On Sept. 9, the American Heart Association (AHA) released a scientific statement  on severe obesity — a "newly defined class of risk" — in children and adolescents. The statement highlights associated health risks as well as the challenges and limitations of current treatment options, and points out areas in need of additional research.

According to the statement, severe obesity — "a body mass index (BMI) greater than or equal to 120 percent of the 95th percentile or an absolute BMI greater than or equal to 35 kg/m2, whichever is lower based on age and sex" — is on the rise, affecting about 5 percent of children and teens in the U.S.

The authors note that even compared with obese and overweight patients, "accumulating evidence suggests that severe obesity in childhood is associated with an adverse cardiovascular and metabolic profile."

"Severe obesity in young people has grave health consequences," said Aaron Kelly, PhD, lead author of the statement and a researcher at the University of Minnesota Medical School in Minneapolis. "It’s a much more serious childhood disease than obesity."

There are several limitations to treatment options, and a "lifestyle modification/behavior-based treatment intervention" has proven to be the most effective in lowering BMI. However, the authors note that "participants have generally remained severely obese and often regained weight after the conclusion of the treatment programs." Kelly adds that "the step from lifestyle change and medication to surgery is unacceptably large because weight loss surgery isn’t appropriate for or available to all severely obese children."

Moving forward, "more work needs to be done to better understand the pathogenesis and distinct pathophysiology that underlie this condition and the psychosocial/behavioral dynamics that allow it to be perpetuated," according to the authors.

Since interventions such as pharmaceutical or bariatric surgery are "limited in applicability and availability," the authors add that "innovative approaches to fill the gap between lifestyle/medication and surgery are urgently needed." Further, "innovative behavior-based treatment, minimally invasive procedures, and medications currently under development all need to be evaluated for their efficacy and safety in this group of patients with high medical and psychosocial risks."

A separate article published Sept. 25 in the Journal of the American College of Cardiology  (JACC) discusses some of the National Heart, Lung, and Blood Institute (NHLBI) research and programs currently in place to address childhood obesity.

The authors of the JACC article note that "interventions which include multiple components across multiple settings have the potential to be more effective than single component interventions because obesity development appears to be dependent on multiple factors: biological and physiological, personal, social, psychological, environmental, societal, and health care-related."

They believe that "the childhood obesity epidemic can be reversed as research identifies the key elements of effective prevention for at-risk children, families, schools, communities and the health care system." Moving forward, the adoption of prevention strategies "will be needed to achieve long-lasting and sustainable impacts," and will need to involve collaboration among all partners to be successful.

Keywords: Child, Cooperative Behavior, Bariatric Surgery, National Heart, Lung, and Blood Institute (U.S.), Body Mass Index, Overweight, Obesity, Morbid, Pediatric Obesity, United States