Why should overweight kids lose weight?
Heart disease. 60% of kids a BMI-for-age above the 95th percentile have at least one risk factor for heart disease. 20 percent have two or more risk factors for heart disease. Plus they are at risk for diabetes and sleep apnea.

How bad is diabetes?
Bad. Kidney failure, peripheral neuropathy, and the leading cause of blindness in the U.S. Ten times as many kids have type 2 diabetes in 2002 as in 1997. It's a direct result of poor diet and limited exercise. Diabetes is a genetic disease, but it can be avoided, delayed and treated with lifestyle change.

Do kids eat emotionally?
Some do-out of habit, when bored, or when stressed. Obese kids often have low self-esteem, and may feel sad, lonely or nervous more than kids who are not obese.

What if your kid is tall, or an athete?
Some kids who are very athletic and have a large muscle mass, may be overweight, but if they do not have excess body fat, then they do not need help with weight loss. However, the vast majority of children who are overweight are also obese and do need help with weight management.

What's the truth about fat kids becoming fat adults?
The more severe and earlier the onset of obesity in childhood, the more severe the adult obesity. And the more severe and earlier the onset of obesity-related diseases, like heart disease.

How much sugar does soda really have?
It's liquid candy - about 9 teaspoons of sugar in every can of most sodas.

What about juice drinks?
It's the same as for pop-about 9 teaspoons of sugar per 12 ounces.

Does soda pop affect calcium metabolism?
Yes. Soda pop sucks the calcium out of bones, just when kids need it most, as they're growing.

What should teens do, especially?

• Don't worry about being the wrong size, shape or weight. It doesn't help, and it's a waste of time.
• Know that diets don't work-except for a few minutes, days or weeks.
• Diet pills are not for kids, and most adults shouldn't take them either-they have side effects and have to be taken for life.
• Fat burners are ineffective---if they really worked, they would be prescripiton drugs.
• Fasting burns muscle faster than it burns fat. Don't do it.
• Single food diets cause starvation of the muscle. Don't do them either.
• Be an intelligent TV viewer-choose what you want to watch, and make the time in front of the TV, PC or Mac really fun, not just there.

Q: What is obesity and how is it defined?

A: Obesity is a complex problem: its etiology is derived from the patient’s diet, their genetics, and environmental factors such as a sedentary lifestyle and exercise. Other times obesity is secondary to a chronic disease such as diabetes, or hypothyroidism.

Genes provide the disposition for obesity and thus have a permissive role in promoting obesity, but are not sufficient without the right environmental factors. There are no single-gene models for obesity that can account for the dramatic rise in obesity prevalence. However, such single-gene defects do exist in humans but there are approximately 10 persons that have been identified worldwide.

Environmental factors thought to be important to obesity include both diet and level of physical activity. Dietary factors proposed to contribute to obesity include overall increases in calorie intake, larger portions, increases in the number of meals eaten out of the home, more frequent snacking, and a high fat diet. Low levels of physical activity reflect time spent on exercise, but also markedly diminished levels of energy spent on day-to-day activities during work and recreation.

Q: How common is obesity?

A: Over 60% of U.S. adults are considered to be overweight or obese. The prevalence has been increasing and is expected to continue to rise. Since obesity is associated with multiple comorbidities as well as diminished quality of life, identifying overweight and obesity is important. Health care providers can provide critical information about risks of obesity, and can help patients choose reasonable and appropriate treatments. Obesity is also increasing in pediatric populations.

Q: What are the comorbidities associated with obesity? Are there any particular comorbidities that need particular attention?

A: Obesity increases risk for certain problems. Thus it is possible to be obese and free of comorbidities. However, the link between obesity and some comorbidities, such as type 2 diabetes and obstructive sleep apnea, is so powerful that the majority of patients with these conditions will be obese. Many times obese patients have difficulty obtaining treatment for theses conditions. Additionally, there are social and psychological effects of obesity such as prejudice, unemployment, verbal harassment, low self-esteem and depression.

Risk for most comorbidities increases with BMI (a marker for degree of overweight). This is the rationale for consideration of treatment options which themselves may have associated risks (such as medications or surgery) at higher levels of BMI.

Q: What are the treatment options? What are reasonable expectations for weight loss?

A: Every patient will respond to a weight loss program individually. It is important to match the person to the right program. It is well studied that a 10 % weight loss over 3 to 6 months is a reasonable starting point. A successful weight loss program combines diet modification and exercise. It is important to stress to you patient that there is no quick fix.

All weight control strategies ultimately need to alter the balance between energy intake and energy expenditure: Body Weight = Energy Intake - Energy Expenditure.

Both reductions in intake and increases in expenditure have roles in weight control. However, to create a caloric deficit, it is usually more effective to reduce intake. For example, consumption of 100 kcal can be accomplished in several bites, whereas expending 100 kcal requires walking about one mile.

Diet and exercise are behaviors, and long-term changes in behavior require considerable effort. “Behavior modification” is not a separate treatment option for obesity, but a method for promoting changes in behaviors that ultimately influence body weight.

Weight loss medications and surgery are adjuncts that improve a patient’s ability to create a deficit in energy intake. Adjuncts improve response rates to lifestyle interventions, but are far less effective when not paired with appropriate diet and physical activity programs.

Q: What’s the first step in a weight loss program?

A: Changing eating and activity patterns in a meaningful way means recognizing what current behaviors are, and understanding why they occur. Self-monitoring is a key first-step in making important changes. It is often useful to keep a diary of what is eaten, how much, the time it takes to eat, the situation in which food is consumed, and the antecedents and sequelae of eating. This will help to determine the contributions of the many factors that contribute to eating, such as hunger, palatability, emotions such as stress, boredom or loneliness, the pattern and frequency of eating, and location of eating.

Q: What types of and how much exercise should be recommended for weight control?

A: There are multiple reasons to include exercise in a weight-control plan. Activity, even though less effective than restricting intake in creating a caloric deficit, does contribute to that deficit. Activity may have a very important role in maintaining lost weight. In studies of successful maintainers of lost weight, one of the most important factors associated with long-term weight control is regular physical activity. Also, increasing physical activity at any level of body weight results in health benefits, even if weight is not lost. Finally, increasing activity improves mood and sense of well-being.

Q: What are the surgical options for obesity? Who is a candidate?

A: Surgery is an option for those who have a BMI over 40 kg/m2, or a BMI over 35 kg/m2 and serious comorbidities such as diabetes, hypertension, or sleep apnea, and should be considered in patients who have not been able to achieve a healthy weight by non-surgical means. Current surgical options always involve a degree of gastric restriction to help reduce intake. Some options also involve varying degrees of malabsorption. While surgery is a powerful tool that can markedly increase a patient’s ability to achieve and maintain a healthier weight, it is important to recognize that efficacy also requires considerable patient effort and life-long vigilance to diet and exercise. Thus, only patients who are well motivated and understand the implications of the surgical procedure should be considered.

Q: Is reducing dietary fat enough? What about cholesterol?

A: Reducing dietary fat without reducing calories has been shown to result in a small average loss (less than 10 pounds), so reducing fat with additional attention to other factors may be needed.

Reducing fat (especially saturated fat) and cholesterol in the diet may help lower blood cholesterol. However, reducing body weight is likely to be equally or more effective in lowering blood cholesterol than reductions in dietary fat or cholesterol.

Q: Is treatment of obesity in children and adolescents different from that of adults?

A: Obesity prevalence in children is increasing at an alarming rate. Treatment of children and adolescents differs from the approach in adults in several ways. The goal of treatment in children may sometimes be to keep weight stable and allow the child to “grow into” their weight. Most childhood obesity experts believe that families should have an active role in treatment of children. Drug treatment of childhood obesity is only conducted under research protocols at this time. Surgery is rarely an option for children or adolescents unless it is deemed to be life saving.