Often when a child is obese, the entire family is in need of a change of lifestyle.
“In the case of severely obese children, at least one of the parents is usually also severely obese. Genes contribute to weight, but they rarely make anyone obese. Rather, they tend to influence our appetite, enjoyment of food, and activeness of lifestyle.”
The treatment of obesity is best begun early: the younger a person is when treatment begins, the better and more permanent the results. Jääskeläinen’s research group has compared the outcomes of obesity treatment in specialised health care in children who were both under and over 10 years of age.
“In children under 10 years of age, their age-adjusted BMI reduced and this reduction persisted in our three-year follow-up. Treatment begun later helped to slow down weight gain, but in the long term, the children's weight nevertheless increased.”
According to Jääskeläinen, treatment in younger children tends to be more successful because their obesity-promoting lifestyle habits aren’t rooted too deep yet, and parents still have good control over their child’s life.
“Later, children and adolescents make more independent choices about what they eat and how they exercise, and parents play a smaller role.”
In the treatment of obesity, it is not usually realistic to strive for normal weight, and weight loss isn’t often even necessary in children who are still growing.
“If we can achieve a moderate reduction in the age-adjusted BMI, we’ll also see positive changes in glucose and lipid metabolism. This requires that the child’s weight in kilograms increases only slightly as they grow.”
In adolescents, the treatment of obesity calls for particular sensitivity.
“Adolescence in general is a sensitive time, and adolescents tend to compare themselves to others and to ideals from the media. Many have also been hurt by ‘well-intended’ comments from friends or relatives. When discussing the well-being and possible treatment of an adolescent, their viewpoints must be taken into serious consideration.”
Almost one in three obese adolescents is suffering from a diagnosable psychological disorder, such as depression or attention-deficit hyperactivity disorder, which can make it difficult to control one's eating.
“Finding the right time to start a lifestyle-changing treatment is something we have to think about. If an adolescent is having difficulties or there is a crisis in the family, psychological support must come first.”
According to Jääskeläinen, the treatment of obesity in children and adolescents should at least include an opportunity to see a psychologist or a psychiatrist. The patient is treated by a multi-professional team that also includes a physical therapist and a nutritionist, or at least a nurse who has been trained in weight management.
“The role of the physician in this team is to support the initiation of the treatment, exclude the possibility of rare obesity-causing illnesses, and chart any possible comorbidities and treatments they require.”