Complications
Approximately 55% of children with obesity go on to be adolescents with obesity, and approximately 80% of adolescents with obesity will remain to be adults with obesity.[39]
In addition, those children with obesity at 8 years of age tend to have more severe obesity and increased morbidity as an adult.[18][19]
Risk factors for the development of diabetes in children include a body mass index (BMI) ≥85th percentile, family history of diabetes, race (e.g., Hispanic or black), and other risk factors such as acanthosis nigricans, polycystic ovary syndrome, or metabolic syndrome.
The American Diabetes Association recommends that all children aged >10 years with a BMI ≥85th percentile plus one or more additional risk factors should have a fasting blood glucose test, a 2 hour plasma glucose during a 75 g oral glucose tolerance test, or haemoglobin A1c every 3 years, or more frequently if BMI is increasing, or risk factor profile is deteriorating.[74]
Data from Denmark showed that an increased risk of adult type 2 diabetes was associated with male childhood overweight at aged 7 years of age only if it continued until puberty or later ages.[137]
A constellation of metabolic derangements including waist circumference >90th percentile for age plus two of the following: hypertriglyceridaemia, low high-density lipoprotein (HDL), hypertension, or glucose intolerance.
Higher risk in most children with obesity.[138]
Treatment is aimed at lifestyle modification and weight loss.
Childhood obesity is associated with glucose intolerance in adulthood.[140]
Systolic blood pressure is elevated in 13%, and diastolic blood pressure in 9%, of children with obesity.[18]
Associated with high BMI and usually indicative of insulin resistance.[145]
A fasting lipid panel should be obtained in children with a BMI ≥85th percentile.[18]
All children should be screened for lipid abnormalities with a non-fasting, non-HDL cholesterol between ages 9 to 11 years and 17 to 21 years.[71]
Lipid abnormalities in children often persist into adulthood.[71]
Cut-off values are as follows: normal: cholesterol <4.40 mmol/L (<170 mg/dL), LDL <2.85 mmol/L (<110 mg/dL); borderline: cholesterol 4.40 to 5.15 mmol/L (170-199 mg/dL), LDL 2.85 to 3.34 mmol/L (110-129 mg/dL); elevated: cholesterol >5.18 mmol/L (>200 mg/dL), LDL >3.37 mmol/L (>130 mg/dL).[71]
Complications of gastric bypass include infection, iron and vitamin deficiencies, cholecystitis, and small bowel or stomach obstruction.
Fewer complications are associated with vertical sleeve gastrectomy as there is no rearrangement of the anatomy.[146]
Irregular menses, acne, and hirsutism are associated with polycystic ovary syndrome. Biochemical evidence of hyperandrogenism and polycystic ovaries on ultrasound is usually found.
Treatment strategies include exercise and weight loss, oral contraceptives containing a progestogen with low androgenicity, and insulin-sensitising agents.
The prevalence of obstructive sleep apnoea is highest in children with severe obesity.[147]
Children may present with a history of snoring with pauses in breathing while sleeping, restless sleep, daytime somnolence, poor attention span, and poor academic performance.
Tonsillar hypertrophy may be seen on examination. The diagnosis is made by polysomnography, and treatment includes tonsillectomy and adenoidectomy (if indicated) and continuous positive airway pressure (CPAP) during sleep.[148]
Sleep apnoea may contribute to pulmonary arterial hypertension.
Children with obesity are at higher risk of developing simple steatosis, steatohepatitis, fibrosis, and cirrhosis.
Children >10 years of age with a BMI ≥95th percentile, or with a BMI ≥85th percentile and other risk factors, should be screened annually with liver function tests.
Definitive diagnosis is made with a liver biopsy.
Treatment is weight loss.
More prevalent in overweight children and children with obesity, and can be associated with rapid weight loss.[149]
Children usually present with intermittent, intense, colicky pain in the right upper quadrant of the abdomen.
Diagnosis is made with abdominal ultrasound, and treatment is usually surgical.
Irritation in the folds of the skin.
Affected areas are typically red and macerated.
Treatment consists of good hygiene combined with mild emollients. Topical corticosteroids can be used as necessary.
Infection in the folds of the skin.
Treatment consists of proper hygiene, hot moist compresses to facilitate drainage, incision and drainage, and antibiotics as needed.
Due to excess adipose tissue on the chest and abdomen.
Treatment is weight loss and continuous positive airway pressure (CPAP) during sleep.
Typically seen between the ages of 9 and 16 years; boys are affected more often than girls.[152] Typically presents with hip or knee pain, pain with walking, and decreased range of motion at the hip. Treatment is surgical.
A bowing of the lower extremities (i.e., tibia vara), which is typically painless.[152] Radiographical features include changes in the proximal medial tibial metaphysis. Treatment is typically surgical, although orthotic management can be attempted in patients <3 years of age.
Children with obesity have a higher risk of asthma independent of other factors.[154]
Overweight/obesity is associated with increased asthma severity, poorer asthma control, and lower quality of life.[155]
Symptoms of shortness of breath and reduced exercise tolerance may be attributed to obesity, confounding the diagnosis.
Adolescent obesity is associated with increased cancer risk in adulthood.
One cohort study with over 2,000,000 participants reported a hazard ratio of 1.26 (95% CI 1.18 to 1.35) in men with adolescent obesity, and a hazard ratio of 1.27 (95% CI 1.13 to 1.44) in women, after exclusion of breast and cervical cancers.[156]
Can be exacerbated by obesity.[150]
Can be exacerbated by obesity.[151]
Children present with severe headaches with photophobia.
They occasionally have double vision and impairment of cranial nerve VI.
Blurred optic discs may be noted on examination.[153]
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