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Childhood Obesity: Should We Give Children Cholesterol Lowering Medications?

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I've written several posts about the epidemic of childhood obesity. Childhood obesity is very serious, mainly because of all the secondary problems associated with it, including death.

Childhood obesity is directly related to poor eating habits, and lack of activity. So, when I heard that the use of statin medication had been approved for children as young as eight, I was quite surprised, and very skeptical.

This is the news clip I saw earlier today...

 

When I first heard it, it almost made sense. But, the problem with this way of addressing childhood obesity, is that you are only treating a symptom (in this case high cholesterol) of a much greater problem. Let me give you an example...

If you have a child that burns their hand on the stove, and the doctor tells you to treat it with burn ointment, that makes sense. However, if this is the tenth time your child has burned their hand on the stove??? Well, maybe it's time to address prevention and not just treatment.

I really believe that we need to focus on preventing and treating childhood obesity, and the answer won't be found in any pill. Lifestyle change and better eating habits are the only way to prevent the longterm effects of obesity. Here are a few sites that might help you improve your child's eating habits...

From Kids Health - Healthy Eating

Nutrition Tips for Kids

From Mom to Mom - Unique Ways to Help Kids Eat Healthy

Tips For Children With High Cholesterol

From PBS Parents - Encourage Kids To Eat Healthy

Games To Get Your Kids Eating Healthy

From WebMD - High Cholesterol in Children

So, while treating some cases of childhood high cholesterol with statins may be appropriate, it's far from a solution. I would say it's like putting a band-aide on a gaping wound...But, it's actually more like not even trying to stop the bleeding, and using blood transfusions to counter the blood loss. It just doesn't make very much sense.

I'm not the only one questioning these new recommendations, this is from The New York Times...

While some doctors applauded the idea, others were incredulous. In particular, these doctors called attention to a lack of evidence that the use of the cholesterol-lowering drugs, called statins, in children would prevent heart attacks later in life.

. . .

Other doctors said the recommendation would distract from common-sense changes in diet and exercise, which are also part of the new guidelines.

“To be frank, I’m embarrassed for the A.A.P. today,” said Dr. Lawrence Rosen of Hackensack University Medical Center in New Jersey, vice chairman of an academy panel on traditional and alternative medicine. He added: “Treatment with medications in the absence of any clear data? I hope they’re ready for the public backlash.”

Newsweek Health has an interesting article on the pros and cons of statins for children...

Newsweek's Mary Carmichael spoke with Peter Belamarich, a pediatrician at Children's Hospital at Montefiore Medical Center in New York City, who has prescribed statins to some kids but takes issue with the new guidelines.

Did you hear about this? What do you think? Here is some of what others are saying...

From Angie at ParentDish...

The AAP has also reversed its original stance against giving children under the age of 2 reduced fat milk. Higher fat milk was recommended because saturated fats are essential for brain development. "But now we have the obesity epidemic and people are thinking maybe this isn't such a good idea," said Dr. Frank Greer of the University of Wisconsin, co-author of the guidelines report, which appears in the July edition of Pediatrics, the group's medical journal.
Young children are now getting the fat they need from sources other than milk and the updated recommendation is based on recent research showing no harm came from younger children drinking the reduced-fat milk.

Theresa from Poked and Prodded...

Dr. Daniels says medication isn’t for every kid. “We are only talking about children who have pretty high cholesterol, cholesterol that would be high for an adult,” he says. Children who are obese and have diabetes or other risk factors are more likely to be candidates for medication.

“It’s

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NurseBarb 5 pts

I'm puzzled by the AAP guidelines since there is no evidence that the use of statins in children has any benefit except in rare familial conditions that predispose people to early heart attacks.  I don't think that there is adequate data about normal cholesterol distribution levels in children and long range data on the correlation of childhood cholesterol levels, when plaques are forming and heart attack.  

Further, I haven't seen any compelling data on when it would be appropriate to initiate treatment, except in the rare familial conditions. 

What I recall from a lipid disorder conference is that the decision to use statins is based on reduction of cardiovascular events.  Hmmm, it's only the last few years that women have been treated more appropriately, but again it's evidence based medicine that showed a reduction in heart attacks, not just lowering numbers. 

And not to digress too much, but there's not enough emphasis on lifestyle changes, including exercise and dietary changes.  Lowering not just fats in the diet, but also decreasing excess carbohydrates, like sugary drinks, chips, fries, candy, etc.

Why is it important to decrease carbs when you're concerned about cholesterol?

When we eat carbohydrates, those are converted to triglycerides, which in turn convert into LDL cholesterol.  (The "bad" cholesterol). Who knew?

So it's not just a reduction in animal fat, it's also important to eat carbs in moderation, because high carbs can lead to elevated triglycerides and that can lead to high LDL.  High triglyceride levels are more likely to occur in folks with diabetes or an underlying insulin resistance.

Bottom line, if anyone out there is considering statins for their child, please see a pediatric cardiologist for specific advice related to your unique child and their situation.

I write a lot about diabetes, obesity and health at www.nursebarb.com ( http://www.nursebarb.com )

Be well,

Nurse Barb 

MissSuzy 5 pts

This was a great post. Thank you for writing it.

Please STOP with the meds.  Get your kids out on bicycles and let them watch television only on Friday nights and Saturday mornings until ten, like we all did.  Make them fresh food.  Keep jump ropes and pogosticks around the house.  

We "decorate" our TV room with a spinning bike, huge exercise balls, balance gadgets, and juggling beanbags.  Soe even when my kids are watching television, they can stretch and use their bodies.

 One of my favorite blog topics is about "old school" parenting and trying to raise healthy kids who aren't casualties of the technological age.

 See:

Alien Generation ( http://introvertigo.typepad.com/licensetolove/2008... )

Time is a Two-Way Street ( http://introvertigo.typepad.com/licensetolove/2008... )

Old-School ( http://introvertigo.typepad.com/licensetolove/2008... )

MissSuzy

www.introvertigo.typepad.com/licensetolove/ 

Dr. Polly 5 pts

As a mother of three kids, I gotta wonder what's going on over at the American Academy of Pediatrics.  But I'm not surprised.  The recent thumbs-up for statins comes on the heels of other recommendations based on either faulty, non-existent or otherwise misinterpreted ("stretched") data.  Like no tv for kids under 2 - without any real evidence of harm, particularly for moderate amounts.  Like breastfeeding exclusively for 6 months - with research showing very modest benefits, mostly for preemies, and some research quite suspect (IQ benefits diappear when controlling for maternal IQ).  And then the AAP's strong approval of the FDA ban on cough and cold meds for kids under 6 despite nearly no evidence of harm and parents snapping up 80 million bottles a year.  Makes me get cranky.

StephanieWA 5 pts

Wow, this is astonishing.

I'm worried about the possibility of adverse side effects, especially after reading the Consults ( http://consults.blogs.nytimes.com/2008/07/07/reade... ) post in the NY Times today. Dr. Sanghavi reports that in the AAP's guidelines "Specific risk-benefit calculations are not offered, and the new
guideline asserts that 'there were few studies of pharmacologic
intervention in children, and the degree to which such therapy would
produce important adverse effects was not known.'"

Yikes!

It also sounds like statins might be worth the gamble in extreme cases, when doctors don't know what else to do for a patient -- not just for any obese child with high cholesterol. But will it get inappropriately overprescribed anyway?

AgnosticMom 5 pts

Plant foods do not contain any cholesterol.  There is much evidence that a plant-based diet is just as effective and statin drugs, plus you get all the other nutritional benefits without the side effects.  But Americans seem hell-bent on avoiding the discussion and encouragement of eating a plant-based diets.   I can't believe these doctors and organizations never get around to mentioning it.  I guess they just can't imagine Americans giving up their animal-flesh, even when their lives and their children's lives are at stake.

Watch video tutorials at <a href="http://www.paperclipping.com">Paperclipping.com</a>.

LizzieH 5 pts

Young children are now getting the fat they need from sources other than milk and the updated recommendation is based on recent research showing no harm came from younger children drinking the reduced-fat milk.  

Good lord, what exactly are these other sources of fat?  I'm guessing that it might be better to recommend that kids under two NOT BE FED these other sources than to tell parents it's okay to give them 2% milk!

Sheesh, what is wrong with people today?!?

--Liz (feeling like an old geezer today - "whole milk was good enough for us back in the day, it should be good enough for you young'uns today!")

I blog about creating a life worth living at:  www.inventingmylife.blogspot.com ( http://www.inventingmylife.blogspot.com/ )

Candelaria Silva 5 pts

The over-medication of Americans and children continues.

How about making sure that exercise is part of every child's life by making sure that physical education (something as simple as walking) is required at school.  (I grew up in apoor, Black community in St. Louis and we had formal exercise two times a week, with the requisite gym suits, and recess every single day.)  How about making sure that, at least at school, children were fed healthy meals?  How about doing public service announcements on TV and posting billboards on healthy eating?

No - instead - let's medicate.  Give me a break!

blog.candelariasilva.com

Good and plenty!