Pediatric Considerations

A longitudinal research study of 1042 children found that the children who were overweight in early childhood are more than 5 times as likely to be overweight at age twelve. Sixty percent of children who are overweight at any time during the preschool period and 80% of children who are overweight at any time during the elementary period are overweight at age 12 years.*

Physical effects of childhood obesity:

Pediatric Endocrine

• Impaired glucose tolerance 
• Insulin resistance, left untreated will lead to diabetes in these children
• Diabetes mellitus type II
• Can be asymptomatic for extended periods of times
• Early diagnosis is essential to minimize neuropathy, retinopathy, nephropathy, and atherosclerotic heart disease
• Metabolic syndrome is cluster of metabolic risk factors which lead to the development of Diabetes type II and atherosclerotic cardiovascular disease include:
  • abdominal obesity
  • hyperglycemia
  • dyslipidemia
  • hypertension
• Puberty may alter this diagnosis for a patient (may ‘grow out of it’ or make it worse) 

Obese adolescent females

• Increased risk of hyperandrogenism
• Hirsutism
• Early onset of polycystic ovary syndrome
• Early onset of sexual maturation
• Accelerated linear growth and bone age

Obese adolescent males

• Delayed sexual maturation
• Accelerated linear growth and bone age

Pediatric Cardiovascular

Hypertension

• Up to 50% of obese children are hypertensive, and it is often a missed diagnosis (Maggio, 2008)
• Hypertension leads to cardiovascular morbidity, coronary heart disease, stroke mortality, and renal injury from glomerular hyperperfusion and hyperfiltration (Stabouli 2009)

Dyslipidemia

• Common in obese children with central fat distribution
• Dyslipidemia predisposes these children to insulin resistence and cardiovascular diseases

Coronary Artery Disease

• Atherosclerosis occurs earlier in adult years, when the child is obese
• Comorbidities of pediatric obesity that increase their risk include:
  • Hypertension
  • Dyslipidemia
  • Insulin resistance syndrome
  • Nutrition deficiencies
  • Sedentary lifestyle
  • Tobacco smoke exposure
• Other cardiovascular changes which are seen in obese children include:
  • Endothelial dysfunction
  • Carotid intimal thickening
  • Early aortic and coronary arterial fatty streaks and fibrous plaque development
  • Decreased arterial distensibility
  • Increased left atrial diameter

Pediatric Gastro-Intestinal

 Fatty liver disease (also known as “nonalcoholic fatty live disease or NAFLD)

• NAFLD is the most common liver disease in children, and seen in up to 38% of obese children (Schwimmer 2006)
• While not clearly identified, the pathogenesis of NAFLD may be related to metabolic syndrome, insulin resistance, dyslipidemia, obesity, and hypertension (Feldstein 2009)
• There are two types of NAFLD:
• Steatosis = increased liver fat without inflammation
• Nonalcoholic steatohepatitis (NASH) = increased liver fat with inflammation
• NASH leads to fibrosis, cirrhosis, and ultimately liver failure
• Most children with NAFLD will be asymptomatic.  If symptomatic, may display:
• Right upper quadrant pain
• Hepatomegaly
• Non-specific abdominal pain
• Fatigue
• The only established treatment for NAFLD in the obese pediatric patient, is weight loss 

Cholelithiasis

• Obesity is the most common cause of gallstones in children

Pediatric Musculoskeletal
Obese pediatric patients are at increased risk for:

• Slipped capital femoral epiphysis
• Tibia vara (Blount disease)
• Fractures
• Genu valgum (“knock knees”)
• Musculoskeletal pain (back, leg, knee, ankle, foot)
• Impaired mobility
• Lower extremity malalignment

Pediatric Neurological

• Pseudotumor cerebri (idiopathic intracranial hypertension)

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