Stories about: JAMA

How would you support a child trying to live healthier?

Daivd Ludwig, MD, MPH

Every month the Journal of the American Medical Association (JAMA) publishes an article called Clinical Crossroads, where a patient case is presented and medical professionals are invited to share their thoughts on how they might treat that person. A few weeks later the case is presented again, this time with commentary from an expert who specializes in the medical condition profiled in the article.

The most recent Clinical Crossroads was written by David Ludwig, MD, PhD, director of the New Balance Foundation Obesity Prevention Center Boston Children’s Hospital. Ludwig’s case focuses around Ms K, a 14 year-old girl struggling to lose weight.

Unlike typical medical case studies that focus on diagnosis and treatment of acute illness, Clinical Crossroads often takes into account the ethical, emotional and economic issues related to the patient’s health and treatment. All three of these elements figure heavily in Ms K’s story, making it ideal for the Clinical Crossroads treatment.

But as Ludwig himself would tell you, overcoming childhood obesity isn’t just the job of pediatricians and their patients; parents play a vital role in helping children achieve and maintain a healthy weight and lifestyle too. With that in mind, we are presenting Dr. Ludwig’s Clinical Crossroads piece to you on Thriving and asking for your input as parents.

Given the following situation, what are some ways Ms K and her parents could work as a team to help her live healthier? If you were her mother or father, what would you do to support her efforts?

Ms K is an obese 14-year-old girl who is struggling with weight loss. She lives in the greater metropolitan Boston area. Ms K began to gain weight at age 8 years. Over the past 7 years, her weight has gone up by 20 to 30 lb annually … She reports trying various weight loss programs but either she did not follow through or they did not work. She has never lost more than 5 lb with any focused effort.

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Should the state intervene on behalf of morbidly obese children?

When we think of child abuse and neglect, we think of burns and bruises and children left unattended. We don’t think of obesity. But maybe, in some cases, we should.

In a recent commentary in the Journal of the American Medical Association (JAMA), David Ludwig, MD, PhD, director of the Optimal Weight for Life (OWL) Program at Children’s Hospital Boston, argues that life-threatening obesity—where a child’s body mass index (BMI) is beyond the 99 percentile and multiple attempts to help the child lose weight have failed—could call for state intervention, and in extreme cases foster care.

Children in this highest BMI category are at great risk for many serious health complications. We all know that childhood obesity can lead to life-long health complications, but in extreme cases it can be life-threatening in the short term. For example, type 2 diabetes, which is being seen in younger and younger patients as the childhood obesity epidemic continues, can cause very serious complications and even be fatal. Sleep apnea, which often occurs in obese children, can lead to very dangerous heart problems.

Because of these dangers Ludwig says the most severe instances of childhood obesity may justify a child’s removal from the home because of imminent health risks to the child and the parents’ continued failure to address those problems.

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