By Nancy T. Browne, MS, PPCNP-BC, FOMA, FAAN, FAANP
Obesity affects almost 20% of U.S. children and adolescents, or approximately 14.7 million youth. The disease of obesity causes numerous other physical and psychological conditions; one estimate is that over 200 medical conditions are caused by obesity.
When we discuss obesity, we are speaking of energy balance dysregulation. Normally, our bodies manage our energy intake (food) and energy expenditure (activity) with incredible precision, and until recently, health care professionals were taught that weight was a result of “calories in” versus “calories out.” This was a sensible understanding for many years, but thanks to advances in understanding how nerves, brain structures and hormones work together to provide feedback to the brain’s energy regulator (hypothalamus), we now know that most of the body’s energy regulation is unconscious. When our normal energy regulating processes do not work efficiently, we have a short-term ability to “override” this system — but these override behaviors are very difficult to sustain. As we understand more about energy dysregulation, the hope is to develop precise therapies to manage — and someday cure — this disease.
Why is there such a gap between what is known about energy dysregulation and what is commonly known by the public about obesity? The answer is pervasive bias, stigma and discrimination associated with obesity. Unlike people living with hypertension, asthma or cardiac disease, people living with obesity are blamed for their weight, told that weight is under voluntary control and they need to just “try harder.” Judgmental assumptions and verbal abuse are common, which adds to internal bias and chronic stress.
Obesity is a serious disease, but there is hope! We are currently in an exciting time in care for all people, but especially for children and adolescents living with obesity. Treatment options are increasing, allowing a health care provider to individualize and optimize care for the child or teen’s specific symptoms and related conditions.
One concern voiced about obesity treatment for children is the treatment itself will result in eating disorders. However, several reviews by researchers find that youth receiving treatment for obesity have fewer eating disorders; as their disease is managed, normal eating patterns and relationships with food emerge.
If your child struggles with weight, seek out a health care professional, optimally a nurse practitioner (NP), who will guide you through the many facets of care for this common health condition. Educational preparation of NPs emphasizes treating the whole patient (holistic care), which is ideal for treating the multifaceted disease of obesity.
In addition, parents should:
- Be aware of the latest guidance for children and teens from the American Academy of Pediatrics and the Obesity Medicine Association.
- Know obesity is treatable, and that treating obesity treats diseases caused by obesity.
- Understand managing stress, sleep, nutrition, activity and personal relationships optimize obesity treatment.
- Seek professional assistance; overcoming obesity is a long journey.
- Call out bias as you feel comfortable and recognize bias is a habit that can be broken.
- Use person-first language. Voice your advocacy when confronted with a term like “obese person,” rather than “person with obesity.” Model correct language.
- Remember that how you speak and relate is modeled by others. Take advantage of this opportunity!
In conclusion, we now understand abnormal physiology drives overeating, and abnormal energy storage is not the fault of the child, teen or parent. Comprehensive, modern treatment is available, and parents should partner with an NP or other health care clinician who understands the complexity of this disease and modern treatment. Together, you’ll be able to move forward and live your best life!