This Health Problem Obesity Has Grown Steadily and Continues to Increase Among American Children

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Diabetes update

Review article

Childhood Obesity: A Review of Increased Risk for Physical and Psychological Comorbidities

Abstract

Background

Worldwide estimates of childhood overweight and obesity are as high as 43 million, and rates continue to increase each year. Researchers have taken interest in the childhood obesity epidemic and the impact of this condition across health domains. The consequences of childhood and adolescent obesity are extensive, including both medical and psychosocial comorbidities.

Objective

The purpose of this review was to consolidate and highlight the recent literature on the comorbidities associated with childhood obesity, both nationally and internationally.

Methods

PubMed and PsychINFO searches were conducted on childhood obesity and comorbidities.

Results

The initial search of the terms obesity and comorbidity yielded >5000 published articles. Limits were set to include studies on children and adolescents that were published in peer-reviewed journals from 2002 to 2012. These limits narrowed the search to 938. Review of those articles resulted in 79 that are included in this review. The major medical comorbidities associated with childhood obesity in the current literature are metabolic risk factors, asthma, and dental health issues. Major psychological comorbidities include internalizing and externalizing disorders, attention-deficit hyperactivity disorder, and sleep problems.

Conclusions

The high prevalence rates of childhood obesity have resulted in extensive research in this area. Limitations to the current childhood obesity literature include differential definitions of weight status and cut-off levels for metabolic risk factors across studies. Additionally, some results are based on self-report of diagnoses rather than chart reviews or physician diagnosis. Even so, there is substantial support for metabolic risk factors, internalizing disorders, attention-deficit hyperactivity disorder, and decreased health-related quality of life as comorbidities to obesity in childhood. Additional investigations on other diseases and conditions that might be associated with childhood obesity are warranted and intervention research in this area is critical.

Introduction

Obesity is the result of a chronic caloric imbalance, with more calories being consumed than expended each day. History of obesity, hereditary factors, environment, metabolism, behavior, culture, and socioeconomic status all play a role in obesity.¹ Most obese adults were obese as adolescents and most obese adolescents were overweight and/or obese as children.² In fact, the origins of obesity are being traced to early childhood development. Children who experience early adiposity rebound (before the age of 5 years) have increases in mean body mass index (BMI) from age 3 to adolescence, and those that experience late adiposity rebound have decreases in BMI from age 3 to adolescence. Differences between those who experience early and late adiposity rebound are maintained into adulthood.3, 4 Evidence is available to support both genetic5, 6 and environmental components7, 8 to obesity. Availability of healthy snacks and meals⁹ and children's choices in food consumption¹⁰ are also important to consider.

In addition to consumption of food, energy expenditure, generally in the form of physical activity, is highly important to maintaining healthy weight. Results from the 2007 Youth Risk Behavioral Survey conducted in the United States indicated that among high school students nationwide, 35% had watched television for 3 or more hours per day on a typical school day during the past month, and 65% had not met recommended levels of physical activity during the past week.¹¹ Recent estimates from the National Health and Nutrition Examination Survey¹² indicate that approximately one third of children in the United States are overweight or obese, with approximately 17% meeting criteria for obesity, as measured by a BMI score ≥95^th percentile.¹³ BMI scores can be converted into standardized scores (zBMI) to conduct comparisons among groups.¹⁴ Ethnic minority children are at an increased risk for obesity.¹⁵ Worldwide estimates of childhood overweight and obesity are as high as 43 million. This number reflects an increase from 4.2% in 1990 to 6.7% in 2010.¹⁶

Rates of obesity in youth are expected to continue to grow. As a result, it is imperative to consider the physical health and psychological correlates and consequences of this condition. The consequences of childhood and adolescent obesity are far reaching, not only including health-related physical outcomes, such as high blood pressure; high cholesterol; metabolic syndrome; type 2 diabetes; orthopedic problems; sleep apnea; asthma; and fatty liver disease, but also psychological, social, and behavioral consequences, such as risk for problems related to body image; self-esteem; social isolation and discrimination; depression; and reduced quality of life.¹ In 2003, Reilly et al¹⁷ conducted a systematic review of the literature on the health consequences of childhood obesity. They concluded that childhood obesity has significant short-term and long-term adverse medical and psychosocial effects extending into adulthood. Strong evidence exists for childhood obesity affecting morbidity and mortality in adulthood.¹⁸ The purpose of this review is to explore and expand on previously identified associations between childhood obesity with physical and psychological comorbidities.

Section snippets

Methods

Electronic searches were conducted via PubMed and PsychInfo in October of 2012 using the search terms obesity and comorbidity. The following types of publications were excluded from this review: letters to editors, commentaries, case studies, and review articles. All other publications were considered for inclusion. Articles that did not provide data on medical or psychological comorbidities of obesity were excluded. Clinical trials and randomized controlled trials that included baseline

Results

The PubMed search initially yielded 4315 results. Limits were applied to narrow the search, including publication dates from 2002 to 2012 (3800 results), age range of participants between 0 and 18 years old (961 results), and written in English (840 results). A similar search was conducted in PsychInfo. This search initially yielded 709 results and using the same limits described was narrowed to 53 articles. Combining the 2 searches resulted in 893 articles. The author and a research assistant

Discussion

The purpose of this review was to summarize the current literature on the medical and psychological comorbidities associated with childhood obesity across national and international investigations. Overall, there are certain medical and psychological comorbidities associated with childhood obesity that have been fairly well established in the literature.

Medically, the association between childhood obesity and metabolic risk factors is evident.52, 106, 107, 108 Other medical comorbidities, such

Conclusions

Seventy-nine studies were identified in a10-year time span on the topic of childhood obesity and comorbidities and the number being published continues to grow. Despite the recognition of the importance of this condition in children, the rates of childhood obesity continue to increase and, unfortunately, the reality of the long-term ramifications is becoming solidified in the literature. There is evidence to support significant medical and psychological sequelae of the condition into adulthood.

Conflicts of Interest

The author has indicated that there are no conflicts of interest regarding the content of this article.

Acknowledgments

The author would like to thank the Pediatric Research Team at the University of Miami for their technical support in preparing this manuscript, especially Ashley Marchante for her assistance with reviewing the literature. The author would also like to recognize Drs Alan Delamater, John Elder, and Sarah Messiah for their guidance on this manuscript. This work was supported in part by National Heart, Lung, and Blood Institute grant number 3R01HL102130-02S1.

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Source: https://www.sciencedirect.com/science/article/abs/pii/S0149291812007266

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