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This chronic disease affects 16.8% of Connecticut’s children. Poverty is the biggest risk factor and it’s more common in boys than girls.

Hartford Courant - 1/16/2023

For centuries, obesity has been a focus of scorn and ridicule. People with obesity are seen as lazy, selfish, behaviorally indulgent or undisciplined. Schoolyard bullies feel free to torment and shame their obese peers.

So Connecticut pediatricians and public health officials cheered this month, when the American Academy of Pediatrics released a guideline declaring obesity a chronic disease.

“I was so happy to see this. This is a significant health issue children are facing and this gives credence to it,” said Dr. Christine Finck, head of the obesity program at Connecticut Children’s Medical Center in Hartford. “Obesity is a chronic disease. It’s not just a cosmetic thing. It’s not a defect of will. This is the first time I’ve seen it highlighted so specifically.”

The AAP report, dated Jan. 9, offered clinical practice guidelines to work with children living with obesity and their families. Clinicians are instructed to help children and families become more physically fit before the children reach adulthood, when the long-term repercussions of obesity — diabetes, high blood pressure, hyperlipidemia, sleep apnea, musculoskeletal injuries, liver disease, depression — take hold.

The AAP guidance stated that 14.4 million American children live with obesity. Connecticut Department of Public Health statistics report that 16.8% of Connecticut children live with obesity. Obesity is defined as being in the 95th percentile or higher on the body mass index.

Obesity is more common in boys than girls; according to those statistics, 19.7% of boys and 13.7% of girls have obesity in the state. Nonwhite children are more likely to be obese: Compared to 11.2% of white Connecticut children, 27.8% of non-Hispanic Black children, 26.3% of Hispanic children and 15% of children who are multiracial or “other race” have obesity.

Obesity happens most frequently in families in lower income brackets. Connecticut households with lower than $35,000 annual income see a 25.3% of childhood obesity, compared to families in the $35,000 to $74,999 range (23.2%) and $75,000-plus range (12.5%).

A lot of that has to do with access to healthy food in lower-income neighborhoods, said Jennifer Vinci, who runs the nutrition, physical activity and obesity programs for the DPH.

“In talking about where grocery stores are located, in a city people might not have access within walking distance. They might have to go to a corner store where the food is highly processed packaged foods that are low in nutritional value and high in calories. That’s a double-edged sword: overconsumption of calories and a lack of nutrients,” she said.

“Additionally some of these communities across the state might experience a lack of access to opportunities for safe physical activity, like parks where children can run and play and burn off energy, or access to trails, bike lanes or simply just sidewalks. The safety factor might deter folks from getting out and moving,” she said.

Vinci said the state works with schools, day-care centers, places of worship and programs that help the food-insecure, such as SNAP and WIC, to ensure that high-nutrient, healthful food be available.

Other factors figure into the causes of obesity, including medication side effects, genetics and psychological factors, and medical professionals say all of those factors must be taken into account when counseling the child and the child’s family.

Melissa Santos, clinical director of the Pediatric Obesity Center at Connecticut Children’s, who focuses on the psychology of children with obesity, said obesity can be so traumatizing it manifests itself in low self-esteem, depression, anxiety and suicidal ideation.

“We know many negative connotations about obesity, that it’s a matter of willpower, that kids have no self-control, that they’re lazy, they’re ugly,” Santos said. “Kids are picked on, teased, bullied. Beyond that, there is the anxiety of not knowing if you can sit in the chair assigned to you at school, anxiety about what happens in gym class. Also their bodies hurt, all the aches and pains. It makes them not want to be active.”

Santos pointed to a 2003 study that concluded that obese children and teens have a comparable decrease in their health-related quality of life to kids who have cancer. “Physicians, parents and teachers need to be informed of the risk for impaired health-related [quality of life] among obese children and adolescents to target interventions that could enhance health outcomes,” the study concluded.

Santos said “that study captures the struggle with obesity. It’s not an appearance thing. It’s not about looking cute. This is a condition that impacts kids so badly. We don’t give kids with it the respect that their condition warrants. Our hearts don’t break for kids with obesity the way they break for kids with other conditions.”

Santos said all obesity-related psychological counseling is family-based. “You want the whole family to come around. There is nothing worse for a kid struggling with his health than to not have his whole family around him,” Santos said. “Also, parents worry so much about children with obesity, they are so concerned, that they may not say the best things.”

Dr. Bhavna Sacheti, a South Windsor-based pediatrician, said when a family starts with therapy to battle obesity, the progress is gradual. She gave an example.

“All three children came to our practice, all elementary-school age, all overweight, mom and dad were overweight. They were very lovely and kind and hard working,” Sacheti said. “They made tiny changes in the beginning, like everyone drink a glass of water every day ... Small changes go a long way. Then they joined a fitness program for all of them. They came every two or three months for follow ups on their BMI and weight. Over a year and a half they were able to slowly make changes. All the kids are growing and continue to do well.

“When the whole family does things, it works. Everybody is motivated. You’re not isolating one kid in the family. The whole family benefits from a healthy eating program and changing lifestyle and how they grocery shop and how they think about food and cope with stress,” Sacheti said.

Sacheti said the AAP guidelines are exciting because when conditions are validated by studies, then research into the condition gets more funding.

Finck hopes that the recognition of obesity as a chronic disease will help legislative efforts to force insurance companies to cover medical procedures, such as teen bariatric surgery, that can help nip obesity in the bud before it becomes more medically problematic.

“Husky plans, we’ve had the most success with those, but private insurance gives us some trouble,” Finck said. “This study might helps us when we petition the legislature. Every year we go to the legislature, that all insurers have to recognize obesity as a disease. Right now they don’t and you have to pay extra. You don’t have to pay extra if you have cancer. It’s biased and it’s not fair.”

Susan Dunne can be reached at sdunne@courant.com.

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