The nation’s continuing epidemic of childhood obesity has provoked a strong reaction from the American Academy of Pediatrics (AAP), but other experts urge caution.

As former U.S. Surgeon General Richard Carmona warned at the recent LIUNA Tri-Funds Conference, the portion of American children of unhealthy weight is growing. Currently, about 30 percent are overweight or obese, conditions often associated in adult populations with high cholesterol. High cholesterol is a significant risk factor for heart disease, heart attacks and diabetes. In the past, these illnesses seldom occurred in childhood, but the AAP is concerned that they will strike overweight or obese children much earlier in life.

In issuing new cholesterol guidelines in July, the AAP aimed at children who have been unable to lose weight after a six- to twelve-month effort relying on lifestyle changes — diet and exercise. For them, the Academy recommends cholesterol screening, and, if “bad” cholesterol (LDL) exceeds 190 mg/dL (90.5 is considered normal) or the family has a history of early heart disease, the AAP says doctors should consider statin treatment for those eight or older. 

Statins are widely prescribed among at-risk adults and are demonstrably effective at lowering cholesterol and the risk of heart attacks with few apparent side effects. However, until recent years, they have not been prescribed for children, so little data exists regarding childhood safety or effectiveness. Also, cholesterol plays a necessary role in adolescent development. 

For these reasons, some experts question the new guidelines and urge caution in their implementation. For instance, in recommendations issued last year, the American Heart Association endorsed screening, particularly among children with multiple risk factors arising from family histories, but did not support drug therapy for boys until age ten and for girls until puberty. Others criticized what they perceive as a tendency to over rely on medication rather than making the hard effort to adopt a healthy lifestyle that is sustainable through a lifetime.

For parents of children who are overweight the controversy may be confusing. The key point is to talk with your family physician about how to help your child develop a healthier lifestyle and lose weight. If you’re still unable to get results, your doctor may recommend cholesterol screening and, possibly, statin treatment. At that point, discuss the pros and cons of the medical intervention and make your decision, but continue to incorporate healthier foods and regular exercise in your child’s life.

[Steve Clark]