Childhood Obesity and Its Even More Dangerous Consequences

Obesity, now one of today's greatest health problems, is becoming more widespread every day as sedentary (inactive) lifestyles and poor nutrition increase. The World Health Organization defines obesity as excessive fat accumulation in the body to a degree that impairs health. Fat tissue constitutes %15-18 of body weight in adult men and %20-25 in women. Ratios above %25 in men and %30 in women, or more simply a body mass index above 30, are considered obesity. Although fundamentally defined as excessive fat accumulation, obesity leads to many diseases and deaths at an early age because of the numerous illnesses it causes.

Obesity does not merely mean a negative body image. Obesity and its associated disorders during childhood and adolescence can even cause premature death in adulthood. Research has observed that women who were overweight as children have an increased risk of breast cancer in adulthood, while men who were overweight as children have an increased risk of death from heart disease as adults. Childhood and adolescent obesity leads to the following conditions, most of which are known as adult diseases:

• Diabetes,
• Fatty liver,
• Endocrine (hormonal system) disorders,
• Cardiovascular diseases,
• Digestive system disorders,
• Cancer,
• Many pulmonary, neurological, dermatological and psychological disorders

Endocrine Disorders

In terms of the endocrine system, obesity leads to diabetes, prediabetes, hyperandrogenism in women, and certain hormonal disorders affecting growth and puberty.

Prediabetes (Before Diabetes): Prediabetes occurs in patients at high risk of diabetes who have not received a definitive diabetes diagnosis and is a common consequence of childhood obesity. It can be detected with fasting blood glucose, an oral glucose tolerance test (OGTT) and hemoglobin A1c. Normally, fasting blood glucose should be below 100 mg/dL.

• Fasting Blood Glucose: Levels of 100-125 mg/dL lead to a prediabetes diagnosis, while levels above 125 mg/dL lead to a diabetes diagnosis.
• OGTT: Below 140 mg/dL is normal, 140-199 mg/dL indicates prediabetes, and 200 or above indicates diabetes.
• Hemoglobin A1c: Its normal level is between %3-5,7. Levels of %5.7-6,4 indicate prediabetes, while above %6,4 indicates diabetes.

In a study with an average age of 11,8 involving 6000 students, approximately %20 were overweight and %30 were obese. Furthermore, %15,5 of overweight students, %20,2 of obese students and %22,5 of severely obese students had fasting blood glucose above 100mg/dL (1).

In a study of 468 obese children, approximately %20 had prediabetes and %2 had type 2 diabetes (2).

Diabetes: Type 2 diabetes is a serious disease caused by obesity. Studies have observed asymptomatic diabetes in %4 of obese children and adolescents. Early diagnosis is very important in this age group because diabetes progresses faster in young people than in older people. As a result, diabetes damages the nervous system, eyes and kidneys, and atherosclerotic plaques (calcification in the arteries) form in blood vessels at an earlier age.

Studies have observed a significant increase in the risk of diabetes in adulthood among people obese since childhood. Conversely, people who were obese as children but are no longer obese as adults have the same diabetes risk as someone who has never been obese.

Metabolic Syndrome: This is a risk factor for diabetes and cardiovascular disorders. Metabolic syndrome is the coexistence of abdominal obesity (excess fat particularly around the abdomen), hyperglycemia (high blood sugar), dyslipidemia (abnormal blood lipids) and hypertension. Studies found that only a very small proportion of obese children had no signs of metabolic syndrome.

Hyperandrogenism in Women (Male Characteristics): Hyperandrogenism means excessive levels of androgens, the male hormones, in women. Obese adolescent girls have an increased risk of hyperandrogenism and polycystic ovary syndrome (benign cysts in the ovaries). Although polycystic ovary syndrome causes symptoms such as excessive hair growth, menstrual disorders and abnormal darkening of the skin, it can be difficult to diagnose during adolescence.

Hypertension: The risk of hypertension rises substantially in overweight and obese children. Studies have found hypertension in %50 of obese children. Childhood obesity has a lasting effect on hypertension risk; even if the person loses weight in adulthood, the risk does not decrease.

Dyslipidemia: Dyslipidemia is generally characterized by increased serum LDL (bad cholesterol), cholesterol and triglycerides, and decreased HDL (good cholesterol). In obesity, it occurs as a consequence of increased fat tissue.

Cardiovascular Effects: In obesity, the heart works harder to meet the blood needs of the increased body mass. Continuous overwork causes the heart to enlarge. Increased fat tissue also means more than normal fat tissue over the heart that nourishes it. Heart enlargement and increased surrounding fat cause dysfunction in contraction and relaxation. Obesity also leads to atherosclerotic plaque development through elevated blood lipids, hypertension and insulin resistance. Even a small increase in fat tissue above normal raises cardiovascular risk, while obesity increases this risk substantially. Studies have found higher rates of coronary heart disease in adulthood among children with high body mass index. Another study of 6328 people observed that those overweight in childhood had a high cardiovascular disease risk, but this risk decreased in those who lost their excess weight in adulthood (3).

Non-Alcoholic Fatty Liver Disease (NAFLD): This is fatty liver caused by factors other than alcohol and is associated with obesity. In obesity, NAFLD, insulin resistance, hypertension and dyslipidemia are strongly interrelated, each promoting the others. NFALD causes no symptoms in most patients. However, it can cause right upper abdominal pain, liver enlargement, weakness and fatigue. Laboratory findings include increased alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase and gamma-glutamyl transpeptidase (GGT). Because these elevations are mild, liver biopsy is recommended for definitive diagnosis. Weight loss is the most important treatment. Studies have detected increased liver activity (ALT, AST) after weight loss and found physical activity beneficial against insulin resistance.

Gallstones: Obesity is a common cause of gallstone formation. Studies have observed that gallstones occur 7 times more frequently in overweight children than in normal-weight peers. Symptoms may include right upper abdominal pain, jaundice and indigestion after fatty foods; definitive diagnosis is made by ultrasound imaging.

Sleep Apnea: Obstructive sleep apnea syndrome (OSAS) is characterized by interruptions in breathing due to repeated narrowing or obstruction of the upper airway during sleep. Obesity predisposes to sleep apnea. Some studies have shown an association between sleep apnea and increased insulin resistance.

Slipped Capital Femoral Epiphysis: This occurs when the femoral head slips across the epiphyseal (growth) plate. It is generally seen in growing children. Although obesity is not its only cause, it is a major risk factor. It can present with hip pain unrelated to trauma and limping.

Idiopathic Intracranial Hypertension: This results from increased pressure inside the skull independent of tumors and other diseases. It is characterized by headache, nausea, vomiting, pain behind the eyes, double vision or vision loss. Its incidence in children increases with obesity. Its findings associated with obesity have been observed to decrease with weight loss.

Dermatological: The dermatological effects of obesity include darkened skin, chafing rash, boils and hidradenitis suppurativa. Hidradenitis suppurativa consists of swellings under the skin. It generally develops through inflammation of sweat glands where skin surfaces rub together (such as the armpits) and is very painful.

Cancer: Today, smoking is the environmental factor with the greatest capacity to cause cancer, followed by obesity. However, obesity is predicted to become the world's leading cancer factor by 2020. The most important role in the increase in obesity-related cancers is played by rising obesity prevalence among children and adolescents. A direct association between obesity and at least 13 types of cancer has been established. The cancers most strongly associated with obesity are breast, kidney, colorectal and uterine cancers (4).

Psychological: Obesity can lead to problems in children such as impaired communication with peers, loss of confidence, anxiety, depression and dissatisfaction with body image. Studies have found that overweight children have lower physical, social, emotional and school-related quality of life than peers, and are also more prejudiced and prone to bullying than their peers.

As shown, although obesity is defined as excess fat accumulation, it brings many disorders and damages our bodies in numerous ways. We should remember that obesity is not our destiny; determined changes in our lives can protect us. A physically active lifestyle comes first. We should exercise, drink plenty of fluids and take care with our diet.