the health impact of childhood obesity · pseudotumor cerebri orthopedic problems joint and...
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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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