At the same time most people are trying to discourage teenagers who are unhappy with their physical appearance from using drugs (especially anabolic steroids), the New York Times reports that fat kids over 10 years old probably should use drugs if they are unable to lose weight after a 6-12 month effort (”Cholesterol Screening is Urged for Young,” July 7).

But proponents say there is growing evidence that the first signs of heart disease show up in childhood, and with 30 percent of the nation’s children overweight or obese, many doctors fear that a rash of early heart attacks and diabetes is on the horizon as these children grow up.

Previously, the academy had said cholesterol drugs should be considered in children older than 10 if they fail to lose weight after a 6- to 12-month effort.

Granted, the New York Times is suggesting cholesterol drugs and not anabolic steroids to obese children. Yet targeting obese kids as requiring drug treatment is sending a contradictory message to teens who are dissatisfied with their body image and at risk of anabolic steroid abuse - it’s ok to take some drugs because you’re fat, but it is wrong to take other drugs because you’re fat.

Reason Hit & Run further explains why it is a bad approach to “conflate” cholesterol levels with obesity (”What About Fat Kids with Low Cholesterol?” July 7).

Shouldn’t the decision to treat a patient for high cholesterol hinge on how high his cholesterol is, as opposed to how much he weighs? Even if there’s a correlation between weight and cholesterol, doesn’t it make sense to focus on the risk factor that’s the target of the treatment, instead of simply assuming that all fat kids have high cholesterol and that failing to lose weight is the same as failing to reduce cholesterol?

Another problem with the New York Times report is that the American Academy of Pediatrics does not actually make the recommendation suggested by the Times. According to the AAP, drug therapy should only be considered in children if multiple risk factors are present (only one of which is “severe obesity”).

Drug therapy should be considered only for children >10 years of age after an adequate trial of diet therapy (for 6 to 12 months) and whose LDL-cholesterol level remains 190 mg/dL or whose LDL-cholesterol level remains 160 mg/dL and there is a family history of premature cardiovascular disease (55 years of age) or two or more other risk factors (Table 1) are present in the child or adolescent after vigorous attempts have been made to control these risk factors.

[...]

Table 1: Other Risk Factors That Contribute to Earlier Onset of Coronary Heart Disease 

• Family history of premature coronary heart disease, cerebrovascular disease, or occlusive peripheral vascular disease (definite onset before the age of 55 years in siblings, parent, or sibling of parent)
• Cigarette smoking
• Elevated blood pressure
• Low HDL-cholesterol concentration (<35 mg/dL) 
• Severe obesity (95th percentile weight for height) 
• Diabetes mellitus
• Physical inactivity