Obesity is a disease, not a character flaw. Scientific studies have identified several genetic markers that increase the risk of obesity, and we now know that babies whose mothers have gestational diabetes are far more likely to become insulin resistant—another risk factor for obesity.
So, let’s stop suggesting that people with obesity just suck it up and take better care of themselves. Instead, let’s have the same compassion for those diagnosed with obesity as we do for those diagnosed with diabetes, high blood pressure, asthma, or any other illness. Almost all illnesses are influenced by risk factors from both sides of the nature/nurture divide, some of which we can control, some of which we can’t.
I run an obesity clinic for children where I see the impact of environment on patients, especially those younger than 12 years old. Some families show love and build connection through an abundance of food. Some believe excess weight is a sign of prosperity. Some come from a scarcity mindset where children are forced to eat everything on their plate, even when it’s too much. Others simply do not know enough about nutrition to provide healthy, balanced meals.
When I work with families, we talk about all of this. My primary job is to educate patients and their families so they can make decisions that work best for them. To be clear, healthy people come in all shapes and sizes, and a positive body image is important regardless of whether someone fits with another person’s definition of beauty. Our obesity clinic is only open to children and adolescents with body mass indexes greater than the 80th percentile for their ages, especially those whose weight is causing metabolic, physiological, and/or psychological problems.
The goal of our treatment plan is to help patients feel good in their bodies and to be able to engage in the activities they enjoy. When I’m working with teens, they can make many decisions for themselves, but when I’m working with younger patients, it is crucial for all the adults in that child’s life to adhere to the treatment plan. It’s not fair to a child to have one parent or grandparent setting limits and another undermining them. Without clear limits and plenty of support, children cannot be successful.
According to the most recent clinical practice statement from the Obesity Medical Association, children’s responses to obesity fall into three categories: endocrine or immune responses, physical responses, and psychological responses. Immune responses include conditions such as fatty liver disease, early onset or delayed puberty, and hypertension. Physical responses include conditions such as a lack of mobility, obstructive sleep apnea, scoliosis, and orthopedic disorders. Psychological responses can include decreased social interaction, depression, anxiety, eating disorders, and being the target of bullying, abuse, or neglect.
I have seen the trauma obesity can cause. I have also witnessed the triumph of children who have taken control of their bodies and transformed their lives. Treatment plans are as varied as the patients who need them. Some patients focus on behavior changes alone; with others, we incorporate medication to reduce binge eating or to address other issues.
We typically start with nutrition, where I focus mostly on portion control and avoiding processed foods. It’s about eating the right amount of the right kind of food. We also work on strength and mobility. We start slowly and build stamina. Having personally lost 60 pounds since the pandemic started, I know how hard but rewarding this can be. I used to get tired walking around the block. Now I am preparing for a multi-day backpacking trip. It is amazing how small efforts can add up. Finally, because obesity is often connected with psychological pressures, we pay attention to the mental health aspects, both the causes and effects.
Sustaining behavior changes and lifestyle changes is hard for most of us. Reducing obesity requires health education, commitment, and a support system, and even with that, there are sometimes setbacks along the way. But transformation is possible.
This is all very personal for me. My cousin died in his 40s of an obesity-related illness. I don’t want another family to go through this. My goal is to help as many children as I can to overcome obesity and live happy, healthy lives.
Cindi Condos is a family nurse practitioner at MCHC Health Centers, a community-based and patient-directed organization that serves Mendocino and Lake Counties, providing comprehensive primary healthcare services as well as supportive services such as education and translation that promote access to healthcare. Learn more at mchcinc.org.