Obesity in Children

The Washington Post How Obesity Harms a Child's Body For the first time in history, American children could have a shorter life span than their parents. The cause: obesity. With about a third of all youths overweight or worse, adverse health effects are being seen in alarming proportions. And medical experts fear those problems foreshadow what tomorrow's young adults will face as the years of excess pounds add up. BRAIN To diagnose pseudotumor cerebri, doctors look for the presence of swollen optic nerves called papilledema, seen by examining the back of the eye. Obese children are prone to pseudotumor cerebri, a little-understood buildup of pressure in fluid around the brain. It can cause severe headaches and impaired vision. At least one study has suggested obese children might also tend toward lower IQs and be more likely to have brain lesions similar to those seen in So what happens inside a child or teen carrying this kind of load? Alzheimer's patients. NORMAL SWOLLEN As this organ-by-organ summary shows, obesity kills slowly, causing damage from head to toe, with painful lasting effects. LUNGS Fat deposits in the chest wall can push against the lungs and diaphragm, making it harder for the lungs to expand and bring in oxygen. An obese child can feel out of breath while standing still. HEART Try squeezing a tennis ball 10 times in one minute, and you will get an idea of how hard a healthy heart works to pump out blood. Excess weight expands total blood volume, forcing the heart to work harder. Over time, the heart muscle thickens, making it more difficult to pump. Obese children are two to five times as likely to develop sleep apnea, in which breathing is temporarily interrupted during sleep when the thicker tissues in the throat and neck sag. As a result, less oxygen is sent to the brain, which can hamper a child's ability to concentrate and learn. Sleep apnea can also heighten the risk of heart attack and stroke. Obesity can directly affect the structure and function of the heart. In some cases, the size of the heart muscle and left atrium appears to increase in obese children. Irregularities in the left atrium would affect the heart's ability to fill properly. The pumping action of the hearts of obese children may increase, along with the amount of blood pumped out with each beat. Among children 6 to 17, hospitalizations LUNG for sleep apnea increased fivefold from the late 1970s to the late 1990s. ASTHMA Obese children are two to three times more likely than normal-weight children to develop high blood pressure and high cholesterol, increasing the risk for heart attacks (and strokes). As a result, more youths are being prescribed medications to minimize the risk; many will be on drugs for life. SHEART Obesity increases the risk of asthma, a disease in which the airways become constricted. Having asthma can trigger a cycle in which a child is unable to be physically active and therefore gains weight. Studies already show that overweight children are at risk of developing heart disease as early as their 20s. Obese children have a twofold risk of asthma. LIVER LIVER Stages of damage Fatty liver disease, typically found in adults who indulge in high-fat foods or large amounts of alcohol, now occurs in GALLBLADDER PANCREAS Fat causes liver to enlarge a third of obese boys and girls, particularly Hispanics. In the short term, it can cause NORMAL BRONCHIOLE ASTHMATIC BRONCHIOLE recurrent abdominal pain, infection and fatigue. In the long term, it is linked Scar tissue forms to scarring and cirrhosis of the liver, liver failure (potentially requiring a trans- plant) and BONES and GROWTH PLATES In a child, there are special structures at the end of most bones called growth plates. The growth plate is made of a type of cartilage that lengthens the bone as a person grows. Cirrhosis: Liver cells are destroyed GROWTH PLATE The top part of the thigh bone is shaped like a ball that fits into the hip socket. liver cancer. Pelvis Pelvis GALLSTONES Gallstones – solid clusters of cholesterol that form in the gallbladder – used to be rare in children. But now, "not a week goes by when you're not operating on a child with gallstones," said surgeon Kurt Newman of the Children's National Medical Center. Obesity is a major risk factor because of how it affects the gall bladder's metabolism, Femur Femur Femur increasing the amount of cholesterol in the liquid bile that helps digest fats. Gallstones can cause pain, vomiting, inflammation and infection. STABLE UNSTABLE In a condition called slipped capital femoral epiphysis, the top Healthy bone structure of the ball slips off the femoral head through the growth plate. Think of the ball as a scoop of ice cream that falls off the "cone," the thighbone. In obese children, the bone and cartilage are not Among children 6 to 17, hospitalizations for gallbladder disease tripled from the late 1970s to the late 1990s. strong enough to bear excess weight. PANCREAS Obesity causes insulin to not work normally in the body. This is called insulin resistance. Insulin, made in the pancreas, helps bring glucose (sugar) into the body's cells, where it is the main source of energy. When people are obese and insulin-resistant, they have to BLOUNT'S DISEASE Excessive weight on the growth plate of the tibia can cause the lower leg which tend to straighten as a child develops, Blount's disease is progressive and the condition worsens. This condition is more GROWTH PLATES angle inward, resembling a bowleg. Unlike bowlegs, make more and more insulin. Eventually they cannot make enough insulin to meet these demands, and diabetes develops. "Type 2 diabetes will damage your blood vessels throughout your life and decrease your longevity," said Robert H. Lustig, a pediatric endocrinologist at the University of California at San Francisco. "Once you get Type 2 diabetes, figure you have 20 more years of life get it at 15, you'll be dead at 35." common among African American children. METABOLIC SYNDROME Fibula I then you are dead. So if you Obesity can also lead to this relatively new condition. Excess fat in the belly produces noxious factors that interfere with normal Some case reports estimate a tenfold increase in Type 2 diabetes among children and teens, with African American girls particularly vulnerable. glucose and fat metabolism and leads to inflammation in the blood vessels. Metabolic syndrome increases the risk of diabetes Tibia fivefold. If the syndrome persists into adulthood, a person is three times as likely to have a heart attack or a stroke. HORMONAL CHANGES Obese girls are prone to starting their menstrual periods earlier. Because a girl usually stops growing about two years after her period begins, overweight girls might not achieve their full growth potential. Obese girls are also more likely to develop polycystic ovarian syndrome, which can cause unusual hair growth, sterility and other symptoms. SOURCES: Jennifer Miller, assistant professor of pediatrics, University of Florida; Jeffrey Schwimmer, pediatric gastroenterologist, University of California at San Diego; surgeon Kurt Newman, Children's National Medical Center; Lori Karol, pediatric orthopedic surgeon, Texas Scottish Rite Hospital for Children; Robert H. Lustig. pediatric endocrinologist, University of California at San Francisco; Angela Sharkey, pediatric cardiologist, St. Louis Children's Hospital; New England Journal of Medicine; Wiliam Marder, senior vice president, Thomson Reuters: Stephen Cook, professor of pediatrics, University of Rochester; Paul Kaplowitz, chief of endocrinology, Children's National Medical Acthib Center; William H. Dietz, director of the Division of Nutrition, Physical Activity and Obesity, federal Centers for Disease Control and Prevention; David S. Ludwig, obesity program director, Children's Hospital Boston; Matthew Gilman, associate professor of ambulatory care and prevention, Harvard Medical School; Steven Gortmaker, professor of health sociology, Harvard School of Public Health; Michael Goran, professor of preventive medicine, University of Southern Californiax Sonia Caprio, pediatric endocrinologist, Yale University School of Medicine; Francine Kaufman, director of the Comprehensive Childhood Diabetes Center, Childrens Hospital Los Angeles: David Gozal, professor Research indicates that obese adolescent girls of pediatrics, University of Louisville; John Morrison, associate professor of pediatrics, Heart Center at Cincinnati have two to three times the risk of dying by middle Children's Hospital Medical Center; Fredric Wondisford, chief of the division of metabolism, Johns Hopkins Children's Center; Institute of Medicine, National Institutes of Health; Journal of the American College of Surgeons age compared with girls of normal weight. REPORTING BY SUSAN LEVINE, BRENNA MALONEY, BRIGID SCHULTE AND ROB STEIN GRAPHIC BY TODD LUNDEMAN – THE WASHINGTON POST FAT AND THE BODY LOSING WEIGHT A fat cell is like a plastic bag that holds a drop of fat. The number of fat cells a person has is determined by late adolescence – overeating in childhood creates WHAT IS BMI? One pound of fat is about the size of a coffee mug. Weight is determined by the rate at which the body stores energy from the food one eats and the rate at which that energy is used. When one is not eating, food is not absorbed. However, the body is always using energy, and the energy must come from internal reserves. Body mass index is a measure of weight in relation to height that is used to estimate a person's body fat and, by extension, health more. The cells increase and decrease in size risks. BMI is the most widely accepted method used to screen for overweight in children and adolescents, but it is not an actual measure of body fat. Being "obese" means that a child has a BMI at or above the 95th percentile for his or her age. A BMI at or depending on how much fat they store. So although overweight children can become lean (as their fat cells shrink), they do not lose the extra fat cells no matter how much weight they lose. above the 85th percentile is labeled "overweight." © 2008 The Washington Post, 1150 15th St. Nw, Washington, D.C. 20071. Posters reprinted by The Washington Post from the five-part series "Young Lives at Risk: Our Overweight Children." See it online at http://www.washingtonpost.com/wp-srv/health/childhoodobesity/index.html