What physical health problems obesity can cause for children and adolescents?
In 2022, there were 390 million overweight children and adolescents aged 5–19 worldwide. Obesity can cause various physical health problems, e.g. cardiovascular disease, type 2 diabetes, metabolic syndrome and fatty liver disease in children. However, if childhood obesity ends in adulthood, the risk of obesity-related diseases also disappears.
BMI, or body mass index, is the most common way of assessing body composition. Children have lower BMI values than adults, which is why they use the ISO BMI. According to ISO-BMI, a BMI above 25 kg/m2 indicates that a child is overweight and obese if it is above 30 kg/m2.
Diabetes is a disease in which the body’s metabolism of sugar is disturbed
All types of diabetes have in common a disorder of the body’s sugar metabolism caused by a lack of insulin or its reduced effectiveness. Pre-diabetes is the first sign of a developing disorder. The prevalence of type 1 diabetes has been increasing, although the prevalence varies widely between countries for an unknown reason. It has been observed that being overweight or obese in adolescence seems to increase the risk of developing the disease in early adulthood. Type 2 diabetes in young people is most often caused by obesity. The disease is partly hereditary.
In metabolic syndrome, a person develops several metabolic disorders at the same time. In adults, the criteria for the syndrome consist of central obesity, impaired sugar and lipid metabolism and hypertension. In children, the criteria for the syndrome are not yet well established. However, metabolic syndrome is the most common metabolic disorder in children and its prevalence increases in obese children from the age of 10 years. The changes in the syndrome in children are similar to those in adults. In practice, changes in the syndrome are manifestations of a metabolic disorder caused by insulin resistance.
Obesity is a major risk factor for fatty liver
Non-alcoholic fatty liver disease (NAFLD) is the most common childhood liver disease. However, it is rare in children under 10 years of age. Obesity is a major risk factor for fatty liver disease in children and adolescents. The location of fat also influences the risk of developing fatty liver disease. In fatty liver disease, the normal function of cells in the liver is disrupted when fat accumulates inside liver cells. As the liver becomes fatty, it becomes insulin resistant. Fatty liver disease, if left untreated, can lead to fatty liver inflammation and in the worst case to cirrhosis.
Cardiovascular diseases are the leading cause of morbidity and mortality worldwide. The most common cardiovascular risk factors associated with childhood obesity include high blood pressure, lipid metabolism disorders, vascular endothelial dysfunction and insulin resistance. Childhood obesity has similar adverse effects on cardiovascular health as in adults. Cardiovascular diseases tend to develop slowly and therefore obesity that starts in childhood is harmful. Weight loss in childhood before puberty reduces the risk of adult morbidity.
Risk factors for kidney failure include diabetes, hypertension, inflammation of the renal tubules, polycystic kidney disease and, in older age, arterial angiopathy. The prevalence of chronic kidney disease has been on the rise in recent years, particularly in adults, but the prevalence in children has also increased. Kidneys of obese children are larger and have a faster blood flow. Studies on the effects of obesity on children’s kidney health have shown conflicting results. A challenge for research is that changes in kidney function are difficult to detect early.
Being overweight can impair lung function
Obesity increases the incidence of sleep-disordered breathing (obstructive sleep apnoea) in childhood by about four times compared to normal weight children. Children and adolescents who are overweight have a higher incidence of asthma than their normal-weight peers. However, studies have not been able to fully demonstrate whether being overweight or sedentary lifestyle has a greater impact on the development of asthma.
Increased body size makes movement more difficult. Obesity can cause flexion of the tibia and femur in children. Legg-Perthes and epiphyseolysis (the head of the femur slips out of place) are more common in overweight children. Flat feet are also more common in overweight children and adolescents. A link has been found between childhood obesity and developing osteoarthritis as an adult. Studies show that bone fractures are more common in overweight children. Overweight people have a larger bone mass, which is thought to be related to the extra bone stress caused by weight, which activates bone growth.
Childhood obesity is associated with early puberty
The association between obesity and precocious puberty is stronger in girls than in boys. Early onset of puberty has been found to be strongly associated with morbidity in adulthood. In obese girls, menstruation is often irregular. In adolescent boys, gynaecomastia is quite common and obesity increases its prevalence. Gynaecomastia refers to male breast growth. In young girls, especially adolescents, obesity has also been found to be associated with polycystic ovary syndrome, one of the most common endocrine disorders in women of reproductive age.
Studies have shown that obesity in children and adolescents is associated with an increased risk of developing cancer in adulthood. Several mechanisms are involved in the association between childhood obesity and cancer, but these are not yet fully understood. Factors such as increased inflammatory susceptibility due to obesity and changes in the function of some hormones and growth factors have been identified as contributing factors. Addressing and treating obesity in childhood and adolescence can reduce the risk of developing cancer.
Low-grade inflammation caused by obesity can affect the prevalence and severity of autoimmune diseases
A link between obesity and autoimmune disease has been established even before the onset of puberty. Childhood and adolescent obesity is a risk factor for multiple sclerosis (MS). Chronic inflammation is probably the main reason why obesity increases the risk of developing the disease. An association between obesity and the onset or worsening of other autoimmune diseases has also been observed.
Thyroid function is regulated by the thyrotropin hormone secreted by the pituitary gland. TSH is abbreviation for thyroid-stimulating hormone. Elevated levels of thyroid-stimulating hormone (TSH) have been found in obese children, which is a sign of thyroid dysfunction. Elevated TSH in obese children is associated with cardiometabolic markers in childhood and later cardiovascular disease.
You can read more about treating and managing child obesity in the following Cielo-project’s article.
Authors
Paula Lehtola, Public health nurse, Turku UAS
Ellamari Nikkanen, Public health nurse, Turku UAS
Maika Kummel, PhD, Principal lecturer, Public health nurse, Turku UAS
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