Treatment options few for overweight kids

By Diane Carman

Dr. Daniel Feiten has been shepherding babies and their parents through the challenges of childhood and adolescence for more years than he cares to count. He is a clinical professor of pediatrics at the University of Colorado School of Medicine, where he received the Career Teaching Scholar Award in 2009. He is one of the founders of Greenwood Pediatrics, one of the largest practices in Colorado.

And, to his dismay mostly out of necessity he has become an expert on childhood obesity.

So lets start with a little good news.

Its my favorite success story, he said.

A young man, lets call him Mark, came to his office and said he wanted to lose 40 pounds.

Mark was 16 and his body mass index was above the 95th percentile.

He had been an ostrich at school, said Feiten. Hed never had a date, never been kissed. He had one friend.

The pediatrician had seen dozens of cases just like Marks and knew better than to expect too much, but he did his best to help.

Marks favorite drink was Mountain Dew. He told the doctor he usually had one or two a day. That means he probably had a least two and who knows how big they were, said Feiten.

They calculated how many calories per day he was consuming in Mountain Dew alone. If he ate the same number of calories as he needed given his activity level and just added one Mountain Dew a day to that diet, Feiten said, we figured at the end of 15 days, hed gain one pound. After 30 days, two pounds. At the end of a year, hed be 24 pounds overweight.

He took that as a challenge.

Mark decided to replace his Mountain Dew with water and take up one hour of exercise per day. He left Feitens office and never returned for a follow-up.

Nine months later, his mother saw me at a store and stopped me, Feiten said. She said, You wont believe it, but Mark has lost 40 pounds. Hes an entirely different kid. He loves life; he loves school; he has lots of new friends. I just want to thank you.

Feiten was surprised and delighted.

Dr. Daniel Feiten

He just needed to understand the story of why and how it was possible, he said.

Unfortunately, Feiten said, success like Marks occurs in about one out of every 30 cases of childhood obesity.

Some cases are truly heartbreaking.

Feiten saw another child at the insistence of his mother. The boy had immersed himself in the lonely pursuit of philosophy studies, focusing on the writing of the stoics.

He would sit around with his two buddies, studying philosophers who wrote about suicide and the relative value of life, Feiten said. His mother was extremely worried. Feiten did his best to counsel the child and get him the help he needed.

What the boy was doing is not that unusual, Feiten said.

We all want to be good at something, but these kids because of their weight cant be good at sports; they cant be very good at friendships because people ostracize them; and they cant be good at anything that requires self-confidence, he said.

So what do they do? They become experts at things like video games, said Feiten, and that sedentary activity only exacerbates their weight problems.

About two years ago, one of the parents of a patient in his practice urged Feiten to develop a program to address the obesity epidemic. A former trainer for the Denver Nuggets basketball team, the dad kept hounding me, Feiten said, until the two of them forged a plan.

They call it Five Alive.

Five Alive was inspired by the ski industry program that gives fifth-graders free ski passes at Colorado resorts. Once its implemented, Five Alive would make fifth grade really special, Feiten said.

Through a consortium of community leaders, educators and professionals in the food, restaurant and recreation industries, a wide range of discounts would be available to fifth-graders for activities that encourage fitness and foods that support good nutrition. With foundation support, Feiten hopes to launch the project this year.

Not that he expects it to change the culture around obesity overnight.

Its a very tough problem, he said. And I want to be very clear some kids cant help it.

A wide range of biological causes are under investigation and clearer understanding of the many causes of obesity is challenging researchers around the world.

But the sharp increase in obesity among children primarily reflects the change in our culture, he said. Weve moved to viewing rather than doing active things, and diets have moved away from whole foods to more processed foods, and from home cooking to restaurant (mostly fast-food) meals.

So the question is: Can we change the culture enough to bend the trend line?

Feiten paused.

There was a time in our country when littering was commonplace, he said. We were able to change the paradigm and get people to stop littering.

There was a time when more people smoked than didnt and it was the youth who told their parents to stop smoking because they learned it at school. The same thing happened with recycling.

I think that if we can put together a communitywide program that makes it the norm not to little or smoke and to recycle, then we surely can put together a program that will influence people to eat more sensibly and move their bodies, he said.