Too many kilos

Nearly two metres tall and weighing in at 112 kilos, Alvaro López (not his real name) can be considered chubby. But that doesn’t mean he’s not proud of his weight, because just six months ago the 17 year old topped the scales at 158 kilos. “I didn’t realise that I was so fat until I saw myself now in comparison with what I was not too long ago,” he told Metropolitan. “The quantities of what I was eating before were immense. I could eat a whole family-sized pizza by myself, for example.”

The secret to López’s success was a surgical technique known as vertical banded gastroplasty, in which the volume of his stomach was permanently reduced by stapling a portion of it shut, immediately diminishing the quantities he consumed.

López is another statistic in an explosion of childhood and adolescent obesity that has spread not just globally, but especially in Spain. The latest studies completed for Spain by AVENA and enKid, report that one in four Spanish children and adolescents are overweight or obese, with Barcelona corresponding to the national average, according to a 2007 report published by the Generalitat’s Department of Public Health.

“Fifteen years ago, nine percent of infants and adolescents were obese,” said Vicente Varea, a physician who heads Childhood Digestive Services at Sant Joan de Déu Hospital. “Now 16 percent are obese and around 12 percent are overweight.”

Obesity is defined by the World Health Organisation (WHO) as a medical condition in which excess body fat has accumulated to the extent that it may have an adverse effect on health. Its prevalence in youth can have a long-term impact: of the children who are obese at 16, 80 percent become obese adults, which can contribute to arteriosclerosis, type-II diabetes, cancer, hypertension, osteoarthritis, gout and various cardiovascular diseases.

It can seriously infringe on one’s quality of life, as well. Among children and adolescents, the effect of stigmatisation, either perceived or real, can be particularly devastating. “I felt a little isolated,” said Alvaro López. “I would feel panic if I went to a discotheque or even just to go out. It scared me just to meet people, as if they were going to laugh at me or something. But I felt the most different because of my clothes. My friends treated me the same as always, but they would always talk about the stores for buying cool clothes and I couldn’t go there because I had to buy clothes in stores for large people.”

The causes of obesity among young people are multifactorial, Varea explained to Metropolitan. “Fundamentally, there’s a genetic factor. Then there are endocrine diseases and digestive diseases, although diseases constitute a small percentage of what causes obesity.”

The primary cause for the boom in obesity, he said, comes from changing personal habits. “A human being is genetically prepared to conserve all the calories that he can, because we’ve always eaten little and had to work a lot. In the past 50 years, this has become inverted in the first world. Now, there is a lot of food and very little movement.

“We did a study and found that parents drive their children to school, even if it’s less than a kilometre away. Before, we used to go out on the street and run around. We didn’t have video games, nor was there so much television. Nowadays, because of traffic, children can’t go out in the street. It’s too dangerous. There are no public spaces like there were before.”

Economic factors can also contribute to childhood obesity, because low-income parents must work longer hours and therefore lack the time and resources to buy and prepare fresh and healthy food. What’s more, wealthier parents are able to pay for extra-curricular activities like sports and dance, where children are able to burn away calories. One Spanish study, published in 2009, found a direct correlation between income and obesity. Communities with a per capita income of €24,100 suffered a 14.9 percent overweight and obesity rate in their children, while a per capita income of €8,800 corresponded to 29.4 percent.

The main way to avoid having overweight and obese children is to increase the amount of physical activity in which they engage. The WHO recommends at least 60 minutes daily of intense physical activity five days a week. Less than that is considered ‘sedentary’. The Generalitat estimated in 2007 that 23.9 percent of 15-year-old Catalans were sedentary, while 14.9 percent were moderately or very active. They also found that 6-14 year olds watched approximately 11 hours of television per week in Catalunya—and that estimate doesn’t include time surfing the internet or playing video games.

When a child becomes obese, however, the difficulties can be a little more complex than simply a change of eating habits and exercise. Alvaro López spoke of the psychological challenge of overcoming his problem: “I was so fat that, well, I needed to lose 50 kilos, but I knew that I wasn’t going to lose it by dieting. So, I didn’t really try.”

Vicente Varea acknowledged the difficulties faced by his own patients. “The success rate is usually very low. If you can cure 30 percent, then you’re doing well. That’s because 70 percent aren’t mentally prepared.”

Nuria Roca, the physician who treated Alvaro López in the Metabolic Surgery Unit for Morbid Obesity at the Sagrat Cor hospital in Barcelona, described the number of specialists necessary to treat a child when the problem becomes unmanageable. “Treatment must be coordinated by a multidisciplinary unit in a hospital environment, counting on the participation of surgeons, nutritionists, psychiatrists, psychologists, pediatricians and other consultants when necessary. In the case of children who are still growing, our team involves the parents and teachers when giving dietary suggestions. We also insist on physical exercise and try to reeducate them on bad habits.”

While Roca declined to specify the costs at Sagrat Cor, Vicente Varea provided an estimate. “It depends on the number of people who intervene. If you include many specialists, the cost will obviously be higher. If a patient has a balloon put in for six months, it could be m5,000. But if you have a biweekly visit with a psychologist and dietician, that could be between m400 and m800 a month.”

Alvaro López went through all the procedures for obesity including diet, increased physical exercise, medication, the insertion of a gastric balloon and surgery to staple his stomach. At 14 years old and 120 kilos, and after medication failed, a gastric balloon was inserted in his stomach for six months. He lost 20 kilos, but immediately gained them back after the balloon was removed. The only thing that managed to help him in the end was having his stomach stapled.

Still, he wishes that it hadn’t been necessary. “It’s true that it hurts a little if somebody says, ‘You know, you’re fat.’ But, I really would have preferred that somebody had said something to me early and then, at 17, I wouldn’t have been operated on.”

Nevertheless, he said, he is happy with the current situation. He continues to eat lightly and anticipates that he will lose even more weight in the future. “Things are much better now. I can buy my clothes in any store. It doesn’t scare me to meet people. It’s changed my life completely.”