Though the childhood obesity rate has been declining over the past several years, more than 1 in 6 children in the United States are still considered obese. Obesity takes both a physical and psychological toll on children. Obese children are more likely to be bullied, suffer from low self-esteem, and become depressed. They also face serious health risks such as a greater likelihood of obesity in adulthood, heart disease, type 2 diabetes, and cancer. Obesity risk is influenced by a multitude of factors including genetics, environment, access to healthcare, and behavior. However, often times the only factor that can be modified and controlled by the patient is behavioral decisions, which account for 30% of an individual’s health. Personalization of care starting in early childhood could be a strategy for properly targeting behavioral factors such as diet and exercise to continue the decrease in childhood obesity rates.
Childhood obesity is difficult to treat since children do not have full control over their health behavior. In fact, it has been found that parental health behavior heavily influences their children’s eating habits and preferences being formed in the first five years of life. Not only this, but with one obese parent, a child has a 50% chance of becoming obese. With two obese parents, this chance increases to 80%. Change cannot solely come from personal adjustments, but needs family support as well. Thus, treating childhood obesity means improving health behavior for the entire family. Personalized health planning between individual patients and providers has already been developed and is being adopted by many health providers. However, in order to effectively combat childhood obesity, personalized health planning for entire families needs to be further explored.
A study conducted by New York University’s Langone Medical Center found that over 90% of parents believed their overweight children were “about the right weight.” When parents are unwilling or unable to recognize their children’s true health status, it is up to primary care providers to refer children and their families for treatment. One program specifically targeting childhood obesity through family-centered solutions is the Duke Healthy Lifestyles Program. The Healthy Lifestyles Program relies on lifestyle modification with the help of dietary, medical, physical therapy, and behavioral providers. Each family receives personalized treatment options. Unlike with adult obesity, the treatment goal of childhood obesity is usually to stabilize rather than lose weight since children are actively growing. The Healthy Lifestyles Program not only involves medical professionals at Duke Pediatric Primary Care, but also partners with the Durham City Parks and Recreation Department. This unique model connects health care with community resources, which is needed to overcome some of the economic and environmental barriers to beneficial health behaviors. When standard interventions such as the Healthy Lifestyles Program are not effective in combatting obesity, pharmacological options need to be turned to. While there are many medications available for treating adult obesity, Orlistat is currently the only medication approved for treating childhood obesity by the Food and Drug Administration. Even with the personalization of medicine among youth and adults in treating obesity, doctors should examine further personalization among individuals, as Orlistat is less effective in children with type 2 diabetes.
Personalizing care in childhood obesity presents unique barriers because coordination between the child, the family, and the healthcare team is challenging to achieve. Moving towards a personalized, proactive, and participatory care model for children by involving a child’s family support system should be seriously considered in order to effectively combat not just childhood obesity, but also a multitude of chronic illnesses that often begin in childhood.
Wendy Ji is an intern for the Duke Center for Research on Personalized Health Care and a junior attending the University of North Carolina at Chapel Hill.