Symptoms and Complications of Childhood Obesity

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1. Symptoms

Childhood obesity occurs most often in infancy, between ages 5 and 7, and during puberty, and more than 50% of cases begin before age 6. Since body fat percentage increases to 25-26% in the first year after birth, babies may look chubby and appear obese, but most become normal in body shape after their first birthday. However, children who are too overweight may progress to obesity in early childhood. From age 1 to 6, height grows relatively faster than weight, so body shape may become normal, but from around age 3, obesity should be watched carefully.

From age 6 onward, weight increases faster than height. As body fat increases again, most obesity that begins between ages 4 and 11 often progresses to adult obesity and, in many cases, severe obesity, so caution is needed.

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· Children with obesity are taller than others of the same age, and their bone age is also advanced.

However, puberty may come early, so their final adult height may be shorter.

· Fat is mainly deposited around the breasts, and in boys this may make them appear to have gynecomastia.

· In boys, the external genitalia may appear small. However, in such cases, the external genitalia are usually normal in size and only appear small because they are buried by fatty tissue.

· The abdomen protrudes markedly, and fat accumulates heavily on both sides of the waist, creating folds,

and in severe cases, white or purple stretch marks, as seen in pregnant women, may appear.

· Darkened skin due to excessive pigmentation on the back of the neck and under the armpits may be seen as acanthosis nigricans,

which is associated with insulin resistance and indicates a high risk for type 2 diabetes.

· Children with obesity may be teased or excluded, leading to mental and psychological problems.

This psychological stress can also increase appetite and make obesity worse.

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2. Complications

1. Psychogenic mental disorders

In the surrounding environment, children with obesity are often portrayed as unattractive, while relatively thin people are often described as ideal. In particular, when watching movies or cartoons, most main characters are thin, while the actors playing the clumsy sidekick who follows the main character around and causes trouble are often fat. In addition, because they may not be good at physical activity during gym class, children with obesity are easily prone to feelings of inferiority. In particular, for adolescent girls, since it is a period of high concern about appearance, being overweight can lead to dissatisfaction with their body shape, which can reduce confidence, make them feel lazy, sleep more, and lose concentration, potentially affecting school performance. In addition, eating disorders, including anorexia nervosa and bulimia nervosa, may occur.

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2. Early onset of adult diseases

(1) Type 2 diabetes

Worldwide, type 2 diabetes, which mainly occurs in adults, is increasing among children, and this is thought to be a result of the increase in childhood obesity. In particular, when abdominal fat increases, insulin resistance develops against insulin, the hormone that lowers blood glucose, and insulin resistance increases insulin secretion from the pancreas, leading to hyperinsulinemia. If the pancreas secretes enough insulin to compensate for insulin resistance, normal blood glucose can be maintained; however, as pancreatic overload gradually reduces insulin secretion, blood glucose regulation becomes imbalanced and diabetes eventually develops. The prevalence of type 2 diabetes in children is not yet well known, but overseas studies have reported that 25% of obese children aged 4-10 and 21% of obese adolescents aged 11-18 had impaired glucose control, and 4% of adolescents were diagnosed with type 2 diabetes. In Korea, there are still no exact statistical data, but type 2 diabetes among diabetes cases is increasing.

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(2) Non-alcoholic fatty liver disease

Fatty liver refers to a condition in which fat simply accumulates in the liver, and non-alcoholic steatohepatitis refers to fatty liver progressing and causing inflammation in the liver; together, these are called non-alcoholic fatty liver disease. Recently, as childhood obesity has increased, non-alcoholic fatty liver disease has also increased. According to several domestic reports, this disease occurs in about 22.5-52.8% of children with obesity. In the past, non-alcoholic steatohepatitis was believed to follow a benign course, but recently it has been reported that 7-16% of non-alcoholic steatohepatitis cases progress to cirrhosis, so it is considered serious. In fact, there have recently been domestic reports of progression from non-alcoholic steatohepatitis to cirrhosis in Korean children.

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(3) Hypertension

Hypertension commonly occurs at any age and is related to body mass index, skinfold thickness, and the hip-to-waist circumference ratio.

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(4) Heart disease

Excess adipose tissue increases blood volume and cardiac output and causes cardiomyopathy. It also increases the thickness of the carotid intima, which carries blood from the heart to the head, and causes fibrosis and fat deposition in the coronary arteries that supply blood to the heart muscle, increasing the risk of myocardial infarction and stroke.

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(5) Hyperlipidemia and arteriosclerosis

Hyperlipidemia is a condition in which blood contains a large amount of lipids such as cholesterol. When blood cholesterol increases, fat residue can easily accumulate on blood vessel walls and cause arteriosclerosis. When arteriosclerosis develops, angina, myocardial infarction, or stroke can occur due to blockage of the heart’s blood vessels.

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3. Orthopedic problems

In childhood and adolescence, growth plates are still open, and the cartilage is immature, so the bones are soft and unsuitable for bearing excess weight, leading to various orthopedic problems such as growth plate damage, slipped capital femoral epiphysis, and osteochondritis.

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4. Respiratory

The relationship between asthma and obesity is still controversial, but since the prevalence of obesity and asthma appears to increase together,

there is a high possibility that they are related. It is also associated with the occurrence of snoring and obstructive sleep apnea, which are known to cause

hypertension, cardiovascular disease, and behavioral disorders.

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According to recent studies, adult diseases such as hyperlipidemia, fatty liver, hypertension, and diabetes were found in about 4 out of 10 obese children and about 7 out of 10 severely obese children, so childhood obesity can be said to be serious.

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Up to this point, I have explained the symptoms and complications of childhood obesity.

In the next installment, we will look at the diagnosis of childhood obesity.

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Source: Korea Disease Control and Prevention Agency National Health Information Portal

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