Tales from Adolescent Medicine
By Jessica Shannon Castonguay, DO, MPH
Jessica Shannon Castonguay, DO, MPH
Obesity is an epidemic. We as physicians and the broader society have acknowledged this and, as a result, there have been incredible pushes towards solving this problem. Less talked about, however, is who exactly is obese.
As health care providers, we know the definition of obesity as greater than the 95th percentile for BMI, but do patients, and specifically adolescent patients, know what that means? Adolescents are going through a period of life where they are figuring out who they are. Almost every adolescent doubts his or her body, and the majority of them will identify that they want to lose weight. But the problem is that although teenagers recognize they want to lose weight, many do not know that they need to lose weight. In 2011-2012, the CDC reported that 20.5% of 12-19 year olds were obese. Adolescents are rarely told they are obese from a healthcare provider and they should know. It is time we use the word “obese” to patients – to adult patients, to parents of young children, and to teenagers.
As pediatricians, we fear hurting the patient’s feelings, and that leads to miscommunication of the severity of the situation. Knowing you are “overweight” can feel like a suggestion to lose weight. Knowing you are “obese” feels like a punch in the gut but is also a kick in the butt to get moving. For providers, calculating the BMI, charting it on a growth chart, and coding for obesity will push us towards recognizing obesity and remind us to guide our patients towards a healthier life.
Why is this especially important for adolescents? The adolescent time period is a pivotal time in your life where your psyche is fragile. Obesity can affect social, physical and emotional functioning. It leads to being bullied which can lead to depression, self-harm and risky behaviors. These can affect school performance, which will affect the rest of their lives. They are also more likely to develop cardiovascular disease, hypertension, and type 2 diabetes. Females are at risk to develop Polycystic Ovarian Syndrome which can affect fertility. Obesity can lead to asthma or sleep apnea, which can affect cognitive development.
We can help. First, as a provider, recognize your obese patients and acknowledge this diagnosis with them. Obesity is a disease just like migraines, asthma, or constipation. Discuss why they have the diagnosis. And then plan a way to fix and monitor it. Check blood pressure at every visit. Check their cholesterol (on all children) at 11-12 years old and again between 17-21. See if you have a healthy weight clinic in your area and make a referral. For females, make sure they are having regular periods. Do a good physical exam on every teen, looking for signs of metabolic disorder.
Provide counseling for obese adolescent patients. Allow them to start taking responsibility for themselves. Talk to the teen directly, not just at their parent. But include the family, as they will be more successful with weight loss if the family helps. Knowing that they are obese could be the first step towards turning those plans to lose weight into action. Remind the teen that weight loss is slow but is possible. Give them small goals, like cutting their soda intake to one can a day. Make a goal to take just “X” amount of steps a day.
Utilize technology. And most teenagers never take a step without their phone. They can track their steps and other health indicators using their phones. Follow up frequently for weight checks. Make them responsible for their own body and help them transition safely through their adolescence.
April 6-9, 2017
Hyatt Regency Louisville