Amanda Jonnet weighs nearly 300 pounds and has struggled with her weight for a good portion of her 16 years.
"Doctors always told me, 'You've got to lose weight,' " said the teen, who lives in a suburb of Pittsburgh. "There was a time I gained 20 pounds in one month, and I was 10 years old, and my doctor was like, 'Amanda, you can't do this.' "
Steven Jonnet, her father, said he tried everything to help his daughter, to no avail.
"It was constantly trying to have her lose the weight on diets, even ordered programs over the TV," he said. "Nothing would work, and I didn't know how to help her."
His daughter said that she simply couldn't limit her eating.
"I was always hungry," Amanda said. "They'd say, 'Eat a cup of rice.' I'd look at this cup of rice — I'd even put it on a smaller plate so I felt like I was eating more, and I'd sit there after dinner and I'd be like, 'I'm so hungry.' "
By age 12, Amanda had already tried diet pills and was attending Weight Watchers. She is far from alone, but doctors say extra pounds are dangerous, even for children, who are more likely to suffer further potentially fatal health problems at a younger age.
"The bigger they are, the higher the early death rate, and it's usually a cardiovascular-related death, heart attack or stroke," said Dr. Philip Schauer, an obesity specialist at Magee Women's Hospital in Pittsburgh. "Teenagers who have this problem now — that continue to increase or stay the same in terms of their weight — will likely have a much higher risk of premature death."
Larger, Flabbier Hearts
As children gain weight, changes happen in their bodies. The heart may get larger and flabbier, making it harder for it to pump blood. The pancreas releases more insulin, and blood pressure skyrockets, which causes arteries to get thicker and stiffer. Just as occurs in adults, the arteries clog with deadly fat, all of which makes kids vulnerable to early heart attack and stroke. Amanda Jonnet's health has already begun to suffer. She is fighting liver disease along with diabetes. A family history of high cholesterol and high blood pressure put her at high risk for debilitating side effects.
Only recently have doctors begun to see the long-term consequences of obesity firsthand, as young, overweight Americans begin suffering earlier and earlier.
"We're going to have a lot of 20- and 30-year-olds who are having significant medical problems," said Dr. Ron Williams, who runs the pediatric obesity clinic at Penn State Children's Hospital in Hershey, Pa. "They're going to have high blood pressure, they're going to have earlier heart attacks, earlier strokes, more arthritis in their knees — they'll be unhappy."
For Amanda, that unhappiness has already set in.
"These doctors are listing more and more problems, and it's like well, I don't want to die from fatty liver, problems associated with that," she said. "I don't want to have to put insulin in my body every day. My life is like a time bomb right now."
The 16-year-old is headed for more health problems down the road, Schauer said.
"She's already on medication for diabetes," he said. "That will progress and today even with the best medical treatment for diabetes, it's still a progressive disease, and over time — five, 10, 15, 20 years of uncontrolled diabetes — complications tend to develop."
Heart Attack at 34
One possible complication is retinopathy, an eye disease that is a complication of diabetes, and kidney failure. Amanda might need a kidney transplant, and could develop heart disease. She might also need heart bypass surgery.
Lesa Small was just 34 when she suffered a heart attack. "I went to bed that night and I just got a feeling like my heart was just going to break bones, bust, skin and everything and come right out of my chest," said Small, of Fayetteville, Pa. "And I knew as soon as it hit me what it was."
Small was obese as a child and teenager, and she went on to become an obese adult, eventually weighing more than 250 pounds.
The only way Small could lose her excess weight was to have so-called gastric bypass surgery, which reduced the size of her stomach, and, she hopes, will save her from another heart attack. She has lost 90 pounds and continues to lose weight.
"They say a lot of times when you have them and you're that young — most people don't survive — so I was given a second chance, and I didn't want to blow it," Small said.
Schauer, who is slated to perform gastric bypass surgery on Amanda next week, said that obesity in children has long-term consequences.
"The next 10 to 20 years are scary," Schauer said. "Right now, our children's generation may be the first generation that doesn't outlive its parents. And it's principally because of obesity."
It used to be unusual to see a 400-pound person, but these days, it is much more common, and some people are tipping the scales at 500 to 600 pounds, Schauer said.
"As the society has gotten heavier, we look and say, 'I think that's normal,' because they look like everybody else," Williams said. "I have kids that come and see me in my pediatric practice, and [their parents] say, 'My child is underweight' — when they're at perfect ideal body weight. And it's like no — keep them exactly where they are, they're doing great." As younger children struggle with obesity, weight-loss surgery could become an option at an even younger age. Some doctors are opposed to such surgery on children, saying it is unlikely children have exhausted all other weight-loss alternatives.
"Weight-loss surgery in teenagers is quite controversial," Schauer said. "How low do you go? I don't know. We are beginning to see children, 10-, 11- and 12-year-olds who have such severe obesity that their quality of life is unacceptable. And if they have tried other measures, this may be a reasonable approach."
Amanda Jonnet is desperate for a solution.
"I don't want to die young," she said. "I want to live until I'm old, I want to see my grandkids. I want to be able to have kids, and then I want to watch them grow up, and then I want to watch them have kids. And if I stay the way I am — I'm not going to make it that far."