Innovative ways to combat severe obesity

Aaron Kelly

Aaron Kelly and Claudia Fox, members of the U’s pediatrics faculty and co-directors of the new Center for Pediatric Obesity Medicine, are passionate about helping young people fight obesity. With support from Minnesota Masonic Charities, they are finding new approaches to tackle this challenge head-on.

When it comes to severe obesity, “you’re never really cured,” says Aaron Kelly, Aaron Kelly Ph.D., about a condition that affects 80,000 children and adolescents in Minnesota and 4 to 5 million nationally. “You can put patients into remission and that’s probably how we should think about it.”

Severe obesity is defined in children and adolescents aged two to 18 years as having a body mass index (BMI) near the 99th percentile. Because 40 to 70 percent of one’s BMI is genetically predetermined, Kelly is not holding out hope for a silver bullet to end adolescent severe obesity. But the U of M pediatrics faculty member and his colleagues at the Center for Pediatric Obesity Medicine remain determined to find ways to address this severe health problem.

New thinking leads to promising results

Part of the approach used by the Center for Pediatric Obesity Medicine (CPOM) is to develop and test nontraditional treatments that may offer benefits to adolescent obesity patients. In many cases, Kelly and his colleagues are the first in their field to do so.

For example, CPOM faculty members represent one of the leading research groups in the world when it comes to studying obesity medications for teens. One current study examines the impact of a diabetes drug called exenatide.

When combined with diet and lifestyle modifications, exenatide, which has a “side effect” of weight loss, led to significant weight and BMI reductions in a small group of pilot participants. Today, Kelly and his CPOM team are working to recruit a large group of teens to enroll in a more expansive study of the drug.

Without the support of Minnesota Masonic Charities, the work of Kelly and others at the Center for Pediatric Obesity Medicine would not be where it is today. Additional research projects that could help tens of thousands of teens statewide and millions more nationally include:

  • The identification of markers in blood that tell health providers critical information about artery health so that it can be improved with targeted treatments.
  • Financial incentives for weight loss. In collaboration with a local food vendor, this study provides three healthy, calorically portioned meals per day to more than 100 teens with severe obesity and compares results for those who are offered a financial incentive versus those who are not.
  • The exploration of gut microbes that control eating behaviors and calorie utilization.
  • The use of magnetic resonance imaging (MRI) to identify areas in the brain related to eating behaviors and obesity and to quantify the amount of fat in the liver and other important areas.

 

Inside the box: diet and exercise

When Kelly came to the U in 2008, little was known about severe obesity, only that it was on the rise while moderate obesity was leveling off.

In an early study, his 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, and other groups were seeing similar results at that time,” says Kelly. “It was a sea change for us. We quickly realized that we needed to start thinking differently about how we were approaching this group of teens.”

In another example, Kelly recalls a teenage patient managed by CPOM co-director Claudia Fox who went on a 1,400 calorie per day meal plan. “When she came back multiple times and wasn’t losing weight, the knee-jerk reaction was that she was not complying with the dietary advice.

“But after measuring her resting metabolic rate, Dr. Fox found that she was only burning half as many calories as she should’ve been,” he explains. “In order to lose weight, she would’ve needed to limit herself to just 800 calories a day.” That’s the equivalent of approximately one bagel with cream cheese.

Addressing obesity, and so much more

Severe obesity causes a number of severe health problems—especially in teens.

Issues such as artery plaque, high blood pressure and cholesterol, and increased risk for heart disease and diabetes, which typically don’t surface until adulthood, are common. And the psychological effects caused by weight-related bullying—from anxiety to depression—are also very real.

Support from Minnesota Masonic Charities, which helped Kelly and Fox create the U’s Center for Pediatric Obesity Medicine, is crucial to the continuing success of these studies and, ultimately, to the health of countless young people, says Kelly.

“It’s easy to judge,” he says. “But how would you do eating just one bagel per day? We need to come up with good treatments that will always be there, and will continue to try things outside of the box. We can and must do better.”

Severe obesity

  • Defined as having a body mass index near the 99th percentile
  • Affects 80,000 children and adolescents in Minnesota and 4 to 5 million nationally
  • Health impacts include artery plaque, high blood pressure and cholesterol, increased risk for heart disease and diabetes, anxiety, depression, and more
  • Likely caused by genetic and biological factors, making it especially challenging to treat

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