"At this weight, you can't sit in seats," said Dr. Keith Ayoob, director of the Nutrition Clinic and assistant professor of pediatrics at the Albert Einstein College of Medicine in New York City. "You're talking about three, 150-pound people, and then put a 100-pound, 10-year-old in their lap."
"He's at high risk," Ayoob said. "The point is to get this kid help. Otherwise, he's at a very high risk for an early death. He won't make it until 50."
Ayoob said a 14-year-old's skeleton may suffer significant damage under the extra 400 pounds. That pressure would likely lead to hip and knee problems. Being morbidly obese also puts children at high risk for hypertension, which puts the them risk for heart troubles. At that weight, Ayoob said, there is a high risk for Type 2 diabetes, which puts a person at risk for a slew of other health complications.
"With Type 2 diabetes, he is at risk for a heart attack, and he's at risk for kidney failure, and he's at risk for circulation problems meaning he may lose fingers and toes and sometimes limbs," said Dr. Reginald Washington of the American Academy of Pediatrics and the chief medical officer for the Rocky Mountain Hospital for Children in Denver.
Added to that laundry list are sleep apnea and a fatty liver, with risk of liver failure, Washington said.
But obesity, as much of a public health issue as it its, is not always a proven grim health sentence.
Dr. Marc Jacobson, of the American Academy of Pediatrics, Obesity Leadership Workgroup, said a sizable fraction of obese people don't have co-morbid health problems.
"He could have orthopedic complications like bowed legs," he said, "It's called Blount's disease, he could have metabolic complications ... breathing complications. But he could also conceivably not have any of those."
"Believe it or not, there are people who are quite overweight who don't have any medical complications, about 1 out of 3," he said. "But that data comes from adults."
But even if an obese child were lucky enough to not face any medical problems, those who treat childhood obesity say there are frequently co-morbid psychological problems or family dynamic issues.
"There's a chance that he has one of the genetic problems that can cause massive weight gain," Washington said. "When we see a child, especially at that age who is massively obese, we test him for that, but often they're negative. The [genetic] problems are very rare, but they're known.
"But you have to imagine that a 14-year-old probably doesn't have the resources to eat that much. Someone had to enable that to happen."
Ayoob, who treats morbidly obese patients on a regular basis, agreed. "If he's eating like a typical 14-year-old, he would lose weight," Ayoob said. "The heaviest patient I had was 675 pounds. That man was put in the hospital on 2,000-calories a day and he was losing six pounds a day at first."
Ayoob said the first question he often asks of his obese pediatric patients is, "Where is the food coming from," because there is often an enabler. Ayoob also insists on psychological treatment and family counseling.
"It has nutritional consequences but it's a mental health issue," Ayoob said. "I could put someone on all the right foods and nutrition but then you're just going to have a normal-weight person with an eating disorder. You work together with a counselor."