More Than Numbers on a Scale: How CHOP Cultivates Childhood Obesity Awareness

Children’s Hospital of Philadelphia researchers encourage a holistic view of obesity, one of the most prevalent diseases in children and adolescents.

As the number of children in the United States with obesity continues to rise, Children's Hospital of Philadelphia researchers are analyzing how to achieve and maintain healthy weights in children by understanding genetic factors, identifying environmental contributors, and developing personalized comprehensive management programs.

Among the many divisions and departments conducting this research, David Hill, MD, PhD, attending physician in the Division of Allergy and Immunology, and Rachana Shah, MD, MSTR, attending physician in the Division of Endocrinology and Diabetes, shared their insights and desire to reduce stigma to leave lasting, positive impacts on population health.

"We're learning more and more is that obesity and weight in general do not have a simple solution," Dr. Shah said. "It's not just knowing what to eat or how to exercise. We must unpack a combination of internal and external factors and adverse experiences that our patients have had with weight bias and stigma."

More to Obesity Than Genetics

The Hill lab is interested in how stress affects macrophages in the body, which are immune cells that remove dead cells and repair tissues..

By encouraging a holistic view that encompasses more than a patient's body mass index, Dr. Hill hopes to reduce negative societal connotations that will improve the way patients can be treated. His lab focuses on the relationship between diet and metabolism on immune health and inflammatory diseases such as allergies and obesity, some of the most common, chronic childhood diseases.

Dr. Hill studies how macrophages, a population of immune cells that remove dead cells and repair tissues, undergo dramatic reprogramming when subjected to stress in the form of long or excess caloric intake, which leads to the kind of inflammation found in children with obesity.

"We've identified a new molecule secreted by adipose tissue macrophages that's actually beneficial towards improving a mammal's metabolic health," Dr. Hill said.

Adipose tissue macrophages help keep adipose tissue, or body fat, healthy. In a study published in Nature Communications, Dr. Hill and colleagues discovered that these macrophages secrete miR-6236, a micro-RNA molecule, to help balance the harmful effects of obesity and type 2 diabetes at a cellular level.

Dr. Hill is also interested in how diet affects the immune system and contributes to obesity. As an allergist, he wants to understand why obesity and food allergies tend to go hand in hand. Through the study of specific dietary components like fatty acids found in common preservatives, researchers identified pro-inflammatory features that suggest diet directly causes both obesity and inflammatory changes, rather than obesity causing inflammation.

"What we're finding is that obesogenic diets are pro-inflammatory in their own right," Dr. Hill said. "It's what you're eating, as opposed to your weight divided by your height, which is enlightening in terms of the way that we've been thinking about obesity and the inflammatory conditions that are associated with it."

Focusing on a Family Effort

The Healthy Weight Program participates in clinical trials at CHOP to better understand the effects of weight loss medications in children.

One of the biggest ways obesity research has changed in the last several years is how physicians are moving toward a more proactive approach regarding excess weight in younger children, according to Dr. Shah, medical director of the Healthy Weight Program at CHOP since 2020. Her program prides itself on working with patients ages 2 to 20 wherever they are in their weight management journey.

"We offer a comprehensive approach," Dr. Shah said. "It's important to us to treat the whole child and not just the number on the scale."

The clinic is participating in an ongoing clinical effort geared toward caregivers of children with obesity and developmental disorders, such as autism spectrum disorder, to learn how to best treat their needs. They are also involved in studies that analyze the short and long-term effects of weight loss medications and bariatric surgery on overall health.

With a multidisciplinary team comprised of endocrinologists, registered dieticians, clinical psychologists, and exercise physiologists, Dr. Shah equips patients with a weight management plan that acknowledges a child's physical and mental health, in addition to their weight. Often, these plans encourage family participation, improving the health of not just the child but also the entire family.

"We don't want to single out a specific child to make them feel like something is wrong with them," Dr. Shah explained. "Instead, we recommend a full family effort towards achieving better health."

While keeping safety and efficacy a top priority for their patients, they strive to provide the most up-to-date evidence-based care, aided by CHOP scientists, ranging from lifestyle to pharmaceutical and surgical options.