Americans are increasingly becoming worried about weight and weight related health problems in of our kids, teenagers, and adults alike. Teen and childhood obesity is becoming more and more common and seems to be spreading much like an epidemic, with more children becoming extremely morbidly obese than ever before.
While dietary and behavioral approaches represent the first line of treatment for childhood obesity, bariatric or weight loss surgery is increasingly being considered as an appropriate option for the treatment of teens and even a few children in pre-teen years when they have obesity-related health and quality of life problems. This trend is largely due to the better understanding that we have about surgery. Also, doctors and patients realize lifestyle changes and dieting are fairly ineffective for those with extreme obesity. Furthermore, weight loss surgery is being seen by parents, pediatricians, and even government officials as a beneficial and generally safe way to help younger patients with severe obesity.
We would like to provide information for those parents, children and teens who are concerned about extreme childhood obesity and the health problems they may be facing. The weight loss surgery field is ever changing, and improving in safety and effectiveness. In some cases it is entirely appropriate today to consider invasive treatments for pediatric obesity which would not have been proposed in years gone by.
What is morbid or extreme pediatric obesity?
Morbid or extreme obesity is no longer a disease seen only in adults. Extreme obesity is increasingly affecting children as well. A single BMI measure does not accurately define obesity in children and adolescents since height increases during the pre-teenage and into the mid-teenage years. Instead, BMI is indexed to age and presented as a percentile to determine obesity in children and adolescents. A BMI for age ≥ 95th percentile indicates obesity in pediatric populations while a BMI for age ≥ 99th percentile is deemed “extreme” or morbid obesity; this percentile curve tracks toward BMI values of 35-40 kg/m2 in young adulthood.
Four percent of all children and adolescents are considered extremely obese when using this definition, which is interesting, as extreme obesity similarly prevalent in adults. More striking is the fact that nearly 60% of the extremely obese children in the United States have two cardiovascular risk factors. When these same children reach their 30s, their BMI will often average around 43 kg/m2. Bottom line, extreme childhood obesity is directly linked to health problems during childhood and leads to extreme obesity in adulthood.
How did this happen?
Simple answer: Energy in (consumed/ingested) must equal energy out. The more thorough answer however, is far more interesting. During periods of famine our early ancestors depended on formidable physiologic processes to inhibit weight loss. Storing excess fat is one of these protective mechanisms utilized when food was scarce. Now that food production processes have been developed, most industrialized countries do not have the same food scarcity problems our ancestors once had. These same manufacturing processes that have increased food shelf life and increased the amount of food available to us, also remove healthy nutrients such as fiber and leave the tasty salts, sugars, and fats in place. To summarize, with less physical activity required in everyday life due to technological advances and food shortages no longer an issue, energy imbalances accumulate day after day.
Is obesity really a major problem for children?
Obesity is associated with numerous and significant health problems; this also applies to childhood and adolescent obesity. Childhood and adolescent obesity has been associated with a number of significant health problems. This condition significantly increases the risk of
- hypertension
- hypercholesterolemia
- hypertriglyceridemia
- hyperinsulinemia
- and atherosclerosis
Type 2 diabetes mellitus is also becoming more prevalent in adolescents, especially among obese adolescence.The incidence of Type 2 diabetes in children has grown ten fold over recent decades where one third of toddlers are expected to be affected by this condition at some point in their lives. Metabolic syndrome also becomes a concern as 33-50% of obese adolescents have been identified as having metabolic syndrome.
Obstructive sleep apnea syndrome occurs more frequently in obese children and has serious adverse effects on daytime learning and quality of life. More than 50% of all teens seeking bariatric surgery have this condition.
Obese children also are at increased risk of:
- pseudotumor cerebri
- skeletal complications
- polycystic ovary syndrome
Risk of gynecologic and gastrointestinal malignancies also has been closely linked to obesity, specifically to BMI during the teen years.
Non-alcoholic steatohepatitis also occurs in obese youth and may eventually prove to be an important cause of end-stage liver disease for young adults who were obese children.
Psychosocial issues also occur because obese adolescents are more stigmatized by peers and cite fewer friendships when compared to adolescents without a weight problem. Adolescent obesity is also associated with:
- higher high school dropout rates
- lower rates of satisfaction with life
- lower rates of marriage and later family income
Obesity confers at least a 2-fold elevation in mortality risk during a 30-year period of follow-up. Racial differences in the risk of premature mortality also has been identified, with black men and women losing over 20 years and 5 years respectively, and white men and women losing 13 years and 8 years respectively as a result of extreme obesity in young adult years.
Information courtesy of Dr. Thomas Inge.
Dr. Inge is the Surgical Director of the Surgical Weight Loss Program for Teens at Cincinnati Children’s Hospital Medical Center, a national leader in the pediatric weight loss surgery field. Dr. Inge also serves as the chairman of Teen-LABS, the largest scientific study to date designed to learn more about the risks and benefits of surgery for teenage obesity. Click here to learn more about this study.
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