Obesity in Children

By Dr. Sally Zeinatie


Definition

Obesity is an excess of body fat resulting in a significant impairment of limited mobility, function and health. Obesity results when the size or number of fat cells in a person's body increases beyond and above average terms. A healthy person has somewhere around 25 billion fat cells. For a person to gain fat weight, these cells first increase in size and once they bust at the seams, they later increase in number.

The height and build of the child affects whether a child is considered obese at a given weight. A child usually is obese when she is significantly over ideal body weight for her height. In general, if a child's weight is 20% or more in excess of the expected weight for a given height, a child is probably obese. Other more accurate ways to determine obesity include the measurement of skinfold thicknesses, bioelectrical impedence, and whole-body densitometry.

Obesity most commonly begins in childhood between the ages of 5 and 6, and during adolescence. Studies have shown that a child who is obese between the ages of 10 and 13 has an 80 percent chance of becoming an obese adult.

Overweight and Obesity Defined:

Overweight and obesity for children and adolescents are defined respectively in this fact sheet as being at or above the 85th and 95th percentile of Body Mass Index (BMI).
Some researchers refer to the 95th percentile as overweight and other as obesity. The Centers for Disease Control and Prevention (CDC), which provides national statistical data for weight status of American youth, avoids using the word "obesity," and identifies every child and adolescent above the 85th percentile as "overweight."

The AOA uses the 95th percentile as criteria for obesity because it:
corresponds to a BMI of 30 which is obesity in adults. The 85th percentile corresponds to a BMI of 25, adult overweight.
is recommended as a marker for when children and adolescents should have an in-depth medical assessment.
identifies children that are very likely to have obesity persist into adulthood.
is associated with elevated blood pressure and lipids in older adolescents, and increases their risk of diseases.
is a criteria for more aggressive treatment.
is a criteria in clinical trials of childhood obesity treatments.


Prevalence

Prevalence and Trends:
Approximately 30.3 percent of children (ages 6 to 11) are overweight and 15.3 percent are obese. For adolescents (ages 12 to 19), 30.4 percent are overweight and 15.5 percent are obese.
Excess weight in childhood and adolescence has been found to predict overweight in adults. Overweight children, aged 10 to 14, with at least one overweight or obese parent (BMI> 27.3 for women and > 27.8 for men in one study), were reported to have a 79 percent likelihood of overweight persisting into adulthood.




A family history of obesity increases a child's risk of becoming obese, especially if both the parents are obese. In addition, the high level of fat and calories in the average United States diet combined with the inactive lifestyle of many children is contributing to the dramatic increase in the prevalence of childhood obesity.


Pathophysiology

Obesity tends to persist through life. While most obese infants will not remain so, they are at increased risk of becoming obese children. These children are in turn more likely to become obese adolescents, who are then very likely to remain obese as adults.

Children become overweight due to genetic factors, lack of activity, horrible eating patterns, and a combination of all the above. Rarely is it due to a medical problem, such as an endocrinal issue. If it is, it was brought on by, you guessed it, one of the above. Your physician can verify this.

Children whose family members are overweight are at an increased risk of becoming overweight too. Although this is true, not all children with an obese family will become overweight. However, it is more likely then not, shared family behaviors such as bad eating habits that influence your child's body weight.


The genetic elements associated with obesity are seldom traced back to a mutation in a single gene. Many genetic factors may contribute to obesity, but none of them are sufficient to account for any large proportion of the risk by themselves. Also, an increased susceptibility to obesity is likely to result from more than one combination of genetic and environmental risk factors.




We divide the genes into two groups:

Rare gene variants that have a strong influence
A few genes have variants that are powerful enough to cause obesity all by themselves. For example, rare variants of the POMC gene on chromosome 2 and the PC1 gene on chromosome 5 cause obesity, among other problems. In two families, a variant of the leptin gene (chromosome 7 ) specifies a protein that has no action. These people have increased appetite and obesity.

Variants of the MC4R gene on chromosome 18 are more common. Inheriting one copy of certain variants causes obesity in some families. These variants are found in 3 to 5% of very obese persons (BMI over 40). Not all persons with uncommon variants of MC4R are obese, however.

Finally, obesity is a feature of more than 30 genetic disorders . Most of these disorders are rare, and their genes have not been found.

Common gene variants that have a weaker influence
Researchers are still looking for the gene variants that cause most cases of obesity. Their most promising leads are regions on chromosomes 20 , 11 , 10 , 5 , and 2 .

The region on chromosome 2 is interesting because it includes the location of the POMC gene. It's possible that common variants of the POMC gene influence obesity in less striking ways than the rare variants mentioned above.

THE OB - GENE

For the sake of science, a genetically obese persons is defined as one who would be obese even in an environment in which less that 10 per cent of the population would be obese. With this definition in mind, scientists estimate that only approx. 21% of people who are obese are genetically obese.

LEPTIN

An obesity gene has been identified in mice, but so far no single human has been identified with this mutation. However, there is a protein, LEPTIN, produced by the OB Gene that circulates in the blood of humans. It is believed that Leptin acts on the brain to signal satiety and thereby reduce food intake. Injections of Leptin reduced feeling and weight in mice. Thus far however, no human has successfully been treated with injections of Leptin, which is at present expensive to produce ( $millions for a vial).

THE DB GENE

The diabetes gene is of greater significance to weight control in humans. It is believed that DB codes for the receptor of the OB protein., enabling humans to experience the effects of Leptin.



Available evidence suggests that obesity results from multiple interactions between genes and environment. Parents obesity is the most important risk factor for childhood obesity. Twin, adoption, and family studies indicated that inheritance is able to account for 25% to 40% of inter-individual difference in adiposity. Single gene defects leading to obesity have been discovered in animals and, in some cases, confirmed in humans as congenital leptin deficiency or congenital leptin receptor deficiency. However, in most cases, genes involved in weight gain do not directly cause obesity but they increase the susceptibility to fat gain in subjects exposed to a specific environment. Both genetic and environmental factors promote a positive energy balance which cause obesity.

The role of the environment in the development of obesity is suggested by the rapid increase of the prevalence of obesity accompanying the rapid changes in the lifestyle of the population in the second half of this century. Early experiences with food, feeding practices and family food choices affect children's nutritional habits. In particular, the parents are responsible for food availability and accessibility in the home and they affect food preferences of their children. Diet composition, in particular fat intake, influences the development of obesity. The high energy density and palatability of fatty foods as well as their less satiating properties promotes food consumption. TV viewing, an inactivity and food intake promoter, was identified as a relevant risk factor for obesity in children. Sedentarity, i.e. a low physical activity level, is accompanied by a low fat oxidation rate in muscle and a low fat oxidation rate is a risk factor of fat gain or fat re-gain after weight loss.


As with most common disorders, both genetic and environmental factors play a role in obesity. In fact, obesity is a good example of the interaction between genes and environment. It is well known that obesity runs in families. For example, children with two obese parents have an 80% chance of being overweight, compared to 40% for children with one obese parent and 20% when neither parent is obese.


There is now scientific evidence for what you may have suspected for years. Overweight people are not weak willed or lazy. Losing weight and keeping it off may not be as easy for some as it is for others, if a tendency to be overweight is inherited. Weight control may not be easy, particularly if you have inherited the tendency to be overweight but it can be done. Providing an environment of low fat foods and increase physical activity can stifle even the most stubborn genes.

Causes

The causes of obesity are complex and include genetic, biological, behavioral and cultural factors. Basically, obesity occurs when a person eats more calories than the body burns up. If one parent is obese, there is a 50 percent chance that the children will also be obese. However, when both parents are obese, the children have an 80 percent chance of being obese. Although certain medical disorders can cause obesity, less than 1 percent of all obesity is caused by physical problems.

Obesity in childhood and adolescence can be related to:
poor eating habits
overeating or binging
lack of exercise (i.e., couch potato kids)
family history of obesity
medical illnesses (endocrine, neurological problems)
medications (steroids, some psychiatric medications)
stressful life events or changes (separations, divorce, moves, deaths, abuse)
family and peer problems
low self-esteem
depression or other emotional problems

Risk Factors

There are some signs that may help you determine if your child has or is at risk for childhood obesity, such as:
Family history of obesity.
Family history of obesity-related health risks such as early cardiovascular disease, high cholesterol, high blood pressure levels, type 2 diabetes.
Family history of cigarette smoking and sedentary behaviors.

Signs in the child of obesity-related health risks from a pediatrician's evaluation including:

Cardiac Risk Factors. Studies of children with obesity show higher than average blood pressure, heart rate and cardiac output when compared to children without obesity.

Type 2 Diabetes Risk Factors. This involves glucose intolerance and insulin levels that are higher than average.

Orthopedic Problems. Some symptoms include weight stress in the joints of the lower limbs, tibial torsion and bowed legs, and slipped capital femoral epiphysis (especially in boys).
Skin disorders. Some are heat rash, intertrigo, monilial dermatitis and acanthosis nigricans.

Psychological / Psychiatric Issues. Poor self-esteem, negative self-image, depression, and withdrawal from peers have been associated with obesity.


Patterns of sedentary behavior (such as too much television viewing) and low physical activity levels.
Taller height - children with obesity are often above the 50th percentile in height.

Smoking initiation. Research studies show that youngsters use smoking as a method of weight control. Parents, pediatricians and schools should work together to discourage smoking as a weight control behavior for three main reasons: a) smoking is not likely to be successful in controlling weight, b) smoking is itself harmful, and c) smoking is associated with a decrease in sound nutrition and physical activity patterns.

Complications

Arthritis
Osteoarthritis (OA)
Obesity is associated with the development of OA of the hand, hip, back and especially the knee.
At a Body Mass Index (BMI) of > 25, the incidence of OA has been shown to steadily increase.
Modest weight loss of 10 to 15 pounds is likely to relieve symptoms and delay disease progression of knee OA.
Rheumatoid Arthritis (RA)
Obesity has been found related to RA in both men and women.


Cancers

Breast Cancer
Postmenopausal women with obesity have a higher risk of developing breast cancer. In addition, weight gain after menopause may also increase breast cancer risk.
Women who gain nearly 45 pounds or more after age 18 are twice as likely to develop breast cancer after menopause than those who remain weight stable.

High BMI has been associated with a decreased risk of breast cancer before menopause. However, a recent study found an increased risk of the most lethal form of breast cancer, called inflammatory breast cancer (IBC), in women with BMI as low as 26.7 regardless of menopausal status.
Premenopausal women diagnosed with breast cancer who are overweight appear to have a shorter life span than women with lower BMI.

The risk of breast cancer in men is also increased by obesity.
Cancers of the Esophagus and Gastric Cardia
Obesity is strongly associated with cancer of the esophagus and the risk becomes higher with increasing BMI.
The risk for gastric cardia cancer rises moderately with increasing BMI.


Colorectal Cancer

High BMI, high calorie intake, and low physical activity are independent risk factors of colorectal cancer.
Larger waist size (abdominal obesity) is associated with colorectal cancer.
Endometrial Cancer (EC)

Women with obesity have three to four times the risk of EC than women with lower BMI.
Women with obesity and diabetes are reported to have a 3-fold increase in risk for EC above the risk of obesity alone.
Body size is a risk factor for EC regardless of where fat is distributed in the body.
Renal Cell Cancer

Consistent evidence has been found to associate obesity with renal cell cancer, especially in women.
Excess weight was reported in one study to account for 21% of renal cell cancer cases.


Cardiovascular Disease (CVD)

Obesity increases CVD risk due to its effect on blood lipid levels.
Weight loss improves blood lipid levels by lowering triglycerides and LDL (“bad”) cholesterol and increasing HDL (“good”) cholesterol.
Weight loss of 5% to 10% can reduce total blood cholesterol.
The effects of obesity on cardiovascular health can begin in childhood, which increases the risk of developing CVD as an adult.
Overweight and obesity increase the risk of illness and death associated with coronary heart disease.
Obesity is a major risk factor for heart attack, and is now recognized as such by the American Heart Association.


Carpal Tunnel Syndrome (CTS)

Obesity has been established as a risk factor for CTS.
The odds of an obese patient having CTS were found in one study to be almost four times greater than that of a non-obese patient.
Obesity was found in one study to be a stronger risk factor for CTS than workplace activity that requires repetitive and forceful hand use.
Seventy percent of persons in a recent CTS study were overweight or obese.
Chronic Venous Insufficiency (CVI)
Patients with CVI, an inadequate blood flow through the veins, tend to be older, male, and have obesity.


Daytime Sleepiness

People with obesity frequently complain of daytime sleepiness and fatigue, two probable causes of mass transportation accidents.
Severe obesity has been associated with increased daytime sleepiness even in the absence of sleep apnea or other breathing disorders.
Deep Vein Thrombosis (DVT)
Obesity increases the risk of DVT, a condition that disrupts the normal process of blood clotting.
Patients with obesity have an increased risk of DVT after surgery.


Diabetes (Type 2)

As many as 90% of individuals with type 2 diabetes are reported to be overweight or obese.
Obesity has been found to be the largest environmental influence on the prevalence of diabetes in a population.
Obesity complicates the management of type 2 diabetes by increasing insulin resistance and glucose intolerance, which makes drug treatment for type 2 diabetes less effective.
A weight loss of as little as 5% can reduce high blood sugar.
End Stage Renal Disease (ESRD)
Obesity may be a direct or indirect factor in the initiation or progression of renal disease, as suggested in preliminary data.


Gallbladder Disease

Obesity is an established predictor of gallbladder disease.
Obesity and rapid weight loss in obese persons are known risk factors for gallstones.
Gallstones are common among overweight and obese persons. Gallstones appear in persons with obesity at a rate of 30% versus 10% in non-obese.
Gout
Obesity contributes to the cause of gout -- the deposit of uric acid crystals in joints and tissue.
Obesity is associated with increased production of uric acid and decreased elimination from the body.


Heat Disorders

Obesity has been found to be a risk factor for heat injury and heat disorders.
Poor heat tolerance is often associated with obesity.
Hypertension
Over 75% of hypertension cases are reported to be directly attributed to obesity.
Weight or BMI in association with age is the strongest indicator of blood pressure in humans.
The association between obesity and high blood pressure has been observed in virtually all societies, ages, ethnic groups, and in both genders.
The risk of developing hypertension is five to six times greater in obese adult Americans, age 20 to 45, compared to non-obese individuals of the same age.


Impaired Immune Response

Obesity has been found to decrease the body’s resistance to harmful organisms.
A decrease in the activity of scavenger cells, that destroy bacteria and foreign organisms in the body, has been observed in patients with obesity.
Impaired Respiratory Function
Obesity is associated with impairment in respiratory function.
Obesity has been found to increase respiratory resistance, which in turn may cause breathlessness.
Decreases in lung volume with increasing obesity have been reported.


Infections Following Wounds

Obesity is associated with the increased incidence of wound infection.
Burn patients with obesity are reported to develop pneumonia and wound infection with twice the frequency of non-obese.
Infertility
Obesity increases the risk for several reproductive disorders, negatively affecting normal menstrual function and fertility.
Weight loss of about 10% of initial weight is effective in improving menstrual regularity, ovulation, hormonal profiles and pregnancy rates.


Liver Disease

Excess weight is reported to be an independent risk factor for the development of alcohol related liver diseases including cirrhosis and acute hepatitis.
Obesity is the most common factor of nonalcoholic steatohepatitis, a major cause of progressive liver disease.

Low Back Pain

Obesity may play a part in aggravating a simple low back problem, and contribute to a long-lasting or recurring condition.
Women who are overweight or have a large waist size are reported to be particularly at risk for low back pain.


Obstetric and Gynecologic Complications

Women with severe obesity have a menstrual disturbance rate three times higher than that of women with normal weight.
High pre-pregnancy weight is associated with an increased risk during pregnancy of hypertension, gestational diabetes, urinary infection, Cesarean section and toxemia.
Obesity is reportedly associated with the increased incidence of overdue births, induced labor and longer labors.
Women with maternal obesity have more Cesarean deliveries and higher incidence of blood loss during delivery as well as infection and wound complication after surgery.
Complications after childbirth associated with obesity include an increased risk of endometrial infection and inflammation, urinary tract infection and urinary incontinence.


Pain

Bodily pain is a prevalent problem among persons with obesity.
Greater disability, due to bodily pain, has been reported by persons with obesity compared to persons with other chronic medical conditions.
Obesity is known to be associated with musculoskeletal or joint-related pain.
Foot pain located at the heel, known as Sever’s disease, is commonly associated with obesity.
Pancreatitis
Obesity is a predictive factor of outcome in acute pancreatitis. Obese patients with acute pancreatitis are reported to develop significantly more complications, including respiratory failure, than non-obese.
Patients with severe pancreatitis have been found to have a higher body-fat percentage and larger waist size than patients with mild pancreatitis.


Psychosocial Effects & Stigma

Overweight children are often taller than the non-overweight.
White girls, who develop a negative body image, are at a greater risk for the subsequent development of eating disorders.
Adolescent females who are overweight have reported experiences with stigmatization such as direct and intentional weight-related teasing, jokes and derogatory name calling, as well as less intentional, potentially hurtful comments by peers, family members, employers and strangers.
Overweight children and adolescents report negative assumptions made about them by others, including being inactive or lazy, being strong and tougher than others, not having feelings, and being unclean.


Sleep Apnea

Obesity, particularly upper body obesity, is the most significant risk factor for obstructive sleep apnea.
There is a 12 to 30-fold higher incidence of obstructive sleep apnea among morbidly obese patients compared to the general population.
Among patients with obstructive sleep apnea, at least 60% to 70% are obese.
Stroke
Elevated BMI is reported to increase the risk of ischemic stroke independent of other risk factors including age and systolic blood pressure.
Abdominal obesity appears to predict the risk of stroke in men.
Obesity and weight gain are risk factors for ischemic and total stroke in women.


Surgical Complications

Obesity is a risk factor for complications after a surgery.
Surgical patients with obesity demonstrate a higher number and incidence of hospital acquired infections compared to normal weight patients.
Urinary Stress Incontinence
Obesity is a well-documented risk factor for urinary stress incontinence, involuntary urine loss, as well as urge incontinence and urgency among women.
Obesity is reported to be a strong risk factor for several urinary symptoms after pregnancy and delivery, continuing as much as 6 to 18 months after childbirth.


Other

Several other obesity-related conditions have been reported by various researchers including:
abdominal hernias, acanthosis nigricans, endocrine abnormalities, chronic hypoxia and hypercapnia, dermatological effects, depression, elephantitis, gastroesophageal reflux, heel spurs, hirsutism, lower extremity edema, mammegaly (causing considerable problems such as bra strap pain, skin damage, cervical pain, chronic odors and infections in the skin folds under the breasts, etc.), large anterior abdominal wall masses (abdominal paniculitis with frequent panniculitis, impeding walking, causing frequent infections, odors, clothing difficulties, low back pain), musculoskeletal disease, prostate cancer, pseudo tumor cerebri (or benign intracranial hypertension), and sliding hiatil hernia.

Treatment

When a person starts losing weight, the cells decrease in size but the number of fat cells generally stays the same. This is part of the reason that once you gain a significant amount of weight, it is more difficult to lose all of it. There is no returning to 'normal' because you have altered your body's chemistry. However, studies imply that fat cells can be destroyed as a result of maintaining a proper body weight for a prolonged period of time. That means you will lose weight, but it takes time to tighten up. So stick it out. Make it a lifestyle change.

Ways to manage obesity in children and adolescents include:
start a weight-management program
change eating habits (eat slowly, develop a routine)
plan meals and make better food selections (eat less fatty foods, avoid junk and fast foods)
control portions and consume less calories
increase physical activity (especially walking) and have a more active lifestyle
know what your child eats at school
eat meals as a family instead of while watching television or at the computer
do not use food as a reward
limit snacking
attend a support group


Dietary Therapy

Consultation with a dietitian / nutritionist that specializes in children's needs is often a valuable part of obesity treatment. Nutrition consultants can outline specific and appropriate nutritional needs for healthy growth.

As with adults, a nutrition consultant may or may not recommend reducing the number of calories the child eats and implementing strategies like learning to read nutrition labels and the food guide pyramid, selecting proper portion sizes, and prepared foods. Some eating behaviors that nutrition consultants typically encourage include taking smaller bites, chewing food longer, and to avoid eating too quickly by putting the utensil down between bites.

Guide to Physical Activity

An increase in physical activity is an important part of your weight management program. Most weight loss occurs because of decreased caloric intake. Sustained physical activity is most helpful in the prevention of weight regain. In addition, exercise has a benefit of reducing risks of cardiovascular disease and diabetes, beyond that produced by weight reduction alone. Start exercising slowly, and gradually increase the intensity. Trying too hard at first can lead to injury.


Your exercise can be done all at one time, or intermittently over the day. Initial activities may be walking or swimming at a slow pace. You can start out by walking 30 minutes for three days a week and can build to 45 minutes of more intense walking, at least five days a week. With this regimen, you can burn 100 to 200 calories more per day. All adults should set a long-term goal to accumulate at least 30 minutes or more of moderate-intensity physical activity on most, and preferably all, days of the week. This regimen can be adapted to other forms of physical activity, but walking is particularly attractive because of its safety and accessibility.

Guide to Behavior Change

Effective goals are 1) specific; 2) attainable; and 3) forgiving (less than perfect). "Exercise more" is a commendable ideal, but it's not specific. "Walk five miles everyday" is specific and measurable, but is it attainable if you 're just starting out?" Walk 30 minutes every day" is more attainable

Nothing Succeeds Like Success

Shaping is a behavioral technique in which you select a series of short-term goals that get closer and closer to the ultimate goal (e. g., an initial reduction of fat intake from 40% of calories to 35% of calories, and later to 30%). It is based on the concept that "nothing succeeds like success." Shaping uses two important behavioral principles: 1) consecutive goals that move you ahead in small steps are the best way to reach a distant point; and 2) consecutive rewards keep the overall effort invigorated.

Get The (Fullness) Message

Changing the way you go about eating can make it easier to eat less without feeling deprived. It takes 15 or more minutes for your brain to get the message you've been fed. Slowing the rate of eating can allow satiety (fullness) signals to begin to develop by the end of the meal. Eating lots of vegetables can also make you feel fuller. Another trick is to use smaller plates so that moderate portions do not appear meager. Changing your eating schedule, or setting one, can be helpful, especially if you tend to skip, or delay, meals and overeat later.

Surgery for obesity

Gastric partitioning (laparoscopic banding) Another technique, especially popular in Europe, is called gastric partitioning. The surgeon uses a band instead of staples to partition the stomach into two parts. This band is wrapped around the upper part of your stomach and pulled tight, like a belt, creating a tiny channel between the two pouches. The band keeps the opening from expanding. Some surgeons can perform this operation by inserting laparoscopes — tiny, tubular instruments with a small camera attached — through small incisions made in the abdomen.The tiny camera on the tip of the scope allows the surgeon to see inside you. Many doctors in the United States have reservations about the long-term effects of this surgery and don't currently perform the procedure. It's considered experimental


Gastric bypass

This is the weight-loss surgery most often recommended by doctors. It creates a small pouch at the top of your stomach and adds a bypass around part of your small intestine.
The surgeon staples your stomach all of the way across the top, sealing it off from the rest of your stomach and leaving a tiny pouch that can hold about a half an ounce of food. Then the surgeon cuts the small intestine and sews part of it directly onto the upper pouch. This redirects the food, bypassing most of your stomach and the first section of your small intestine, the duodenum . Food flows directly into the middle section of your small intestine, the jejunum, limiting your body's ability to absorb calories. Even though food never enters the lower part of your stomach, the stomach stays healthy and continues making digestive juices that flow into your small intestine.

Vertical banded gastroplasty (VBG)

Called VBG for short, this surgery is designed to partition the stomach into two parts. It's rarely done anymore, but it works by limiting the space for food, forcing you to eat less. There is no bypass. Using a surgical stapler, the surgeon divides your stomach into upper and lower sections. The upper pouch is small and empties into the lower pouch, which is the rest of your stomach.
At the dime-sized opening where the upper pouch empties into the rest of your stomach, the surgeon wraps the tissue with a piece of nonexpandable plastic. This "banding" of the opening between the upper pouch and the rest of your stomach prevents the opening from stretching. If the opening were to stretch enough, the two pouches essentially become one again, defeating the purpose of the surgery.
This surgical procedure is called vertical banded gastroplasty because the staple line creating the upper pouch is placed vertically on the stomach and the opening of the upper pouch is banded.

Small bowel bypass (jejunoileal bypass)

This was the first operation for obesity. It caused your food to bypass almost all of your small intestine. As a result, most of the food you ate never came in contact with the absorptive area of your intestine, so nearly all of the nutrients were lost in the stool.
People lost a large amount of weight following this surgery, but many also experienced severe complications, including liver failure, arthritis, kidney stones and severe diarrhea. For this reason, this operation is no longer performed. Many doctors recommend that people who underwent this operation have it reversed if they have active complications.

Gastric partitioning (gastric stapling)

Also known as gastric stapling, this is an operation that divides your stomach into a tiny upper pouch and a large lower pouch.
In one technique, the surgeon uses a surgical stapler to apply a horizontal row of staples, dividing your stomach into two sections. The surgeon leaves a dime-sized opening between the two sections. Although this is faster and slightly safer than some more common operations, the weight loss is less. This is because the opening between the two stomach pouches gradually dilates, defeating the purpose of the operation. Most surgeons no longer perform this surgery.
Images of surgery

In conclusion, there's no magic bullet for losing weight. The only way to lose weight and keep it off is through permanent lifestyle changes: Eat a healthier diet, watch portion sizes and exercise regularly. It's not very exciting, but it works.

Prevention

Strategies to Prevent Weight Gain
To prevent weight gain:

Assess Your Behavior and Environment
Adopt Healthy Habits


Assessing Your Behavior and Environment
The amount and types of foods you eat, and your physical activity habits are important factors in controlling weight. The environment in which you live may also contribute or cue you to adopt poor eating or exercise habits. This is especially true in today's society, which is dominated by speed and convenience. For example, escalators, elevators and remote-control appliances make us less physically active. Also, greater availability of foods that are high in calories, fat and added sugars, and larger portion sizes promote unhealthy eating behaviors.

Create an Active Environment:

Make time for the entire family to participate in regular physical activities that everyone enjoys. Try walking, bicycling or rollerblading.
Plan special active family-outings such as a hiking or ski trip.
Start an active neighborhood program. Join together with other families for group activities like touch-football, basketball, tag or hide-and-seek.
Assign active chores to every family member such as vacuuming, washing the car or mowing the lawn. Rotate the schedule of chores to avoid boredom from routine.
Enroll your child in a structured activity that he or she enjoys, such as tennis, gymnastics, martial arts, etc.
Instill an interest in your child to try a new sport by joining a team at school or in your community.
Limit the amount of TV watching.


HEALTHY EATING SUGGESTIONS

Follow the Dietary Guidelines for healthy eating
Guide your family's choices rather than dictate foods.
Encourage your child to eat when hungry and to eat slowly.
Eat meals together as a family as often as possible.
Carefully cut down on the amount of fat and calories in your family's diet.
Don't place your child on a restrictive diet.
Avoid the use of food as a reward.
Avoid withholding food as punishment.
Children should be encouraged to drink water and to limit intake of beverages with added sugars, such as soft drinks, fruit juice drinks, and sports drinks.
Plan for healthy snacks.
Stock the refrigerator with fat-free or low-fat milk, fresh fruit, and vegetables instead of soft drinks or snacks that are high in fat, calories, or added sugars and low in essential nutrients.
Aim to eat at least 5 servings of fruits and vegetables each day.
Discourage eating meals or snacks while watching TV.
Eating a healthy breakfast is a good way to start the day and may be important in achieving and maintaining a healthy weight.


Here are some tips to help you keep your child at a healthy weight:

Don't make your child eat when he or she isn't hungry--it's OK if not every drink or every meal gets finished.
Don't use food to comfort or to reward.
Don't offer dessert as a reward for finishing a meal. Doing this teaches your child to value sweets more than other foods.
Offer your child a healthy diet. No more than 30% of all the calories your child eats should be fat calories. Ask your doctor or a dietitian to teach you about the right kinds of food to feed your child. Your child needs to get lots of fiber from fruits, vegetables and grains.
Don't eat at fast-food restaurants more than once a week.
Limit how much TV your child watches. Try to get your child to do something active instead, like riding a bicycle or playing ball.
Spend time being active with your child--go on family walks and play outdoor games together whenever you can.
Teach your child good eating and exercise habits now to help him or her have a healthy life.


If your child is overweight, further weight gain can be prevented. Parents can help their children keep their weight in the healthy range:
In infancy, breastfeeding and delaying introduction of solid foods help prevent obesity.
In early childhood, children should be given healthful, low-fat snacks and take part in vigorous physical activity every day. Their television viewing should be limited.
Older children can be taught to select healthy, nutritious foods and to develop good exercise habits. Their time spent watching television and playing with computer or video games should be limited.

Conclusion

" Effective weight management involves behavior modification which is a lifelong commitment and includes at least two components:

Healthful eating in accordance with the Dietary Guidelines for Americans, emphasizing a reduction in total calories, a lowered fat consumption, and an increase in vegetables, fruits and whole grains.

Increased frequent and regular physical activity of at least moderate intensity."