The Health Impact of

Childhood Obesity Kristen Vogt, MD, FAAP

September 27, 2011

STATS

The prevalence of obesity in children ages 2-11

from 1999-2002 was double that of 1976-1980.

For adolescents it was triple (16)

NHANES Survey 2003-2006: 31.9% of US

children (6-19) overweight, 16.3% obese(17)

How do we define obesity? A child's weight status is determined using an age- and

sex-specific percentile for Body mass index (BMI)

BMI is a measure of a child's weight proportionate to

height.

BMI does not measure body fat directly but is a

reasonable indicator of body fat content for most

children and teens.

BMI correlates with obesity-related complications

Body Mass

Index CDC Growth Charts are used

to determine the

corresponding BMI-for-age

and sex percentile. For

children and adolescents

(aged 2—19 years):

Overweight - BMI at or above

the 85th percentile and lower

than the 95th percentile for

children of the same age and

sex.(1)

Obesity - BMI at or above the

95th percentile for children of

the same age and sex.(1)

Causes Multi-factorial

Result of increasing caloric intake and decreasing physical activity

Diet high in sugary, high-fat, refined foods and beverages promotes weight gain.

Lack of regular exercise and excess sedentary behavior

Endocrine and genetic causes account for less than 1% of pediatric obesity

Why do we care? Overweight and obesity are the second leading preventable

cause of death in the US, second only to smoking.

Obese children are more likely to become obese adults(9, 10, 11)

Greater likelihood that obesity beginning in early childhood

will persist through life

If children are overweight, obesity in adulthood is likely to be

more severe. (13)

Obesity is associated with a number of serious health

conditions both immediate and chronic(12)

Comorbidities Breathing problems

Asthma, sleep apnea

Neurologic

pseudotumor cerebri

Orthopedic problems

Joint and musculoskeletal complaints

Gastrointestinal complications

Fatty liver disease, gallstones, and gastro-esophageal reflux

Type 2 diabetes or impaired glucose tolerance

Menstrual abnormalities

PCOS

Premature puberty

Cardiovascular risk factors

Hypertension and elevated cholesterol

Psychosocial effects

Depression, anxiety, lower self esteem, bullying, eating disorders

Comorbidities

Breathing

problems Asthma, sleep apnea

Neurologic

pseudotumor cerebri

Orthopedic problems

Joint and musculoskeletal

complaints

Gastrointestinal complications

Fatty liver disease, gallstones,

and gastro-esophageal reflux

Type 2 diabetes or impaired

glucose tolerance

Menstrual abnormalities

PCOS

Premature puberty

Cardiovascular risk factors

Hypertension and elevated

cholesterol

Psychosocial effects

Depression, anxiety, lower self

esteem, bullying, eating

disorders

Sleep Apnea Disorder of breathing during sleep characterized by

prolonged partial and/ or intermittent complete upper airway obstruction

Fat tissue in upper airway can contribute to obstruction

Characterized by snoring, heavy breathing, restless sleep

Frequent night awakening, bed wetting, morning headache, daytime tiredness, poor school function, irritability, elevated blood pressure

Disrupts normal sleeping pattern, can cause cognitive deficits, and cardiopulmonary problems

Asthma and Obesity

Obese children with asthma compared to non-obese

asthmatic children:

miss more school

require more asthma medications

have lower peak expiratory flow(13)

Weight reduction reduces asthma symptoms (14)

Asthma and Obesity

Changes in pulmonary mechanics

Added weight of chest wall squeezes lungs and causes

restricted breathing

Airway narrowing with fixed airflow obstruction due to

fatty infiltration of airways

Comorbidities Breathing problems

Asthma, sleep apnea

Neurologic pseudotumor cerebri

Orthopedic problems

Joint and musculoskeletal complaints

Gastrointestinal complications

Fatty liver disease, gallstones, and gastro-esophageal reflux

Type 2 diabetes or impaired glucose tolerance

Menstrual abnormalities

PCOS

Premature puberty

Cardiovascular risk factors

Hypertension and elevated cholesterol

Psychosocial effects

Depression, anxiety, lower self esteem, bullying, eating disorders

Pseudotumor Cerebri Elevated intracranial pressure with swollen optic discs

and a normal cerebral spinal fluid in the absence of

ventricular enlargement

Presents with headaches, vomiting, blurred or double

vision

30-80% of affected children are obese

Obesity and recent weight gain are the only known

factors found more often in those with pseudotumor

cerebri than controls

Comorbidities Breathing problems

Asthma, sleep apnea

Neurologic

pseudotumor cerebri

Orthopedic problems Joint and musculoskeletal

complaints

Gastrointestinal complications

Fatty liver disease, gallstones, and gastro-esophageal reflux

Type 2 diabetes or impaired glucose tolerance

Menstrual abnormalities

PCOS

Premature puberty

Cardiovascular risk factors

Hypertension and elevated cholesterol

Psychosocial effects

Depression, anxiety, lower self esteem, bullying, eating disorders

Slipped Capital Femoral

Epiphysis

Present with complaints of limp and pain in groin, thigh,

or knee

70 % of patients with SCFE are obese

Requires surgical intervention and weight loss

SCFE XRAY From learningradiology.com

Blount’s Disease

Bowing of tibia and femur

Results from injury to the

growth plate and

overgrowth of the medial

aspect of the proximal

tibial growth plate

2/3 of patients are obese

Comorbidities Breathing problems

Asthma, sleep apnea

Neurologic

pseudotumor cerebri

Orthopedic problems

Joint and musculoskeletal complaints

Gastrointestinal complications Fatty liver disease,

gallstones, and gastro-esophageal reflux

Type 2 diabetes or impaired glucose tolerance

Menstrual abnormalities

PCOS

Premature puberty

Cardiovascular risk factors

Hypertension and elevated cholesterol

Psychosocial effects

Depression, anxiety, lower self esteem, bullying, eating disorders

Fatty Liver Disease

Elevated liver enzymes with fatty deposits in liver

Present in 20-25% of obese children

Can progress to cirrhosis of liver

Loss of just 10% of weight resulted in normalization of

liver enzymes and decreased ultrasound evidence of

fatty liver

Metformin can be helpful

GI Complications

50% of gallbladder disease in teenagers related to

obesity

Children and adolescents ages 6 to 19 who were

moderately or extremely obese were 16% to 40% more

likely to have a GERD diagnosis

Comorbidities Breathing problems

Asthma, sleep apnea

Neurologic

pseudotumor cerebri

Orthopedic problems

Joint and musculoskeletal complaints

Gastrointestinal complications

Fatty liver disease, gallstones, and gastro-esophageal reflux

Type 2 diabetes

Menstrual abnormalities

PCOS

Premature puberty

Cardiovascular risk factors

Hypertension and elevated cholesterol

Psychosocial effects

Depression, anxiety, lower self esteem, bullying, eating disorders

Type 2 Diabetes Increased risk of impaired glucose tolerance,

insulin resistance and type 2 diabetes (3)

Type 2 DM currently accounts for up to 45% of all newly diagnosed diabetes in the pediatric population (15)

Rate of type 2 diabetes increased 10-fold from 1982 to 1994

Estimated that more than one third of all children born in 2000 will eventually develop diabetes, either during childhood or after adolescence.

Acanthosis

Nigricans

Darker pigmentation and velvety thickening of skin primarily on neck, axilla, and groin

Indicator of decreased insulin sensitivity

(dermatology.cdlb.org)

Comorbidities Breathing problems

Asthma, sleep apnea

Neurologic

pseudotumor cerebri

Orthopedic problems

Joint and musculoskeletal complaints

Gastrointestinal complications

Fatty liver disease, gallstones, and gastro-esophageal reflux

Type 2 diabetes or impaired glucose tolerance

Menstrual abnormalities PCOS

Premature puberty

Cardiovascular risk factors

Hypertension and elevated cholesterol

Psychosocial effects

Depression, anxiety, lower self esteem, bullying, eating disorders

Earlier Pubertal Development Overweight can contribute to early pubertal development in some girls.

Typical age of pubertal development: 10 in girls, 12 in boys

Precocious pubertal development: prior to age 8 in girls, 9 in boys

Consequences of precocious puberty: earlier growth spurt and achievement of final height meaning bone maturation ends earlier as well.

Children with early puberty may be tall for their age at the time of puberty but may mature into short adults.

Boys may actually have delayed pubertal development

Polycystic Ovarian Syndrome Elevated testosterone level

Abnormal menstrual cycles

Excess hair growth

Acne

Polycystic ovaries

Infertility

Comorbidities Breathing problems

Asthma, sleep apnea

Neurologic

pseudotumor cerebri

Orthopedic problems

Joint and musculoskeletal complaints

Gastrointestinal complications

Fatty liver disease, gallstones, and gastro-esophageal reflux

Type 2 diabetes or impaired glucose tolerance

Menstrual abnormalities

PCOS

Premature puberty

Cardiovascular risk factors Hypertension and elevated

cholesterol

Psychosocial effects

Depression, anxiety, lower self esteem, bullying, eating disorders

Cardiovascular Risk Factors 70% of obese children had at least one CVD risk factor, and 39% had two

or more. (2)

High blood pressure and high cholesterol- risk factors for

cardiovascular disease.

Hardening of the arteries (atherosclerosis) occurs more commonly in obese

than non-obese individuals.

Coronary artery disease which can lead to heart attack is more common in

obese individuals because fatty deposits build up in the arteries that feed the

heart.

Stroke is more common because blood clots can form more easily in these

narrowed arteries.

Comorbidities Breathing problems

Asthma, sleep apnea

Neurologic

pseudotumor cerebri

Orthopedic problems

Joint and musculoskeletal complaints

Gastrointestinal complications

Fatty liver disease, gallstones, and gastro-esophageal reflux

Type 2 diabetes or impaired glucose tolerance

Menstrual abnormalities

PCOS

Premature puberty

Cardiovascular risk factors

Hypertension and elevated cholesterol

Psychosocial effects Depression, anxiety, lower

self esteem, bullying, eating disorders

Decreased Quality of Life

5.5 times more likely to have decreased health

related quality of life than normal weight child

Regardless of age, sex, socioeconomic status, or

race

Higher BMI scores correlated with lower physical

functioning

What can we do?

Managing weight contributes to decreased comorbidities

Lifestyle changes including eating a variety of healthy foods, getting regular physical activity and maintaining a healthy weight can be effective in lowering the risk of obesity related comorbidities.

Best hope for prevention of adult obesity and its associated comorbidities is prevention/ treatment of pediatric obesity.

Preventing childhood obesity requires us to make these major lifestyle changes to prevent this generation of children from being the first to have a shorter life expectancy than their parents.

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