Young bodies awash in the hormones and metabolic burden of excess weight can suffer from conditions that take a significant toll on their quality of life. Chronic disease in the United States, much of it associated with obesity, accounts for 70 percent of deaths and 75 percent of healthcare costs, and the epidemic of childhood obesity is positioning kids to live up to--if not exceed--older generations' track record of chronic ailments. About two thirds of U.S. adults and one fifth of children are overweight or obese.
Research published in July in the journal Health Affairs estimates that medical spending associated with obesity in people over age 18 has risen to nearly 10 percent of total medical spending per year, or $147 billion annually. And findings published earlier this month in Health Affairs online revealed that costs associated with obesity-related hospitalizations in children rose from $125.9 million in 2001 to $237.6 million in 2005 (in 2005 dollars).
The biggies that land an obese kid in the hospital are orthopedic conditions because of compromised bones; asthma, which is associated with or intensified by obesity; and diabetes-related problems like infections, explains Marc Jacobson, a pediatrician who specializes in nutrition, lipids, and weight problems in Great Neck, New York, and also sits on the American Academy of Pediatrics's Obesity Leadership Workgroup. Additionally, being obese can take a big toll on a child's:
--Mental health. Not to be underestimated, experts say, is the emotional impact that being overweight or obese can have on the mental health of a young person. Not being chosen for sports in gym class, being bullied or teased, even being physically abused by peers, not surprisingly, can foster depression and anxiety, leading these kids to miss class.
"School becomes an adverse environment," says Sandra Hassink, who directs the Weight Management Program at the Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware, and also heads up the AAP's Obesity Leadership Workgroup. As a result, performance in school may suffer.
--Sleep. Another potentially negative effect on school performance is the higher rate of sleep disorders in obese kids. Obstructive sleep apnea, which tracks with carrying excess pounds and results in a less-than-restful night, causes a person to stop breathing, sometimes for a minute or more, snore loudly, and sometimes gag or cough, eventually causing the body to rouse itself. The results "can be confused with ADD ( attention deficit disorder)," says Jacobson. The kids "aren't getting refreshing sleep, they're drowsy during the day, and they're hyperactive." Because there are a myriad of reasons a kid might not be doing well in school, "this one might be overlooked," he adds.
Another pulmonary-related problem associated with obesity is asthma, which seems to be spreading in parallel with the rise in obesity rates, though one cannot be called a cause of the other, says Hassink. Asthma in obese kids is a double-whammy, since carrying around extra pounds itself causes wheezing and shortness of breath.
-- Liver. The body's workhorse organ, the liver, can take a significant hit in obese children. With fatty deposits around and marbled throughout their organs, about 15 to 20 percent of obese children have elevated liver enzymes that reflect an inflammation known as NASH, or nonalcoholic steatohepatits. Inflammation is known to play a significant role in many disease processes from heart disease to diabetes.
NASH can lead to scarring in the liver tissue and loss of critical function. While this condition has been seen in adult populations for some time, explains Hassink, "we already see children who have this process."
-- Bones and joints. Extra pounds put a heavy burden on developing bones and joints. Knees suffer, and obese kids can develop Blount's disease, which is thought to result from pressure on the lower leg that prevents the inner shinbone from developing properly. Often a child will develop bowed legs.
Hip joints suffer, too, and weight may cause the head of the femur in the hip joint to fracture, explains Hassink. The treatment requires a pin or screw to be inserted for support.
--Menstrual cycle. Girls who are obese may get their first period earlier than is typical. Population studies have suggested that such early-onset menstration is a risk factor for breast cancer, Jacobson says. The mean age of onset in the United States, he says, is 12.5 years of age, but "with overweight girls it is significantly earlier--it might be a year or so."
Later on, obese women may develop irregular or stopped periods, more acne, and excessive hair growth as a result of polycystic ovarian syndrome. This, of course, becomes a problem as they grow up and want to have children, Hassink says.
But parents and obese children alike need not feel overwhelmed or powerless. "I've seen many, many kids do very well in managing this problem," says Jacobson. Yes, it takes concerted effort--not only on the part of the child, but also on the part of parents and siblings. A supportive household is essential, as is a real hard look at the family's nutritional and activity habits.
One common struggle occurs in families with one obese or overweight child among others who are picky eaters and skinny. Parents often believe that ice cream, cookies, and sugary beverages are necessary to get the slender kids interested in food.
"That's a fallacy," Jacobson says, since "picky eaters who happen to be slim need the same five servings of fruit and vegetables, lean meats, and low-fat dairy." Another challenge for parents is the busy factor. Meals may not get made ahead of time, which means relying too heavily on the fallback takeout or microwavable dinners. "The literature is pretty good at showing the number of restaurant and takeout meals (a child eats) is pretty well correlated with a child's body mass index," says Jacobson.
Of course, a big part of the problem is that recess during school is not a given like it used to be, and children spend more time riding in cars than riding their bikes. It falls to parents to turn off the television set and move the fun outdoors. One effort worth making: rallying neighborhood parents.
"The average child wants to exercise," Hassink explains. "What gets them there is play with other kids."