At Alamanda Elementary in Palm Beach Gardens, Florida, P.E. is just one part of a health and wellness curriculum. And that learning a weapon in the fight against childhood obesity.
"The students are learning how to make healthy choices. They're learning about portion sizes. And then most importantly, they're learning how to have an active lifestyle," said Cary Ferrera, the principal.
More than 14 million children are considered obese. Obesity can be a contributing factor for heart disease, diabetes and certain cancers. Recent guidance from the American Academy of Pediatrics focuses on the treatment of the chronic condition. The academy says for kids 6 and older doctors should consider lifestyle treatment for the family and child. That is at least 26 hours of face-to-face counseling and training focused on things like activity, sleep and nutrition.
"Rather than kind of letting parents and kids have a DIY approach with lifestyle, let's use the evidence and let's give them this comprehensive, holistic care that we know works," said Sarah Commisso Armstrong, co-author of the AAP's new guidelines.
The AAP has added medications and surgery in its guidelines for certain children. Doctors should consider weight loss meds for kids 12 and older — in addition to health behavior therapy and lifestyle treatment. Adolescents 13 and older with severe obesity could be evaluated for surgical intervention.
The diet and fitness industries have raised some concerns.
"I think that we've kind of got to be careful. When the first thing that we say is 'let's throw them on this medication,'" said Mike Blue, a trainer.
"These surgeries should be offered to patients much older," said Mallory Cooper, a dietitian.
To understand how doctors define obesity and severe obesity we have to talk about BMI, or body mass index.
Pediatrician Dr. Kavitha Selvaraj, with Lurie Children's Hospital of Chicago, has spent her career specializing in nutrition and weight management for children and teenagers.
"Body mass index is a ratio of your height to weight. It's kilograms per meter squared," Selvaraj said.
American Academy of Pediatrics shares how to treat childhood obesity
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She explains BMI is great at the wider population level when talking about health.
"It's fast, it's quick, you can apply it to broad populations. If you take five million people and you put them in categories based on their weight to height ratio, you can start to see big picture patterns," Selvaraj said.
The CDC uses the BMI ratio in their growth charts — a tool pediatricians and doctors use to compare one patient’s body development against the pediatric population.
The CDC defines severely obese as BMIs that are the top 120%, the 95th percentile on BMI-for-age growth charts.
But using just a BMI metric on the individual level doesn’t work as well on its own. Even the BMI’s creator didn’t use it that way. 19th century Belgian Mathematician Lambert Adolphe Jacques Quetelet developed the formula to help his government allocate resources.
Many components impact one person’s BMI.
"The factors that go into affecting our metabolism and our energy and our weight gain and things like that are incredibly complex," Selvaraj said.
They include factors like brain and hormonal activity, genetics, mental health, where someone lives and the access they have to activity or healthy foods.
In December 2022 the CDC updated its growth charts to include much higher BMIs. It could help doctors and researchers get more detailed data on children with severe obesity. Doctors also keep a variety of growth charts with all sorts of data for a patient, not just one on BMI Dr.Selvaraj says it shows so much of a patient.
"In some cases you can sort of see the story of a child in a growth chart. You can sort of see when they started school, You can see when they went through a period of depression and when they recovered, you can see when the medications started and stopped," Selvaraj said.
It’s also a visual way doctors can show families how a child is responding to treatment, which is potentially more helpful given the new changes from the American Academy of Pediatrics.
