Medical Risks of Childhood Obesity

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Medical Risks of Childhood Obesity

• Elham Al Amiri
• Pediatric Endocrinologist
• Al Qassimi Hospital
• Sharjah

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Can you see a mans face?
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Why is obesity of such concern?

• Obesity in adults is strongly associated with
  many serious medical complications that impair
  quality of life and lead to increased morbidity.
• Obese children are at high risk for adult obesity
  and hence its complications

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Diabetes Hypertension High Lipids

• Growth
• Taller
• Early Puberty

• I can tell you lots more ..!

Kidney Urine microalbumin
Liver Gall Bladder

• Skin
• Infected creases
• boils

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Diabetes Diabesity

• Alarming increase in T2DM in children
• The most rapidly growing form of diabetes in
  America, Europe, Japan, and Australia
• AAP ADA recommend screening obese child at risk
  for T2DM beginning at age 10 yr or at the onset
  of puberty and every 2 yr thereafter.

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Which children should be screened for Type 2
diabetes?
Age gt10 y or at puberty

• Weight
• gt120 of ideal for height
• BMI gt 85th percentile

OR
Plus 2 of following
Ethnic background African-American, Hispanic,
American Indian, Asian, Pacific Islander
Family history of Type 2 DM in a first / second
degree relative
Signs of insulin resistance
Adapted from American Diabetes Association Type 2
Diabetes in children adolescents consensus
statement. Diabetes Care 2000
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Metabolic Syndrome (MS)

• Is defined differently according to different
  authorities.
• The U.S. National Cholesterol Education Program's
  Adult Treatment Panel III requires three of five
  characteristics
• abdominal obesity given as waist circumference gt
  102 cm in men and gt 88 cm in women
• hypertriglyceridemia (150 mg/dl or 1.7
  mmol/liter)
• abnormal cholesterol profile with (HDL)
  cholesterol lt 40 mg/dl or 1 mmol/l in men and lt
  50 mg/dl or 1.3 mmol/l in women
• blood pressure 130/85 mm Hg or more
• impaired glucose tolerance, i.e. elevated fasting
  plasma glucose 100 mg/dl or 5.5 mmol/liter or
  more.

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modified guidelines for adolescents

• Triglycerides 110 mg/dl or 1.2 mmol/l and the
  HDL 40
• Waist circumferences 90
• Blood pressures 90

• The WHO and American Association of Clinical
  Endocrinologists criteria require in addition
• impaired glucose tolerance, or frank T2DM
• urinary albumin excretion rate gt 20 µg/min

Using modified criteria, risk of MS was 50 in
12-19 yr olds
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• Poly-Cystic Ovaries in females
• Menstrual irregularity
• Hirsutism, acne, acanthosis
• Thin greasy hair

• Breast development in males

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Respiratory

• Asthma
• Sleep disorders

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Sleep disorders

• There is a strong association between obesity and
  obstructive sleep apnea (OSA).
• OSA is diagnosed by an overnight sleep study
• OSA is related to development of hypertension,
  cardiovascular diseases, behavioural disorders,
  and poor quality of life
• Can benefit from tonsillectomy CPAP ventilation

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Cardiovascular

• Heart disease.
• Obesity increase work of heart.
• OSA hypoventilation may contribute to pulmonary
  arterial hypertension, right heart failure. ?
  lethal

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Cardiovascular

• Hypertension
• Childhood obesity is the leading cause of
  Pediatric hypertension.
• Genetic, metabolic, and hormonal factors.

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Liver Gall Bladder

• fatty liver disease Nonalcoholic/ NonAlcoholic
  Steatohepatitis (NASH)
• Biochemical findings elevations in hepatic
  enzymes.
• A spectrum from benign clinical course to
  hepatitis and even cirrhosis.
• Commonest reason for liver transplant in USA
• Gall Bladder stones

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Visceral factors Gall Bladder Disease

• Obesity, MS, hyperinsulinemia, or alternatively
  rapid significant wt loss are important risk
  factors for gallstone development

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Orthopedic

• Slipped capital femoral epiphysis
• Knock knees
• Bow legs (Blount's disease)
• flat foot
• low back pain
• scoliosis
• osteoarthritis

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Skin

• Acanthosis nigricans correlates with elevated
  serum insulin levels
• skin tags
• keratosis pilaris

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Neurologic

• IIP idiopathic intracranial hypertension,
• headache, vision abnormalities, tinnitus, and
  sixth nerve paresis.

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Treatment

• Prevention is better than Cure

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Prevention

• Primary
• Secondary Screening for complications
• Tertiary Prevent treat complications

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Primary Prevention

• Pregnancy
• Postpartum and Infancy
• Families
• Schools
• Communities
• Health care providers
• Industry
• Government and regulatory bodies

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Perinatal life is there a need for preventive
strategies in infancy or even prenatally?

• High and Low birth weight may both be ass with
  obesity
• Restricted prenatal growth with rapid postnatal
  growth
• ? Protective effect of breastfeeding

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Perinatal life is there a need for preventive
strategies in infancy or even prenatally?

• A. Pregnancy
• Normalize BMI prior to pregnancy.
• Do not smoke.
• Maintain moderate exercise as tolerated.
• In gestational diabetics, meticulous glucose
  control.
• Postpartum infancy
• Breast-feeding is preferred for a minimum of 3
  months.
• Postpone introduction of solid foods and sweet
  liquids

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Treatment

• Diet Exercise Behavior
• Diet Exercise Behavior
• Diet Exercise Behavior
• Diet Exercise Behavior
• Diet Exercise Behavior
• Pharmacotherapy
• Surgery

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OBESITY MEDICATIONS
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• Stimulants
• To ? energy expenditure
• Not recommended
• Safety issues

• Drugs that limit nutrient absorption
• Orlistat inhibits pancreatic lipase
• FDA license older than 12
• increases fecal losses of triglyceride
• 3kg loss

• Anorectic
• Suppress caloric intake
• Sibutramine, older than 16 yr
• Remonabant
• 4-5 kg loss, short term
• side effects cost

• Insulin sensitizers and suppressors
• Metformin
• Helps wt loss, improve lipid glucose
• FDA License for T2DM but not Obesity

• Future Drugs
• Incretins
• Amylin
• Ocreotides
• Leptin

COST SAFETY LIMITATION
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Bariatric Surgery

• More aggressive approaches may be indicated in
  selected subjects with extreme obesity and
  serious comorbidities.
• Surgical approaches most commonly used are
  laparoscopic gastric banding and the Roux-en-Y
  gastric bypass (RYGB).
• Only postpubertal.

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Children have never been very good at listening
to their elders, but they have never failed to
imitate them.  J.Baldwin
THANK YOU