outlook: OBESITY epidemic

Surgery May Be Complicatedfor Overweight, Obese Kids

Just as obese adults face potentialcomplications when they undergo surgery,obese and overweight children arefacing the same problems when theyhave surgery. According to a recent study,nearly one third of children undergoingsurgery are overweight or obese, makingthem high-risk surgical candidates.

To investigate this trend further,Olubukola O. Nafiu, MD, FRCA, and colleaguesat the University of MichiganMedical Center reviewed the cases of6017 children who had surgery at theUniversity of Michigan Hospital between2000 and 2004. In those kids, the overallprevalence of overweight and obesitywas 31.5%; 10% were obese, and 4.5%were morbidly obese. The researcherswere surprised to find that many of theobese and morbidly obese children wereclassified as healthy patients with noincreased surgical risk, which is contraryto reports that show that certain surgicalcomplications occur more often in obesepeople than in normal-weight people.These surgical complications that obesechildren face may include breathing difficulties,postsurgical upper airway obstruction,and the need for more antiemeticmedication. Complete results oftheir data review appear in the Journal ofthe National Medical Association.

Extra Weight May Lead to FootProblems for Kids

Children who are carrying extra weightmay be vulnerable to foot problems thatcould cause permanent damage. Footand ankle surgeon Darryl Haycock, DPM,noted that children's feet are not fullydeveloped until "age 14 or 15 for girls, 15to 17 for boys," meaning that their bonesare "easily moldable." According to Dr.Haycock, "When there is an increasedamount of weight and stress beingplaced on the foot, it can cause some significantchanges in foot structure.

He further noted that as few as 15 to20 extra pounds can lead to fallen archesand inflammation of the growth plate inthe heel. Treatment for these foot problemsgenerally starts with the use oforthotics and physical therapy, and ifthose approaches do not work, then surgeryis recommended. Dr. Haycock'sremarks appeared in a January 17, 2007,press release from the American Collegeof Foot and Ankle Surrgeons.

Researchers Examine Weight-lossSurgery in Children

As more obese adults are turning toweight-loss surgeries to help combatobesity, obese children are also undergoingsurgery to remedy excessiveweight.

In response to increasing interest inweight-loss surgeries for this youngpatient population, 4 hospitals willbegin a large-scale study this spring toexamine how children respond to thedifferent procedures, such as gastricbypass and gastric banding. Three otherhospitals recently received FDAapproval to determine outcomes forteenagers who undergo laparoscopicgastric banding.

To demonstrate the potential that gastricbanding has for young patients, NewYork University Medical Center conducteda study of 53 boys and girls, aged 13to 17, who underwent the surgery andlost nearly half their extra body weightwith relatively minor complications. Asimilar study is being conducted at theMorgan Stanley Children's Hospital ofNew York, which houses a weight-losssurgery center for teens and anticipatesperforming about 50 such operations thisyear. Critics of weight-loss surgery forchildren are concerned about the long-termeffects,which are not yet known, aswell as the effects of altering the digestivetract of young people.

The Associated Press ran the completearticle on February 5, 2007.

Low-income Hispanic ChildrenMore Likely to Be Obese

New research on childhood obesity,focusing on poverty and its correlationwith kids at risk for obesity, has foundthat Hispanic children are at the highestrisk for obesity (see Table). Whileresearchers could not explain why moreHispanic children were overweight, comparedwith white and black children, theydid find an important predictor: if a childwas still using a bottle at the age of 3, thechild had a greater likelihood of beingoverweight in preschool.

Lead researcher Rachel Kimbro of theUniversity of Wisconsin at Madison usedstudy data on more than 2000 3-year-oldsfrom low-income families in 20 largeUS cities. Data showed that 32% of thewhite and black children were eitheroverweight or obese, compared with44% of Hispanic children. After reviewingfactors such as television habits andmothers'access to grocery stores,researchers were unable to account forthe discrepancy.

Study results were published in theonline version of the American Journal ofPublic Health.

Ms. Farley is a freelance medicalwriter based in Wakefield, RI.