Severe obesity in children and teens, defined as having a body mass index near the 99th percentile, is as serious as cancer or other childhood illnesses. The difference, says Claudia Fox, co-director of the U’s Center for Pediatric Obesity Medicine, is that in spite of the many health problems it can cause—from heart disease to diabetes—"people think obesity is a lifestyle choice and therefore not worth addressing."
The truth is 40 to 70 percent of a person’s body mass index (BMI) is genetically predetermined and severe obesity often isn’t treatable with run-of-the-mill solutions such as more exercise, less junk food, or more fruits and vegetables. Rather, obesity is a biological disease that needs a biological treatment, says Fox.
That’s why with Masonic support, Fox and others at the Center for Pediatric Obesity Medicine (CPOM) are working diligently to battle the health repercussions, and stigma, that affect young people with severe obesity.
A stubborn stigma
Several years ago, Fox’s colleague and CPOM co-director Aaron Kelly quickly learned that it takes more than behavioral changes to solve severe obesity in young people.
In 2008, Kelly’s team enrolled 20 teens with severe obesity and their families in an intensive 12-week lifestyle modification program. Their weekly visits included diet counseling; physical activities such as tennis, swimming, and walking; and free gym memberships. The results? “We didn’t see a change in weight or BMI,” Kelly says. “It was a sea change for us.”
More research has followed that has led to similar results, but even a decade later, it has been difficult to shake the pervasive stigma that surrounds obesity.
“There’s a sentiment in the lay public, even among health care practitioners, that obesity is a choice, that parents are to blame for their child’s weight, or that their kids are lazy,” says Fox. “That’s far from the truth. Severe obesity is a disorder of energy regulation. It’s not from eating too many cookies or watching too much TV. It’s a dysfunction of how the body operates.”
When Fox tells families that a primary determinant of a person’s shape and size is genetics, and that genetics determine how a person’s energy regulation works, “they immediately relax, knowing that we’re not there to judge, shame, and blame.”
“This is a real disease like any other disease—whether it’s asthma, diabetes, or what have you—that deserves appropriate treatment,” Fox explains. “Diet and exercise are behavioral changes, but if you think of obesity as a biological condition, it really needs a biological treatment.”
Anti-obesity medication: finding the right formula for kids
CPOM prides itself on outside-of-the-box thinking, Kelly says, including one idea that might not seem unique at all: treating kids and teens who have severe obesity with medication.
Such medications for adults are widely available, while options for young people are limited. Kelly says the discrepancy stems from the idea that obesity in kids should be controlled by behavioral changes.
But he and Fox are pressing ahead.
Kelly is completing a study on whether a diabetes drug called exenatide helps maintain weight loss in adolescents.
And in one of the center’s latest studies, Fox is exploring the optimal timing for starting anti-obesity medications in teens who are not losing weight with diet and exercise alone. “We don’t know how long a kid should try lifestyle changes before we say ok, you need medication to help with the weight loss,” she says. “It’s a fine balance between not overmedicating, but also not undermedicating.” The study is also examining which anti-obesity medication young people should take, because, Fox says, not all medications work for all people.
The study, funded by a five-year grant from the National Institutes of Health (NIH), will follow 150 participants for 18 months. Fox hopes that data from the study will lead to new guidelines for how different pharmacotherapies can be tailored to young people with severe obesity.
“Not all obesity is the same, just like not all cancers are the same,” says Fox. “If you have a person with breast cancer, for example, you might not give them the same medication as someone with prostate cancer. That’s the same with obesity—what works for one child may not work for another. It’s about getting the right treatment, to the right kid, at the right time.”
Growth in Masonic support leads to growth in center’s impact
Since its launch in 2017, CPOM has grown immensely, with its success integrally linked to the support of Minnesota Masonic Charities.
Masonic funding enabled Fox and Kelly to launch the center and continues to provide essential support for its work. In only four years, it has helped CPOM:
- Become the only program in Minnesota (and one of only 50+ nationally) that combines research, education, and care in the fight against pediatric obesity
- Launch research that is making a measurable difference for young people: as of 2020, CPOM faculty were leading clinical studies that had reached nearly 3,000 participants
- Lead the way in providing specialized training in pediatric obesity medicine: last year, CPOM launched one of only four fellowship programs in the nation focused on this area, and each year the center hosts a conference that draws pediatricians from around the world
- Increase its faculty from two to nine
- Make key hires for clinical research, including research coordinators, lab technicians, medical technicians, a regulatory specialist, and a recruitment and communications specialist
- Leverage millions of dollars in new grant support
But perhaps most important, says Fox, is the hope that Masonic funding provides to young people experiencing major health challenges through no fault of their own.
“These kids are desperate for intervention. It says a lot about the Masons that they support pediatric obesity medicine,” Fox says. “Just as kids who have cancer or congenital heart disease don’t deserve it, kids with obesity don’t deserve it either. The Masons have allowed us to be the champions of these kids who don’t otherwise have anyone in their corner. It really gives us a chance to be their cheerleaders.”