Q: What are the new guidelines on prescribing statins, or cholesterol-lowering drugs, for children?
It used to be that parents and grandparents were the only ones comparing LDL numbers from lipid panel test results. Children should get a pass on that type of thing until they grow up and have kids of their own, right?
Wrong. Obesity among children is a growing concern, given the consequences associated with excess body weight, according to the American Academy of Pediatrics (AAP). CIGNA pediatrician Leslie Barakat, M.D. says that around 30 percent of the patients she sees in her practice are overweight, which is right in line with the national average.
Just last summer, the AAP began recommending that children be screened for cholesterol levels beginning at the age of 2, and no later than the age of 10. The new guidelines also gave doctors the go-ahead to prescribe cholesterol-lowering drugs, or statins, for children as young as 8. Statins — including Lipitor, Crestor and Zocor — reduce the production of cholesterol by the liver, which can help keep blood cholesterol levels low.
The announcement caused a stir among medical professionals. Some of the outcry was from doctors who said that prescribing the drugs to children was a far too aggressive approach to treat obesity. Many medical professionals are concerned because the drugs are relatively new, and long-term effects are not yet known. And although statin use might lower cholesterol, no evidence shows that giving statins to a child will succeed in lowering the risk for heart attack in middle age.
At first pass, any of us might blanch at the idea of prescribing pills to treat high cholesterol to kids who have barely learned to read. Shouldn’t adults be able to control the diets of overweight children?
In reality, statins likely will be prescribed to a relatively low number of children, based on family history. “The new guidelines aren’t going to change things a lot,” says Barakat, who notes that the previous recommended age for statin use was age 10. “Statins should be targeted to high-risk children.”
The recommendations do seem to alert pediatricians to pay close attention to the data revealed in growth charts. With the rise in obesity, Barakat says doctors need to be more cognizant of their young patients’ family histories. Do close relatives have diabetes, or heart disease? “We are going to be asking about those things a lot more,” she says.
If you are concerned about your child, talk less and do more, recommends another recent AAP study, which found that children and teens who needed to lose weight and improve their diets were far more successful if parents simply provided a healthy home environment. Make sure fruits and vegetables are available and refrain from bugging kids about dieting.
Instead, says Barakat, model healthy choices and find opportunities for group activities. “It is often changing a whole family’s behavior,” she says. “Stick with a low-animal-fat diet, walk together after dinner and make the changes as a group.”
Cutting down on saturated fat:
- Read labels: avoid any product that contains partially hydrogenated oil of any kind.
- Pay attention to food “staples” that kids often eat. For example, macaroni and cheese isn’t exactly full of saturated fat, but it does contain some — around two grams per serving. Substitute olive oil, canola oil or vegetable oil spread for butter or margarine, and reduce the amount from four to two tablespoons. Use fat-free milk.
- Choose treats carefully. A good substitute for doughnuts is angel food cake, which is made with egg whites, not yolks, and contains very little fat. Beware: commercial muffins are very high in saturated fats.
- Know what you are eating at the drive-through. Most chains post nutrition information on their websites. Try ordering a plain hamburger instead of a larger-sized burger dressed with bacon, cheese and sauces. Choose apple wedges, applesauce, carrot sticks, etc. when available as a substitute for French fries. Choose water or 100 percent juice or water instead of sodas and milkshakes.
