Childhood obesity

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief:

Synonyms and keywords: Obesity in Kids, Obesity in Children, Childhood Obesity


Overview

Childhood obesity is a medical condition that affects children.Overweight and obesity are defined by the World Health Organization (WHO) as "abnormal or excessive fat accumulation that may impair health"[1] Childhood Obesity is a Body Mass Index (BMI) at or above the 95th percentile for children of the same gender and age.[2] Childhood and adolescent obesity is an epidemic in the United States.[3] About 13.7 million (18.5 %) of American children and adolescents are currently considered obese[4]

Historical Perspective

The word obesity is a Latin word which was first used in 1611 by Randle Cotgrade.[5]

In 450 B.C., it was first recognized as a medical disorder by the ancient Greeks. Hippocrates quoted "Corpulence is not only a disease itself, but the harbinger of others”.[6]

In 550 B.C., obesity was linked to heart disease and diabetes by the Indian surgeon Shushruta.[7]

Classification

Pathophysiology

Causes

Childhood obesity maybe cause by poor eating habits, lack of physical activity, genetic causes, an underlying medical condition or medications.

Lifestyle and Dietary Intake

Children and adolescents are consuming low nutrient high-calorie foods and beverages at home, school and other places. They are consuming more fast food which is low in nutrients and high in calories, fat and sodium. CDC reports that children and adolescents in the U.S. consumed an average of 13.8% of their daily calories from fast food during 2015-2018. [8] In addition, they are consuming large amounts of sugar-sweetened beverages which has been directly associates with obesity in multiple reviews.[9] [10] Physical inactivity, excess use of screen time and inadequate sleep also contribute to the obesity epidemic.[11] [12]

Environmental factors

Eating habits of the child are also affected by demographics, lunch policies at schools and work demands on parents.[13]

Psychological factors

These factors influence a child's eating habits and many children eat in response to stress and or negative emotions such as boredom, anger, sadness, anxiety or depression.

Genetic factors

Often, a child whose parents are overweight or obese will also be overweight or obese. Although this is often caused by shared unhealthy eating habits in the household, it has been suggested that there may be a genetic (inherited) predisposition toward being obese, although this is as yet unproven and research is ongoing.

Medical conditions

There are genetic syndromes and hormonal disorders that maybe associated with weight gain and obesity in children including: hypothyroidism, Cushing syndrome, growth hormone deficiency, growth hormone resistance, leptin deficiency or resistance to leptin action, polycystic ovary syndrome (PCOS), precocious puberty, prolactin-secreting tumors, Turner syndrome, Down syndrome, Cohen syndrome, Prader-Willi syndrome, Pseudohypoparthyroidism and laurence-Moon-Biedl syndrome.[14]

Medications

Medications that may cause weight gain in children include cortisol and other glucocorticoids, tricyclic antidepressants, sulfonylureas, monoamine oxidase inhibitors, risperidone, clozapine, oral contraceptives, insulin (in excessive doses) and thiazolidinediones. [15]

Hypothalamic obesity

Weight gain may occur after acquired hypothalamic lesions following surgery, cranial radiation or diencepahlic tumors. It can also be a result of cranial trauma or inflammation of the hypothalamus. [16]

Complications

Without a change in diet or exercise patterns, childhood obesity can lead to medical conditions including Type 2 diabetes, high blood pressure, high cholesterol, heart disease, asthma, obstructive sleep apnea, fatty liver disease, gall stones, glucose intolerance, insulin resistance and other disorders.[17] [13] Studies have shown that obese children are more likely to grow up to be obese adults.[18] Obese children often suffer from weight stigma, teasing and bullying amongst their peers.[19] They experience descrimination in the society. These children are more likely to suffer from low self esteem, anxiety and depression.[20]

Differentiating Obesity from other Diseases

Epidemiology and Demographics

The prevalence of children who are overweight or obese worldwide is approximately 38 million in children under the age of 5 in 2019 and more than 340 million between 5 and 19 years old in 2016.[21]

In 2015-2016, the prevalence of obesity among children aged 2-19 years was estimated to be 13.7 million cases (18.5%) in USA.[22]

Age

Children of all age groups may develop obesity. In the USA, obesity is more commonly observed among children aged 12 to 19 years old. This is followed by children aged 6 to 11 years old and then children aged 2 to 5 years old.

Gender

Race

Risk Factors

Common risk factors in the development of obesity in children are high calorie diet, lack of physical activity, children who have family members who are obese, stress and low-income households.

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Criteria

History and Symptoms

Physical Examination

Physical examination may be remarkable for:

dry skin and fatigability may be signs of hypothyroidism.[23]

purple striae and accumulation of fat in the neck and trunk may suggest cortisol excess.[24]

signs of early sexual development may be a sign of precocious puberty.[25]

acne and excess facial hair may suggest cortisol excess or polycystic ovary syndrome. [26]

Laboratory Findings

Treatment

Medical therapy

Surgery

Prevention

See also

References

  1. ↑ https://www.who.int/westernpacific/health-topics/obesity
  2. ↑ https://www.cdc.gov/obesity/childhood/defining.html
  3. ↑ Sanyaolu A, Okorie C, Qi X, Locke J, Rehman S (2019). "Childhood and Adolescent Obesity in the United States: A Public Health Concern". Glob Pediatr Health. 6: 2333794X19891305. doi:10.1177/2333794X19891305. PMC 6887808 Check |pmc= value (help). PMID 31832491.
  4. ↑ https://www.cdc.gov/obesity/data/childhood.html#Prevalence
  5. ↑ http://histowiki.com/history/health/2375/the-history-of-obesity-timeline/#:~:text=The%20Greeks%20were%20the%20first%20to%20recognize%20obesity,obesity%20as%20the%20result%20of%20a%20character%20flaw.
  6. ↑ http://histowiki.com/history/health/2375/the-history-of-obesity-timeline/#:~:text=The%20Greeks%20were%20the%20first%20to%20recognize%20obesity,obesity%20as%20the%20result%20of%20a%20character%20flaw.
  7. ↑ http://histowiki.com/history/health/2375/the-history-of-obesity-timeline/#:~:text=The%20Greeks%20were%20the%20first%20to%20recognize%20obesity,obesity%20as%20the%20result%20of%20a%20character%20flaw.
  8. ↑ https://www.cdc.gov/nchs/products/databriefs/db375.htm
  9. ↑ Keller A, Bucher Della Torre S (2015). "Sugar-Sweetened Beverages and Obesity among Children and Adolescents: A Review of Systematic Literature Reviews". Child Obes. 11 (4): 338–46. doi:10.1089/chi.2014.0117. PMC 4529053. PMID 26258560.
  10. ↑ Hu FB, Malik VS (2010). "Sugar-sweetened beverages and risk of obesity and type 2 diabetes: epidemiologic evidence". Physiol Behav. 100 (1): 47–54. doi:10.1016/j.physbeh.2010.01.036. PMC 2862460. PMID 20138901.
  11. ↑ Ren H, Zhou Z, Liu WK, Wang X, Yin Z (2017). "Excessive homework, inadequate sleep, physical inactivity and screen viewing time are major contributors to high paediatric obesity". Acta Paediatr. 106 (1): 120–127. doi:10.1111/apa.13640. PMC 6680318 Check |pmc= value (help). PMID 27759894.
  12. ↑ Morrissey B, Allender S, Strugnell C (2019). "Dietary and Activity Factors Influence Poor Sleep and the Sleep-Obesity Nexus among Children". Int J Environ Res Public Health. 16 (10). doi:10.3390/ijerph16101778. PMC 6571639 Check |pmc= value (help). PMID 31137502.
  13. ↑ 13.0 13.1 Sahoo K, Sahoo B, Choudhury AK, Sofi NY, Kumar R, Bhadoria AS (2015). "Childhood obesity: causes and consequences". J Family Med Prim Care. 4 (2): 187–92. doi:10.4103/2249-4863.154628. PMC 4408699. PMID 25949965.
  14. ↑ https://emedicine.medscape.com/article/985333-overview#a5
  15. ↑ https://emedicine.medscape.com/article/985333-overview#a5
  16. ↑ https://www.mayoclinicproceedings.org/action/showPdf?pii=S0025-6196%2816%2930595-X
  17. ↑ https://www.cdc.gov/obesity/childhood/causes.html
  18. ↑ https://www.cdc.gov/vitalsigns/childhoodobesity/index.html#:~:text=Children%20who%20are%20overweight%20or%20obese%20as%20preschoolers,and%20suffer%20lifelong%20physical%20and%20mental%20health%20problems.
  19. ↑ Kang NR, Kwack YS (2020). "An Update on Mental Health Problems and Cognitive Behavioral Therapy in Pediatric Obesity". Pediatr Gastroenterol Hepatol Nutr. 23 (1): 15–25. doi:10.5223/pghn.2020.23.1.15. PMC 6966224 Check |pmc= value (help). PMID 31988872.
  20. ↑ Di Cesare M, Sorić M, Bovet P, Miranda JJ, Bhutta Z, Stevens GA; et al. (2019). "The epidemiological burden of obesity in childhood: a worldwide epidemic requiring urgent action". BMC Med. 17 (1): 212. doi:10.1186/s12916-019-1449-8. PMC 6876113 Check |pmc= value (help). PMID 31760948.
  21. ↑ https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight
  22. ↑ https://www.cdc.gov/obesity/data/childhood.html
  23. ↑ https://emedicine.medscape.com/article/985333-overview#a5
  24. ↑ https://emedicine.medscape.com/article/985333-overview#a5
  25. ↑ https://emedicine.medscape.com/article/985333-overview#a5
  26. ↑ https://emedicine.medscape.com/article/985333-overview#a5

External links


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