Adolescent obesity and cardiovascular risk: a rational approach to management

Ten obese adolescents, referred because of elevated cardiovascular disease risk, were treated in a pediatric atherosclerosis prevention center. The focus of treatment was an increase in exercise tolerance and aerobic capacity and a decrease in the percentage of fat in the diet. Weight loss was not a goal of treatment, but continued growth with a slowing of the rate of weight gain was emphasized. All patients were at elevated cardiovascular risk at the entry to the study, and nine of the ten had significant improvements in one or more of their cardiovascular risk parameters. Furthermore, with regard to body composition, eight of the ten patients were able to improve their body mass index. On average, triceps skinfold thicknesses declined 25 percent. Total cholesterol declined 14%, triglycerides declined 33%, LDL cholesterol declined 13%, and HDL cholesterol did not change with this form of treatment. As for systolic and diastolic blood pressure, four of the ten patients who had elevated blood pressures at the initiation of treatment were able to decrease their blood pressure, in absolute terms and on the basis of their percentiles for age and sex. We conclude that, in obese adolescents, improved diet and body composition, a slowed rate of weight gain, and a reduction of cardiovascular risk shown through lipid profiles and blood pressures can be achieved from a multidisciplinary treatment program focused on achievable goals. These goals include (1) increased habitual exercise and increased aerobic exercise and (2) a decrease in the percentage of energy intake from fat and saturated fat, with a concomitant decrease in the balance of energy intake to energy output. It is important to remember that we did not focus on weight loss per se and that the treatment was individualized to the developmental stage of the adolescent.