Obesity in children is on the rise, comes with major health consequences

PRI GEN INT .LOSANGELES FGN7 CHILDHOOD OBESITY Obesity in children is increasing dramatically, and comes with significant and sometimes lifelong health consequences By Christine Nguyen, University of Southern California Los Angeles, May 7 (The Conversation ) In the last two decades, children have become more obese and have developed obesity at a younger age. A 2020 report found that 14.7 million children and adolescents in the US are living with obesity. Because obesity is a known risk factor for serious health problems, its rapid rise during the COVID-19 pandemic raised alarm bells. Without intervention, many obese adolescents will remain obese as adults. Even before adulthood, some children will have serious health problems beginning in their preteens. To address these issues, in early 2023, the American Academy of Pediatrics published its first new guidelines for the management of obesity in 15 years. I am a pediatric gastroenterologist caring for children at the largest public hospital in California and I have witnessed a clear trend over the past two decades. Early in my practice, I only occasionally saw a child with a complication of obesity; I now see multiple referrals every month. Some of these children have severe obesity and various health complications that require multiple specialists. These observations prompted my report for the California Health Equity Fellowship at the University of Southern California. It is important to note that not all children who are overweight are unhealthy. But the evidence supports that obesity, especially severe obesity, requires further evaluation. How Obesity is Measured The World Health Organization defines obesity as an abnormal or excessive accumulation of fat that poses a risk to health. Measuring the composition of fat requires specialized equipment that is not available in a regular medical office. Therefore, most doctors use body measurements to detect obesity. One method is body mass index, or BMI, a calculation based on a child’s height and weight compared to peers of the same age and sex. BMI does not measure body fat, but when the BMI is high, it correlates with total body fat. According to the American Academy of Pediatrics, a child qualifies as overweight with a BMI between the 85th and 95th percentile. Obesity is defined as a BMI above the 95th percentile. Other obesity screening tests include waist circumference and the thickness of the skin folds, but these methods are less common. Because many children exceeded the limits of existing growth charts, in 2022 the Centers for Disease Control and Prevention introduced extended growth charts for severe obesity. Severe obesity occurs when a child reaches the 120th percentile or has a BMI greater than 35. For example, a 6-year-old boy who is 48 inches tall and weighs 110 pounds would meet the criteria for severe obesity because his BMI is at the 120th percentile. 139. Severe obesity carries an increased risk of liver disease, cardiovascular disease, and metabolic problems such as diabetes. As of 2016, nearly 8% of children ages 2-19 were severely obese. Other health problems associated with severe obesity include obstructive sleep apnea, bone and joint problems that can cause early arthritis, high blood pressure, and kidney disease. Many of these problems occur together. How Obesity Affects the Liver Liver disease associated with obesity is called nonalcoholic fatty liver disease. To store excess dietary fat and sugar, liver cells fill up with fat. Excess carbohydrates in particular are processed into substances similar to the breakdown products of alcohols. Under the microscope, a pediatric fatty liver looks like a liver damaged by alcohol. Occasionally children with fatty liver are not obese; however, the biggest risk factor for fatty liver is obesity. With the same BMI, Hispanic and Asian children are more susceptible to fatty liver disease than white and black children. Reducing weight or reducing your intake of fructose, a natural sugar and common food additive, even without significant weight loss, improves fatty liver. Fatty liver is the most common chronic liver disease in children and adults. In Southern California, pediatric fatty liver doubled between 2009 and 2018. The disease can progress rapidly in children, and some will have liver scarring after just a few years. Although few children currently require liver transplants for fatty liver, it is the fastest growing reason for transplantation in young adults. Fatty liver is the second most common reason for liver transplantation in the US and will be the leading cause in the future. Links Between Obesity and Diabetes Fatty liver is implicated in metabolic syndrome, a group of conditions that cluster together and increase the risk of cardiovascular disease and diabetes. In a telephone interview, Dr. Barry Reiner, a pediatric endocrinologist, expressed his concerns about obesity and diabetes to me. When I started my practice, I had never heard of type 2 diabetes in children, says Reiner. Now, depending on which part of the US, between a quarter and a third of new cases of diabetes are type 2. Type 1 diabetes is an autoimmune disease that was formerly called juvenile diabetes. By contrast, type 2 diabetes was historically considered a disease of adults. However, type 2 diabetes is increasing in children and obesity is the main risk factor. While both types of diabetes have genetic and lifestyle influences, type 2 is more modifiable through diet and exercise. By 2060, the number of people under the age of 20 with type 2 diabetes will increase by 700%. Black, Latino, Asian, Pacific Islander, and Native American/Alaska Native children will have more type 2 diabetes diagnoses than white children. The severity of type 2 diabetes in children is underestimated, Reiner says. He added that many people express the misconception that type 2 diabetes is a mild, slow-onset disease. Reiner pointed to a major study showing that childhood-acquired type 2 diabetes can progress rapidly. As early as 10 to 12 years after their childhood diagnosis, the patients developed nerve damage, kidney problems, and vision damage. At 15 years from diagnosis, at an average age of 27 years, nearly 70% of patients had high blood pressure. Most of the patients had more than one complication. Although rare, some patients have experienced heart attacks and strokes. When people with childhood diabetes became pregnant, 24% gave birth to preterm babies, more than double the rate in the general population. Heart Health Cardiovascular changes associated with obesity and severe obesity can also increase a child’s chance of suffering heart attacks and strokes during their lifetime. Carrying extra weight between the ages of 6 and 7 can result in higher blood pressure, cholesterol, and stiffening of the arteries between the ages of 11 and 12. Obesity changes the structure of the heart, causing the muscle to thicken and expand. Although still rare, more people in their 20s, 30s, and 40s are having strokes and heart attacks than a few decades ago. Although many factors can contribute to heart attack and stroke, obesity increases that risk. Talk about being healthy, not focusing on weight Venus Kalami, registered dietitian, talked with me about environmental and social influences on childhood obesity. Food, diet, lifestyle and weight are often an indicator of something bigger going on in someone’s life, Kalami says. Factors beyond a child’s control, such as depression, access to healthy food, and walkable neighborhoods, contribute to obesity. Parents may wonder how to help children without introducing shame or guilt. First, conversations about weight and food need to be age appropriate. A 6-year-old doesn’t need to be thinking about her weight, Kalami says. She adds that even tweens and teens shouldn’t focus on her weight, even though they probably already are. Even good-natured jokes are harmful. Avoid talking about diet and talk about health instead. Kalami recommends that adults explain how healthy habits can improve a child’s mood, concentration or performance in a favorite activity. A 12-year-old won’t always know what’s healthy, Kalami said. Help them choose what is available and make the best choice, which may not be the perfect choice. Any conversation about weight, whether it’s criticism or praise for weight loss, can backfire, she adds. Praising a child for her weight loss can reinforce a negative cycle of disordered eating. Instead, encourage better child health and good choices. Dr. Muneeza Mirza, a pediatrician, recommends that parents model healthy behavior. The changes need to be made for the whole family, says Mirza. It should not be considered a punishment for that child. (The conversation) NSA 05070939 NNNN