Obesity

Introduction

• 1 out of 3 children and adolescents are either obese or overweight; obesity affects 17% of all children and adolescents in the U.S.
• Obese children are more likely to have hypertension, dyslipidemia, impaired glucose tolerance, insulin resistance, Type 2 diabetes, obstructive sleep apnea, asthma, musculoskeletal disorders, nonalcoholic fatty liver disease, cholelithiasis, and gastroesophageal reflux.
• They are also at a greater risk of social and psychological problems, depression, and poor self-esteem.
• Studies have shown that obese children also have a decreased performance in school.

Definition

• BMIs in children are affected by age and sex and are reported as percentiles, while adult BMIs (patients 20 years of age or older) are reported as fixed values.
• Overweight is defined as having a body mass index (BMI) between the 85th and 95th percentiles.
• Obesity in children is defined as a BMI > the 95th percentile.

Risk Factors

• Hispanic and non-Hispanic black individuals have the highest rates of obesity on a population level.
• Higher maternal education is protective against childhood obesity.
• Prenatal factors that indicate an increased risk of obesity include: Excessive weight gain during pregnancy, High birth weight, Gestational diabetes
• Intrauterine growth restriction (IUGR) with early infant catch-up growth is associated with development of central obesity and increased cardiovascular risk.
• A strong risk factor for obesity in a child is having an obese parent (no difference which one); the risk is additionally increased if both parents are obese.

Treatment

• Treatment of obesity is difficult, but it is best managed by a cognitive behavioral approach in combination with changes in dietary habits and exercise.
• Family support and involvement are critical. Parents must also be invested and involved in the program if weight loss is to occur.
• Bariatric surgery, which includes gastric banding (approved in patients 18 years of age), gastric bypass,and gastric sleeve, is often successful in adolescents—but long-term safety has not yet been established.