Obesity in Pediatric Patients

What is Obesity in Pediatric Patients?

Obesity is a widespread and often long-lasting health issue in children and teenagers. It’s defined as having a Body Mass Index (BMI) – a measure of body fat based on height and weight – that’s in the top 5% for a child’s age and sex if they’re two years old or older. Severe obesity means a BMI in the top 20%. For younger kids, the Centers for Disease Control (CDC) suggest using the World Health Organization’s charts that compare weight to height, taking into account age and sex, instead of the BMI.

The number of obese children in the United States has tripled since the 1960s, and it’s more common as children get older. If childhood obesity isn’t prevented, detected, and treated, it can lead to health problems in children that often carry over into adulthood.

What Causes Obesity in Pediatric Patients?

Obesity is caused by a mix of many factors that include genetic, biological, environmental, economic, and cultural influences. While our genes and biology are set from birth, other contributors like our family’s diet, exercise habits, and sleep routines can be changed. Also, having access to nutritious food at school, community, and safe spaces for physical activity can make a big difference in preventing obesity. On the flip side, negative childhood events can also impact obesity rates.

Simply put, when we consume more calories than we burn off, weight gain happens, and this could lead to obesity. The role of genetics in obesity is small compared to lifestyle factors. With a greater range of high-calorie processed foods like fast food and sugary drinks more readily available, people’s eating habits have shifted. Over-consumption of these unhealthy foods, super-sized meals, and frequent snacking have tied to a significant surge in obesity in developed countries.

Moreover, reduced physical activity and excessive screen time on phones, computers, TVs, and video games are contributing to obesity. Interestingly, the rates of obesity increased during the COVID-19 pandemic when schools were closed, and kids replaced outdoor play with screen time.

Feeding styles differ from culture to culture, and kids often mimic their parents’ eating habits from a young age. Studies found out that kids make healthier food choices when their parents are educated about nutrition and they have structured family meals. Things like family dinners, introducing kids to a variety of healthy foods, and not watching TV while eating set a positive food environment, reducing the risk of obesity. On the other hand, the more TV and video games a child indulges in, the more likely they are to eat distractedly and develop obesity.

There are other important risk factors linked to obesity as well. These include a higher BMI in pregnant women, babies born with a high birth weight, rapid weight gain in infants and young children, not breastfeeding, exposure to specific environmental chemicals, using antibiotics early in life, and having adverse life experiences.

There are more rare forms of obesity called polygenic and monogenic obesity. Polygenic obesity happens when several genes interact with environmental factors to increase the risk of obesity. Monogenic obesity, on the other hand, starts severely and early, usually due to a specific gene malfunction. Certain genetic disorders such as Prader Willi, Bardet-Beidl, Beckwith-Wiedmann, and Albright hereditary osteodystrophy are also associated with obesity.

Last but not least, obesity can also be caused by certain medical conditions and medications related to endocrine, neurologic, and psychological factors. This should be considered especially when an individual suddenly or unexpectedly gains weight. This might be due to an imbalance in the hormones that control feelings of hunger and fullness.

Risk Factors and Frequency for Obesity in Pediatric Patients

From 1963 to 2000, the number of children aged 6 to 11 considered obese increased dramatically from 4.2% to 15.3%. Recent data from the National Health and Nutrition Examination Survey conducted in 2015-2016 shows that this trend continues to rise. The survey shows that nearly 18.5% of American children and teenagers are obese.

Among adolescents aged 12 to 19, the rate of obesity is even higher, at 20.6%. This means that around 13.5 million teenagers in America are struggling with obesity. However, obesity rates vary across different racial and ethnic groups. For instance, Black and Mexican American children are more likely to be obese compared to their White peers.

• The obesity rate among children and teenagers is 18.5%.
• The obesity rate among adolescents aged 12 to 19 is 20.6%.
• Around 13.5 million teenagers in the US are struggling with obesity.
• Black and Mexican American children are more likely to be obese than White children.

Certain factors contribute to these disparities in obesity rates, such as parents’ level of education and income, access to healthy foods, and availability of safe environments for physical activities. Additionally, children with disabilities, including autism and intellectual disabilities, are more prone to obesity.

Signs and Symptoms of Obesity in Pediatric Patients

Obesity evaluation in patients typically starts with collecting comprehensive medical history details and thorough physical examination. The main goal of this is to pinpoint the cause of the obesity and identify any accompanying health conditions. It often takes place during a routine check-up, but could also be done during visits regarding specific health issues.

Here are the usual steps involved in childhood obesity evaluation:

• The first step is to inquire if the family or patient has any concerns about the child’s growth and weight.
• The next stage involves reviewing prenatal factors like excessive mommy weight gain during pregnancy or gestational diabetes, which may increase obesity risk.
• Gathering details about the child’s birth history is also important. This should include discussions related to the baby’s size at birth or rapid weight gain after birth.

It’s also important to look into the child’s diet and exercise routine. This involves asking about the family’s eating habits, what kind of meals they eat, the frequency of snacking, and screen time activities. A 24-hour diet recall, or a list of what the child ate over one day, can also provide helpful information.

• Note the number and type of servings of fruits, vegetables, and high-carb and high-calorie foods that are consumed both in meals and snacks.
• Keep track of the type and amount of physical activity the child gets.

Next, the doctor will review the child’s growth chart, looking for sudden changes in weight, height, and BMI that might point to a cause for obesity. The doctor will also ask about the child’s family history of obesity and related health conditions.

Less common causes of obesity can also be identified from the medical history. For example, symptoms like sudden weight gain after a major head injury could imply a hypothalamus related cause while symptoms like easy bruising, muscle weakness, fatigue, and central obesity could be indicative of Cushing syndrome.

The doctor will also ask about any medications the child is on, as some drugs, such as steroids, antipsychotics, and antiepileptics, can contribute to weight gain.

• Look for symptoms indicating complications resulting from obesity, like frequent urination and excessive thirst indicative of diabetes, vision changes and headaches suggesting pseudotumor cerebri, limp and hip/knee pain indicating Blount disease, abdominal pain, vomiting and jaundice hinting at gallbladder disease, and so on.

The process of reviewing these aspects will help the doctor determine possible causes and courses of treatment. Remember that regular check-ups and monitoring are essential in managing conditions like obesity.

Testing for Obesity in Pediatric Patients

Your doctor typically checks for obesity during regular health check-ups. They use a growth chart to understand when obesity started, how severe it is, and potentially why it started. Body Mass Index (BMI) trends can indicate whether weight gain was steady throughout a person’s life or suddenly increased. Sudden changes in BMI can suggest stress, medical issues such as tumors, thyroid problems, or the effects of medication.

Comparing weight and height changes can also provide insights. If both are increasing at the same rate, it could be due to excess calorie intake. If only weight increase is noticed, it might be due to lack of physical activity. If growth is slowing down, it might suggest thyroid problems.

Medical tests help detect other health problems that can come with obesity. The likelihood of these problems increases with age and severity of obesity. Rates of these problems can differ among racial and ethnic groups; for example, Black and Hispanic youths have higher rates of pre-diabetes and type 2 diabetes. Hispanic children are more prone to develop non-alcoholic fatty liver disease. It’s believed these differences are likely due to socioeconomic and environmental, not genetic factors.

For children with obesity, doctors usually start checking for abnormal cholesterol levels, pre-diabetes/diabetes, and liver issues from the age of ten. The tests typically include fasting lipids, glucose levels, and liver enzymes (ALT and AST) and are conducted every two years. If a glucose test suggests higher levels, further tests are done to confirm the findings. For children aged 2 to 9, testing for cholesterol abnormalities is not mandatory but might be conducted if there’s a history of these problems in the family. Screening for pre-diabetes, type 2 diabetes, and liver issues in this age group is typically done if physical exams show certain signs such as dark patches on the skin or if there’s a family history of diabetes.

If there’s suspicion of Polycystic Ovarian Syndrome (PCOS), doctors test for hormone levels, including luteinizing hormone (LH), follicle-stimulating hormone (FSH), and testosterone. They assess thyroid hormone levels if there are concerns about thyroid function and measure serum cortisol levels to diagnose Cushing syndrome.

In certain cases, doctors may consider additional tests. For example, X-rays of hip and knee joints to check for certain diseases, ultrasounds of the abdomen and pelvis to check for PCOS, or CT/MRI scans of the brain to look for tumors. They might also conduct sleep studies to evaluate for sleep apnea or lung function tests for asthma. In rare cases, an invasive procedure like lumbar puncture might be done to diagnose a condition called pseudotumor cerebri.

Treatment Options for Obesity in Pediatric Patients

It’s important to address obesity and related health issues, with the aim of promoting weight loss, preventing weight gain and managing complications. This is especially vital for children, and doctors are advised to carefully explain the importance of addressing obesity without stigmatizing. Using phrases like “unhealthy weight” or “gaining too much weight for your height” can be less harsh than labeling a child as obese.

Managing childhood obesity largely involves encouraging lifestyle changes within the family. These may include limiting sugary drinks and fast food, consuming more fruits and vegetables, and being regularly physically active. Rather than just advising to “eat less and exercise more”, it’s important to stress the benefits of planned, balanced meals and daily exercise. However, there isn’t one particular diet that is proven to be effective for all overweight children, so dietary changes should be tailored to the child’s preferences and the family’s cultural beliefs. One approach could be the “5-2-1-0” guideline, which encourages five servings of fruits and vegetables a day, no more than two hours of screen time, at least one hour of physical activity, and no sugary drinks.

Suggestions for building a healthier food environment at home could include keeping mealtimes free from distraction like TV, and choosing healthy meals and snacks. Regular physical activity, such as walking to school, playing sports or other leisure activities should also form part of the daily routine. Reducing screen time is also beneficial, with guidelines recommending less than an hour a day for children aged 2-5 years, and two hours for older children.

For patients with obesity, a structured weight management plan would likely benefit them. This may include a consultation with a nutrition specialist, behaviour change sessions, possible medication, and in some cases, considering bariatric surgery. Whichever treatment is chosen, it’s essential to include the patient and their parents in the decision-making process.

Regarding medication, Orlistat is approved for children over 12 years old and works by blocking fat absorption. Metformin, while not approved for weight loss, has been shown to result in mild to modest weight reduction. Other medications include Liraglutide and Exenatide, which work to reduce hunger.

In severe cases of obesity, weight loss surgery may be considered for children. Before surgery, there’s a thorough assessment of the patient’s overall health and readiness, followed by detailed discussions with the child and their family about the risks and lifestyle changes necessary for a successful outcome.

What else can Obesity in Pediatric Patients be?

Sometimes obesity can be caused by rare medical conditions that aren’t as well-known. Here are some ways doctors look for these conditions:

• If a child isn’t growing as fast as they should be, this might point to conditions like underactive thyroid, growth hormone deficiency, a tumor in the brain, or Cushing syndrome.
• Some kids might have obesity because of a brain injury. Usually, when this happens, their weight starts to increase a lot right after the injury.
• If a child eats too much, has unusual facial features, and is slow in learning and development, this might suggest genetic disorders associated with obesity. A particular genetic disorder, Prader-Willi syndrome, can be confirmed with DNA studies.
• Eye problems like retinal disease and uncontrollable eye movements could hint at the presence of Bardet-Biedl syndrome and Alstrom syndrome, both of which are often accompanied by obesity.
• If kids are severely obese and also have developmental delays, it could suggest rare conditions which can be confirmed through blood tests that measure certain hormones and regulators in our body.
• MC4R deficiency can also cause early-onset obesity in kids and can be confirmed using genetic studies.

Also, a rare but potentially serious neurologic condition called idiopathic intracranial hypertension (IIH), usually affects overweight or obese young women. While obesity may not directly cause IIH, there is often a connection. People affected by IIH may experience changes in vision and headaches, and a typical eye examination may reveal swollen optic nerves (papilledema). Although brain scans (CT or MRI) can be used, the most definitive way to diagnose IIH is a procedure involving the measurement of the fluid pressure in the spine.

What to expect with Obesity in Pediatric Patients

Research studies examining the effectiveness of behavior and family-based programs in fighting childhood obesity have shown positive results, especially in preschool children. Notably, reducing the amount of time children spend on screens has been identified as a key strategy.

Early diagnosis and quick intervention can help prevent the development of related health problems and improve overall health outcomes. Since the risk and intensity of such health problems increase with age, early detection and treatment provide the best opportunity for maintaining good health.

If lifestyle changes and behavior-based interventions are not successful, medical professionals should consider medication or surgical options promptly. If not properly treated, children with obesity are likely to carry this condition into adulthood, putting them at risk for serious health issues in the long term.

Possible Complications When Diagnosed with Obesity in Pediatric Patients

Childhood obesity and its related health conditions can be difficult and time-consuming to treat. It can also be a challenging process for both healthcare professionals and families. Obesity affects many body systems, particularly the heart and hormonal systems. It can lead to abnormalities in blood cholesterol and blood pressure, increasing the chances of future heart-related problems.

Central obesity, referring to an excess of belly fat, can cause imbalances in the body’s metabolism, leading to insulin resistance and a health condition called metabolic syndrome. Central obesity is also linked to a condition known as PCOS. Additionally, too much body fat can disrupt the liver’s ability to function properly, which may lead to NAFLD. Obesity can also increase the risk of developing gallstones.

Overweight children also have more orthopedic problems due to the extra pressure that the excessive weight puts on the growing bones. Conditions like Blount disease and slipped capital femoral epiphysis (SCFE) often occur in obese children. Patients with Blount disease may experience knee pain, a limp, and severe bowing of the legs. SCFE is suspected when a child has hip pain and decreased internal rotation of the limb.

Obese children often face lung-related health issues, such as asthma and obstructive sleep apnea. Asthmatics may report difficulty breathing, coughing, and difficulty with physical activity. Symptoms like snoring, restlessness, daytime sleepiness, and changes in behavior could indicate the presence of obstructive sleep apnea. Under these circumstances, lung function tests and sleep studies may become necessary.

Obesity can also lead to psychological issues that greatly affect a child’s daily life. It’s crucial these are addressed early on. Through non-judgemental, open-ended questioning, children may be more likely to express their concerns. Healthcare professionals should inquire about possible anxiety, depression, worsening academic performance, and experiences of bullying. If necessary, professional counseling can be beneficial for preventing the continuation or worsening of these symptoms.

Preventing Obesity in Pediatric Patients

Teaching families about healthy lifestyles can be a powerful tool in managing and preventing obesity in children. Families should be guided towards healthier diet choices, like replacing unhealthy snacks with at least five portions of fruits and vegetables daily. It’s also important to encourage good habits, such as having regular meals as a family, and eating a balanced breakfast every day. We should discourage parents from rewarding kids with food, to foster a positive relationship with nutritious diet.

Kids should also be encouraged to participate in physical activities that they enjoy and are able to do. Working with parents or caregivers to set achievable goals for diet and exercise can have a greater impact. Consideration should also be given to cultural food preferences, to ensure the chosen healthier alternatives are still enjoyable.

However, some families might face obstacles that make healthy choices more difficult. For example, parents working multiple jobs might not have time for cooking healthier meals or joining their kids in physical activities. Families experiencing food insecurity may resort to cheaper, less healthy food choices. Sometimes, children may be left unsupervised and could spend more time on screens and less time being physically active. Safety concerns can limit opportunities for outdoor play in some neighborhoods. Health professionals need to fully understand each family’s situation to provide personalized advice and strategies for handling childhood obesity.