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This article is from the WebMD News Archive
Doctors Underestimate Teenage Obesity
March 8, 2004 (San Francisco) -- America's physicians are probably underestimating the problem the of teenage obesity, which means that as many as 2.1 million teens who already have evidence of dangerous complications of obesity are "slipping" through a dangerous gap in diagnostic measurements.
The problem, says Carolyn J. Tabak, MD, a researcher in preventive medicine at Strong Children's Research Center of the University of Rochester in New York, is that pediatricians and other physicians measure obesity in teens using the same formula that they use for toddlers and elementary age children. And that one-size-fits-all approach doesn't work for teens, Tabak told WebMD.
In young children obesity is identified by using growth charts that calculate body mass index (BMI) by charting height and weight and by plotting the calculated BMI to a particular age. "When a child is in the 95th percentile, meaning that child is heavier than 95% of same-age, same-sex children, the child is diagnosed as overweight," she says. This growth chart approach works with younger children because "they are growing and changing rapidly, but that changes in the teen years."
As children grow up and become more like adults, Tabak thinks they should be measured using adult standards to define overweight and obesity "which is simply a BMI of more than 25."
To prove her point, Tabak and colleagues analyzed data collected in a large national survey called the Third National Health and Nutrition Examination Survey or NHANES III, which collected data from 2,392 teens aged 12 to 19. She presented the results of the analysis at the American Heart Association 44th Annual Conference on Cardiovascular Disease Epidemiology and Prevention.
The survey data included not only BMI but also measurements of waist circumference, blood sugar levels, HDL "good" cholesterol, triglycerides (another type of blood fat sometimes linked to a high risk of diabetes), and blood pressure.
"About 11% of teens had BMIs of 25 or more, but did not meet the pediatric standard for overweight because their BMI did not put them into 95th percentile or higher," Tabak says. But even though these teens weren't considered overweight by pediatric standards, they "did have clear evidence of metabolic syndrome, which is a collection of risk factors that greatly increase the risk for developing heart disease or diabetes or both."
Twenty-eight percent had low levels of good cholesterol, more than 8% had high blood pressure, and about one-third had elevated triglycerides. All of these findings increase the risk of being diagnosed with the metabolic syndrome.
Stephen Daniels, MD, PhD, professor of pediatrics and environmental health at Cincinnati Children's Medical Center, University of Cincinnati, tells WebMD that Tabak's study is interesting since it highlights the difficulty of accurately diagnosing weight problems in children. "We have grappled with the problem of how to define overweight in teens and how to connect childhood definitions to adulthood," Daniels says.
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