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Overweight Children and Adolescents: Screen, Assess and Manage

Consequences of Overweight in Children and Adolescents
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2. Consequences of Overweight in Children and Adolescents

Health consequences related to overweight can begin in childhood or adolescence; overweight children and adolescents are at increased risk for various chronic diseases in later life. In a study conducted by Freedman and colleagues (1999), nearly 60 percent of overweight children had at least one cardiovascular risk factor compared to 10 percent of those with a BMI-for-age < 85th percentile; 25 percent of overweight children had two or more risk factors. The psychosocial consequences of overweight are significant. Overweight in children has been linked to social discrimination, a negative self-image in adolescence that often persists into adulthood (Stunkard et al., 1967), parental neglect (Lissau and Sorenson, 1994), and behavioral and learning problems (Mellbin and Vuille, 1989).

Bullet Common Medical Consequences of Overweight (Dietz, 1998)

Bullet Hyperlipidemia
  Hyperlipidemia is a group of disorders characterized by elevated levels of cholesterol, triglycerides, and/or low density lipoproteins (LDL) and low levels of high density lipoproteins (HDL) in the blood. Overweight in children increases the risk for cardiovascular disease and premature death in adulthood (Power et al., 1997; Must et al., 1992). Hyperlipidemia may improve with weight reduction (Caprio et al., 1996; Wabitsch et al., 1994). In a study by Freedman and colleagues (1999), 90 percent of the children with high levels of triglycerides were also overweight.
 
Bullet Glucose intolerance
  Glucose intolerance is a precursor of diabetes. The incidence of non-insulin-dependent diabetes mellitus among adolescents is increasing and accompanying the national rise in overweight among teens (Pinhas-Hamiel et al., 1996). Acanthosis nigricans is associated with glucose intolerance in children and adolescents and is characterized by increased thickness and pigmentation of the skin between folds or juxtaposed surfaces (Richards et al., 1985).
 
Bullet Hepatic steatosis
  Hepatic steatosis is the fatty degeneration of the liver. High concentrations of liver enzymes are associated with hepatic steatosis and have been found in overweight youth (Kinugasa et al., 1984). Weight reduction causes hepatic enzymes to normalize (Vajro et al., 1994). Hyperinsulinemia also may play a role in hepatic steatosis (Wanless et al., 1989).
 
Bullet Cholelithiasis
  Cholelithiasis, the presence of stones in the gallbladder, occurs with increased frequency in obese adults compared to other adults. Although gallstones occur less frequently among children and adolescents who are overweight than in obese adults, nearly 50 percent of the cases of cholecystitis (i.e., inflammation of the gallbladder) in adolescents may be associated with overweight (Crichlow et al., 1972). As in adults, cholecystitis in adolescents may be associated with weight reduction.
   
Bullet Early maturation
  Early maturation, characterized by adolescents with a skeletal age > 3 months in advance of chronological age, is associated with increased fatness in adulthood (Van Lenthe et al., 1996a). It is also associated with an increase in the truncal distribution of fat in women (Van Lenthe et al., 1996b; Garn et al., 1986).


Bullet Less Common Medical Consequences of Overweight

Bullet Hypertension
  Hypertension: persistently elevated blood pressure occurs with low frequency in children, although it has been found to occur approximately nine times more frequently among children who are overweight compared with other children (Lauer et al., 1975). In Lauer's study, almost 60 percent of children with persistently elevated blood pressure had relative weights >120 percent of the median for their sex, height and age. Childhood blood pressure and change in BMI were consistently the two most powerful predictors of adult blood pressure across all ages and both genders (Lauer et al., 1975). Freedman and colleagues (1999) found overweight children were 2.4 times as likely to have elevated diastolic blood pressure and 4.5 times as likely to have elevated systolic blood pressure.
   
Bullet Acute complications
 

Acute complications are those that require immediate medical attention and should be referred to a pediatric obesity center (Barlow and Dietz, 1998).

Bullet Sleep apnea is the cessation of breathing lasting at least 10 seconds during sleep, characterized by loud snoring and labored breathing. During these periods, oxygen levels in the blood may fall dramatically. It is estimated that sleep apnea occurs in approximately 7 percent of obese children (Mallory et al., 1989).
Bullet Pseudotumor cerebri is a rare disorder characterized by increased pressure in the skull that causes headaches.
Bullet Obesity hypoventilation syndrome, also known as Pickwickian syndrome, may be a cause of sleep apnea but this remains unclear. Aggressive therapy is warranted for children with obesity hypoventilation syndrome (Riley et al., 1976).
Bullet A variety of orthopedic complications affecting the feet, legs, and hips can occur, including Blount disease and slipped capital femoral epiphysis.

 




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