CHoR's Healthy Lifestyles Center.

"Trying a variety of [food] flavors and textures is valuable to prioritize for young ones, because adults' eating habits are heavily influenced by how they ate as children," she said.

CHoR's blog offers ideas for creating healthy family meals and breaks down how to balance them with lean proteins and fiber-rich ingredients. In 2012, CHoR opened the Healthy Lifestyles Center, a comprehensive pediatric obesity treatment research center. The center's staff includes a team of registered dietitians, health psychologists, student specialists and dietetic interns.

The center's providers develop individualized treatment plans to address eating and weight concerns with a focus on behavioral support and lifestyle intervention. Weight loss surgery evaluation is also available for patients with severe obesity and weight-related medical problems.

Melanie Bean, M.D., is co-director of the Healthy Lifestyles Center and an associate professor of pediatrics and psychology at VCU. Much of children's weight struggles are the result of a perfect storm of modern society, she said.

"So many unhealthy things have become so normative. We've lost sight of what a normal portion is, what should be on a plate," Bean said. "In general, what we feed children has become less healthy and now there's more screen time and less movement. A lot of the rise in obesity is related to our culture and environment. There are also systematic issues related to socioeconomic status, including lack of access to healthy foods and green spaces among many who live in lower-income neighborhoods."

Credit: Virginia Commonwealth University
Policy vs. palate

Like the national conversation on obesity, Bean said it will take policy changes to help regulate or at least balance out easy access to cheap, less nutritious foods and drinks.

In 2014, federal regulations nixed junk food from elementary and high school vending machines. In November, the American Heart Association and the American College of Cardiology announced new guidelines that lowered the definition of high to 130 over 80 from 140 over 90. The change now categorizes more individuals as having , but the affirming organizations say the new numbers will help identify health complications that can occur at lower , and allow for earlier intervention. According to the AHA, eating a heart-healthy diet is important for managing blood pressure and reducing the risk of health threats like heart attack and stroke.

Dave Dixon, Pharm.D., is an associate professor in the VCU Health Department of Pharmacotherapy and Outcomes Science and holds a joint appointment with the VCU Health Pauley Heart Center. Lowering blood pressure treatment thresholds is a bold move that will require more medications and a greater emphasis on following a , he said.

"As recommended in the guidelines, there needs to be greater adoption of team-based care models that include pharmacists, nurses, dietitians and even technology, to help monitor and manage patients who will now require additional medications and advisement to reach their blood pressure goal," he said.

As online magazines and websites begin publishing their 2018 food trends lists, much of the focus is on plant-based foods and root-to-stem recipes that call for fruits, vegetables and no-waste cooking. The creativity behind these suggestions may also spur societal change, Fischetti said.

"Americans on a national scale typically don't eat the recommended eight-to-10 servings of fruits and vegetables every day," he said. "Overall, from a health standpoint this will hopefully lead people to eating less processed foods and consuming less on a whole."

Early Intervention

Through support from the National Institutes of Health, the Healthy Lifestyles Center is conducting research to examine effective treatment options for adolescents, including the TEENS+ Program, which is specifically examining the role of parents in treatment. In January, another NIH study will begin recruitment for TEENS STRIVE, which will compare different approaches to exercise training within an adolescent obesity treatment program. Pediatric patients are referred from their pediatricians. Similar to the goal of more speedily identifying blood pressure risks, Bean said pediatricians play a key role in infusing early intervention into a child's care.

"If we could, as a health care community, identify lower degrees of overweight [tendencies] and address it before it progresses to , that's best. Pediatricians can be alert to growth patterns and identify when weight is accelerating faster than height. They can then work with families to come up with realistic strategies to promote healthy eating and exercise," she said. "With most of our referrals, kids are already at a body mass index well above the 95th percentile for their age and gender, making treatment more challenging."

Once health risks are diagnosed, young patients and their parents are often more motivated to change habits that were previously unrecognized as unhealthy, Islam said.

"The biggest light-bulb moments I've experienced with families is how easily a single fast-food meal can soar past a child's daily caloric needs, or how seemingly healthy foods like granola bars and yogurt can be absolutely laden with sugar," she said. "The good news is that making a number of small changes can result in significant health improvements. Most people have an easier time losing weight and keeping it off when they rely on nutrition facts labels and the ingredients list to make choices about what fits their dietary needs. Upcoming FDA labeling changes that highlight details like serving sizes and added sugar are important in helping families and individuals make educated choices about what nourishes their bodies."

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