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74 Paediatric Obesity: An Inkling to Serious Health Conditions
DOI Link : https://doi.org/10.5281/zenodo.17505306
Authors:
Abjamilova Jazgul , https://orcid.org/0000-0001-8028-3343
Pallavi Kumari 0009-0003-6860-699X
Rajpriya Deo 0009-0000-5735-6057
Prachi Bhatt 0009-0008-5074-4450
( 1, Department of Paediatrics, International Medical Faculty of Osh State University Osh, Kyrgyzstan
2,3,4, 3rd Year Students, Group 22, International Medical Faculty of Osh State University Osh, Kyrgyzstan )
ABSTRACT
Paediatric Obesity also known as Childhood obesity can be defined as excess adipose deposits under skin which impairs health of children and adolescents. It is a major cause of distress as these are associated with serious health conditions such as Cardiovascular, Metabolic and Reproductive disorders, Diabetes Mellitus (Type 2 diabetes), Hypertension, Dyslipidemia, Non-alcoholic fatty liver disease, sleep disorders such as Obstructive Sleep Apnea Syndrome (OSAS), Obesity hypoventilation syndrome and even psychological sequelae often due to stigmatization of obese children. Many numbers among these have predisposition for obesity related comorbidities but are often left undiagnosed since obesity is often brushed off as non-pathological illness. Early diagnosis and screening is important to bring about early interventions since lifestyle modification once obesity sets in is often difficult. Lifestyle modification, medication and Bariatric surgeries are currently the most popular management indication.This comprehensive review aims to deep dive and gather data that lists down what is known about paediatric obesity and work up effective ways to tackle the issue.
Keywords: Childhood obesity, Paediatric Obesity, Obese children, overweight
INTRODUCTION
Paediatric obesity or childhood obesity is defined as excessive adipose deposits that impairs health. It is linked with the increased risk in development of Type 2 diabetes, heart conditions as well as bone health and reproduction related disorders.[2]
Childhood Obesity has become a penetrating global health crisis with profound implications for long term morbidity and mortality.
The severity of the problem is magnified by its cascading biological, psychological and social consequences. [1]
The UNICEF report and related literature underscore that childhood obesity is not an isolated condition but precursor to multiple noncommunicable diseases that threaten life expectancy. Obese children are at elevated risk of insulin resistance, type 2 diabetes, hypertension, dyslipidemia, non-alcoholic fatty liver, cardiovascular diseases such as atherosclerosis and coronary artery diseases, metabolic syndrome later in life. The early onset of these conditions accelerates vascular damage and metabolic dysfunction, contributing to premature mortality.[3]
In addition to these physiological risks, obesity in childhood often persists into adulthood. Around three quarters of children with obesity in the childhood years remain obese later in life as well, thereby sustaining the load of chronic disease. This persistence is compounded by the low success rates of obesity interventions. [3]
Many pediatric weight-management programs suffer high dropout rates, over 60% in some seen in 24 month follow up studies, which undermines long-term efficacy and allows disease progression. [4]
METHODOLOGY
We did a cross sectional systemic review based study on the current knowledge known about childhood obesity. Its prevalence among different populations, growth index based on low, middle and high income countries, diagnosis criteria of childhood obesity and possible causes and risk factors leading to its incidence, and plausible interventions and management that could help reign it.
DISCUSSION
In the meta analysis by Zhang data from over 45 million children and adolescents across 154 countries, 8.5% of young individuals meet criteria for obesity in a series of studies done in the duration of 2000 to 2023 with reported overweight in children being 14.8% and in adolescents being 22.2%. It was seen that Compared to 2000 to 2011 studies, there was a 1.5 fold increase in the prevalence observed in 2012 to 2023 especially in higher income and higher Human Development Index (HDI) countries. [1]
In 2024 studies, 35 million children under the age of 5 years were overweight. Previous studies showed that obesity was a high-income country problem but there has been a rise of overweight and obesity in low-and middle-income countries as well. In Africa, the number of overweight children under 5 years has increased by nearly 12.1% since 2000. There have been reports that nearly half of the Asian children under the age of 5 years are either overweight or obese as of 2024. [2]
Over 390 million children and adolescents aged 5 to 19 years were overweight in 2022. The prevalence of overweight including obesity among children and adolescents aged 5 to 19 has risen dramatically from just 8% in 1990 to 20% in 2022. In these studies, there was little gender distinction between the rise. As of 2022, 19% girls and 21% of boys were overweight.[2]
Impact of Obesity in Childhood on Health Childhood obesity affects physical and mental health in a variety of ways and is a complicated, multi-systemic illness. The chance of developing chronic diseases is raised by these impacts, which frequently start early in infancy and can last throughout age. [5]
Children who are obese often have hypertension, dyslipidemia, and left ventricular hypertrophy because of altered lipid metabolism and increased vascular resistance. The likelihood of developing early-onset coronary artery disease in adulthood is raised by these alterations. Additionally, adipose tissue crowding the heart over time might affect exercise tolerance and cardiac function.[5]
Obesity interferes with hormone and metabolic regulation. Type 2 diabetes risk is increased by insulin resistance and decreased glucose tolerance. Girls with irregular periods, hirsutism, and infertility have polycystic ovarian syndrome (PCOS). The metabolic syndrome, which includes central obesity, insulin resistance, hypertension, and dyslipidemia. Depending on sex and fat distribution, obesity can either speed up or delay puberty, resulting in
altered pubertal timing.[5]
Bone and joint strain from carrying too much weight results in pain, exhaustion, and reduced mobility. Postural misalignment, tibial bending, pes planus, Blount's disease, and slipped capital femoral epiphysis are among the prevalent structural issues. Furthermore, obesity hinders muscle strength, balance, and coordination, which impacts motor development and levels of physical activity.[5]
Asthma and obstructive sleep apnea (OSA) are more likely to occur in children who are obese because of inflammation and fat accumulation around their airways. Hypoventilation, decreased exercise tolerance, and daytime sleepiness are all consequences of sleep-disordered breathing, which further restricts activity and encourages weight gain.[5]
Children who are obese are at risk for gallstones, diarrhoea, constipation, and non-alcoholic fatty liver disease. These issues can also lead to micronutrient deficiencies and are partially caused by fat accumulation, abdominal pressure, and poor diet quality.[5]
Obesity also affects the kidneys. Both renal dysfunction and glomerulosclerosis are made more likely by obesity. It is also more common to experience urinary problems including enuresis and daytime dribbling which are probably caused by hormonal changes and pressure on the bladder.[5]
Psoriasis, acne, hirsutism, skin infections, pseudogynaecomastia, and acanthosis nigricans are common in obese children. Hormonal abnormalities, insulin resistance, and inflammation are the causes of these alterations.[5]
Idiopathic intracranial hypertension interferes with vision and causes headaches. Obesity-related musculoskeletal and neurological strain results in decreased motor competence and delayed psychomotor development.[5]
Mental and Psychosocial Health is also affected due to obesity. Adolescent obesity is closely linked to disordered eating patterns, depression, anxiety, body dissatisfaction, and low self-esteem. Participation restrictions, social stigma, and bullying worsen psychological stress and lower quality of life. [10]
Paediatric obesity is a risk to long-term adult health. Childhood obesity may persist into adulthood, increasing the risk of type 2 diabetes, cardiovascular disease, infertility, osteoarthritis, and several types of cancer.[2]
Early-life and maternal variables that raise the risk of obesity and its associated consequences include gestational obesity, gestational diabetes, maternal smoking, and early antibiotic exposure.[1]
Moreover, an even major issue is its underdiagnosis, for people cannot do much when they are ignorant of the issue.
Under the guidelines designed by the World Health Organisation, Body Mass Index is one of the prime methods of diagnosis along with other additional measurements like waist circumference. BMI categories for defining obesity varies by age and gender. The method of calculating BMI is (weight in kg)/ (height in m)² [2]
For children < 5 years of age, overweight is weight-for-height greater than 2 standard deviations above WHO Child Growth standards median and for obesity, it is weight-for-height greater than 3 standard deviations above WHO Child Growth standards median.[2]
For children between 5-19 years of age, overweight is BMI-for-age greater than 1 standard deviation above WHO Growth Reference median and obesity is greater than 2 standard deviations above the WHO Growth Reference median.[2]
For the computation of centiles and Z-scores for height-for-age, weight-for-age and BMI-for-age, WHO approved of the LMS model. It is simplified and does not required adjustments for kurtosis. However, a restriction was imposed on all indicators to enable the derivation of percentiles only within the interval corresponding to z-scores between -3 and 3. The underlying reasoning is that percentiles beyond ±3 SD are invariant to changes in equivalent z-scores. The loss accruing to this restriction is small since the inclusion range corresponds to the 0.135th to 99.865th percentiles. [8]
The causes of childhood obesity are multifactorial often interlinked behavioral and lifestyle factors dominate like excessive positive calorific intake especially from ultra-processed, higher-sugar, high fat nutrient-poor foods in relation to the expenditure of energy by the body, sedentary behaviour and reduced physical activity and high screen time. [4]
Underlying these are environmental and socio-economic determinants that take part in proliferation of unhealthy food marketing especially targeting young children. Easy access to cheap energy-dense foods, urban designs that discourage active mobility and socio economic inequalities that limit access to nutritious foods. [4]
Biological and genetical factors also contribute like uterus exposures like maternal obesity or gestational diabetes, epigenetic modifications, famine predisposition and hormonal regulation, all modulate individual susceptibility.[4]
When these casual pathways combine, they entrench a vicious cycle-early excess adiposity, triggers metabolic stress which leads to inflammatory pathways, insulin dysregulation, lipid abnormalities which in turn accelerates organ damage. Over time, multiple non-communicable disease risks accumulate, even in adolescence, setting the stage for serious pathologies in adulthood, the earlier the onset, the greater the cumulative burden. [4]
Inconsistent sleep schedules, poor sleep hygiene, and short sleep duration lead to metabolic dysfunction and weight gain. Excessive screen time and other sedentary behaviors encourage inactivity and poor eating habits. [6]
In the above data sheet, risk factors of obesity were noted down.
● Children of age 6 to 12 exhibited the highest obesity prevalence (9.36%).
● More prevalent in males (9.38%) than females (7.50%)
● Private schools have higher incidence for obesity (11.63%) than public schools (6.53%)
● There were genetic predominance involved where children with obese mothers had significantly higher obesity prevalence (15.92%) than children of nonobese mothers.
● Children with less than 10 hours of sleep (13.68%) had higher obesity incidence than those who got 10 or more hours of sleep (7.23%) [1]
There are certain interventions and preventive factors that are designed to help cope with childhood obesity and childhood overweight in view of the ill effects, risk factors and other comorbidities associated with it.
School based interventions and preventions are usually based on simple energy-balance and environment models like physical activity (PA) or PE classes structured into the curriculum activities, integrated into lessons, after-school activity programs, enhanced PE lessons, or increases in daily MVPA (Moderate to Vigorous Physical Activity). [11]
Educating and spreading awareness like nutrition education, healthier school meals or canteen changes, reducing availability of sugary drinks or snacks, or classroom lessons on healthy eating. Health education (HE) classroom lessons, behavior change education on nutrition, sedentary time, activity, skill building and knowledge toward healthier behaviours.[11]
School policy and environmental changes like food availability, active transport support, timetable changes intended to change behaviours automatically or by shaping the environment are some other examples.[11]
Some other behaviour implementation requires personal and parental based efforts like proper sleep duration according to age. CDC reports the daily recommended hours of sleep changes with age. 3-5 year olds are recommended 10-13 hrs/day including naps, 6-12 year olds 9-12 hrs/day and 13-17 year olds are recommended 8-10 hrs/day. [9]
In addition, other interventions like lowering the screen time, sugar sweetened beverage consumption should also be lowered and active transport and higher MVPA should be promoted. These behaviour changes though not fail proof are helpful in lowering risk in obesity. [6]
ASMBS recommends considering metabolic and bariatric surgery(MBS) for adolescents (10 to 19 years of age) with severe obesity which Skinner and Skelton expanded on the definition of severe obesity to include class I, II, and III obesity using the following American Heart Association criteria.
● Obesity class I (≥95th percentile to <120% of the 95th percentile)
● Obesity class II (≥120% to o140% of the 95th percentile) or a BMI ≥35 to ≤39 kg/m2 or
● Obesity class III (≥140% of the 95th percentile) or BMI ≥40 kg/m2 [12,13,14]
Indications for adolescent MBS according to the guidelines by ASMBS includes BMI ≥35 kg/m2 or 120% of the 95th percentile with clinically significant co-morbid conditions such as obstructive sleep apnea, Type 2 diabetes, idiopathic intracranial hypertension, non alcoholic steatohepatitis, Blount’s disease, slipped capital femoral epiphysis, gastroesophageal reflux disease or hypertension; or BMI ≥40 kg/m2 or 140% of the 95th percentile. [14]
A multidisciplinary team must also consider whether the patient and family have the ability and motivation to adhere to recommended treatments pre- and postoperatively, including consistent use of micronutrient supplements. [14]
However, there are certain contraindications for adolescent MBS like having a medically correctable cause of obesity or an ongoing substance abuse problem. Other contraindications include medical, psychiatric, psychosocial, or cognitive conditions that prevents adherence to postoperative dietary and medication regimens or having current or planned pregnancy within 12 to 18 mo of the procedure. [14]
However, Bariatric surgery comes with its own risks and long term harms like perioperative risks, nutritional deficiencies, reoperative and device complications since some adolescents require revisional surgery. There's also an issue of psychosocial and developmental consideration. There is also lifelong multidisciplinary follow up which includes surgical clinic visits, obesity medications, diet changes, nutritional supplementation, and follow up about growth and pubertal developments. [14, 15, 16]
Since 2020, the FDA has approved 3 antiobesity medications for adolescents 12+ years old including the glucagon-like peptide-1 receptor agonists liraglutide and semaglutide, as well as the combination of phentermine/topiramate extended release. [17]
However, the gap between knowledge of new information and translation of that knowledge into practice is frequently cited to lag. Thus, experts in this workshop section presented data on the known and predicted barriers that will need to be addressed in future research to effectively implement guidance for antiobesity medication prescribing in practice.[17]
In conclusion, childhood obesity though often overlooked is a common starter for a range of serious conditions which leads to related comorbidities. It's causes often ranges from common lifestyle habits that are easy to neglect to genetical factors and gestational factors. The diagnosis is often precarious leading to lack of interventions to deal with it in early stages. It is most likely diagnosed after the onset of visible issues faced by young patients but by then it is often harder to reverse it's effects which includes a wide variety of health conditions including pyschological affects. However, experts report environmental and lifestyle changes which can naturally revert the condition. There are also medications and surgical options available but there is limited information regarding medication effectiveness. While surgical intervention, although successful in decreasing excess weight and imporving related comorbidities require lifelong multidisciplinary follow up and other complications.
Conflicts of interest
There are no conflicts of interest.
Acknowledgement
We would like to thank our supervisor for guiding us through the process of this paper. Moreover, we would also like to thank our colleagues, friends and family for supporting us throughout.
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