SPRINGFIELD – “Heartbreaking,” says Dr. Rushika Conroy on the recent referrals she sees as director of the Pediatric Weight Management Program at Baystate Children’s Hospital.
The program serves those aged two to 22 years.
“We’re seeing an increase in the number of kids coming in for evaluation or for obesity and we’re also seeing a huge increase in the number of kids coming in for a diagnosis of pre-diabetes and type 2 diabetes,” said Conroy. “It’s heartbreaking. “
The program’s services are in high demand as coronavirus pandemic restrictions ease, Conroy said, adding that health care providers are getting fully booked with patient visits revealing its broader impact.
“Before COVID, I had maybe five or six patients with pre-diabetes, and for type 2 diabetes, we’d have maybe one newly diagnosed patient once a month,” Conroy said. “Since COVID, I have about 88 patients with pre-diabetes and we see a patient diagnosed with new type 2 diabetes about once a week.”
She said the obesity clinic where patients are assessed by a multidisciplinary staff is “exploding” with appointments booked in November and efforts are underway to “find places to place people as staff are constantly getting messages about parents and doctors who call to schedule appointments.”
“We’re seeing an increase in disordered eating on the side of anorexia bulimia and we’re seeing disordered eating on the side of binge eating,” Conroy said. “A lot of that goes hand in hand with the increase we’re seeing in mental health issues that have also emerged during the pandemic. “
She said people have “turned to food to relieve stress and probably not the most nutritious food” and not everyone has been able to exercise to prevent weight gain.”
“During the pandemic, we told everyone to stay at home and not everyone has access to gym equipment or workout DVDs or things like that that they can do at home,” Conroy said. “So you lost that physical activity, but you also lost that feeling after exercise. Mental health and physical health and a person’s environment are intertwined. That’s why we see things fly like that.”
Conroy said her pediatric weight management program is for patients with a body mass index greater than or equal to the 95th percentile for their age and gender, meaning the patient’s BMI would be greater than 95% of that in their matched population. and therefore a consideration for with the disease of obesity, and “they must want to be here.”
A bariatric surgery component was recently added, making the program the first program in western Massachusetts to offer such weight-loss surgery to people under the age of 18. Pediatric surgeon Michael Tirabassi has already performed a laparoscopic procedure called a sleeve gastrectomy, in which a large portion of the stomach is permanently removed on half a dozen patients, and Conroy said, “We have another 15 or so who are on the pre-operative side of the things are.”
“We ask primary care physicians or sometimes specialists who want their patient to be seen in weight management, talk about it with the family, and if the family is interested in being a part of the program, have them call for an appointment,” Conroy said. “Within the program we have dietitians, behavioral therapists and they can meet with patients on a more regular basis to assess their nutritional plans and also their mental health.”
Conroy, a pediatric endocrinologist, evaluates patients “to make sure they don’t fall into that 5% of the population with obesity stemming from some pathology, be it a syndrome, a disease, or a genetic defect.” .”
“Part of what I do is assess that and I can also assess them for any complications or co-morbidities of their weight gain,” she said.
She added that Baystate Children’s pediatric gastroenterology team “became involved in helping patients with fatty liver disease so we can send them there for further evaluation if needed.”
Conroy said estimates indicate that about 20% of the pediatric population is obese, and between 4 and 6% are considered morbidly obese. It is these severely obese adolescents who need to lose 100 pounds or more who are seen as benefiting from bariatric surgery to help with sustained weight loss and reduce the risks of the disease for developing chronic medical conditions in the long term. to turn.
Conroy said patients in Baystate Children’s weight management program “are not put on diets” to achieve a healthy weight or body mass index, but meet with dieticians to focus on individualized ways to change overall eating habits.
“In younger children, this can be about the parents changing a bad dynamic between them and the child when it comes to food and the parents understanding that, yes, the child may be angry or cry when you say, no, you may not have ice cream today, but that you’re doing it for the sake of the child and for their health,” Conroy said. “With the older kids, it’s less about the parent and more about the child and making them understand why we need to do this .”
She added, “We’re not trying to explain to them that we’re going to worry about cardiovascular disease 20 years from now.”
“We’re talking about what’s going on now.” said Conroy. “We tell them about seeing kids taking blood pressure pills and getting injections for their diabetes and having to use machines to sleep.”
She said the team also “talks to patients about what they’re feeling.”
“Some of these kids have self-esteem issues, some are bullied at school,” Conroy said. “We’re trying to capitalize on what they might want to get out of a program like this so we can use that to motivate them to stay on track.”
Conroy said there is also “our Mighty Program which stands for Moving and Improving and Gaining Health Together at the YMCA and has been around for a long time.”
“It’s a free program for our patients where classes are held every other week and there’s an exercise component, a healthy eating component, and a healthy behavioral component,” Conroy said. “This is all to try to empower the child mentally, physically and emotionally to take care of themselves and lead a healthy lifestyle.”
Conroy said she has long advocated bariatric surgery as part of Baystate Children’s weight maintenance program, now a consideration for people between the ages of 15 and 20, as she sees where behavioral and lifestyle adjustments fall short in helping patients with extreme obesity.
“Surgery is what’s going to help these patients,” said Conroy, pediatric medical adviser to Baystate Health’s bariatric surgery program. “It’s not going to help the patient who needs to lose 20 pounds, but the person who needs to lose 120 pounds. If someone has that much weight to lose, it can help.”
She said the fact that it’s “surgical and permanent” might be seen by healthcare providers and parents as “drastic” for adolescents, but the data supports it as part of a pediatric weight management program as it shows that ” teens with bariatric surgery find that their co-morbidities disappear and they can stay in remission even longer than the adults.”
“We know that children who carry their obesity into adulthood have many more complications from their obesity than adults who were normal weight as children and who developed obesity in adulthood,” Conroy said. “They are already committed to really big risks for comorbidities.
She said the program has “kids who can lower their body mass index” without surgery, but often involves a lot of “tossing and turning” to achieve and maintain it.
“Some were able to reach a healthy weight and go from morbidly obese to overweight or class 1 obesity, but overall we haven’t seen the success we all hope for and there are so many different things that come into play.” play at that,” said Conroy. “Our success with weight management and diet modification alone reflects what people are seeing in the adult population and in other parts of the country as well. People can do it for a month or two, then something happens and they get off track. Now we have to get them back.” getting on track. It’s that bouncing back and forth.”
She said that “we know that in children who were overweight or obese in childhood who were able to reach a normal rate in adulthood, their risk of complications from their obesity is the same as someone who was never obese.”
“So we know if we can nip this in the bud when they’re kids, we can help them live a much healthier life from a metabolic standpoint and a much longer life, so it’s so important that we tackle this now and not wait until they are adults and see what happens,” Conroy said.