CHAPTER 13: CHILDHOOD OBESITY-RELATED COMORBIDITIES: IDENTIFICATION AND TREATMENT

INTRODUCTION

This chapter will address the following American College of Graduate Medical Education competencies: patient care and medical knowledge.

Patient Care: Understanding assessment and treatment of obesity-related comorbidities is essential in caring for children with obesity. This chapter will help the pediatric health care provider carefully assess and screen for significant comorbidities so that measures can be taken to prevent additional organ system damage from occurring while the patient concurrently works to achieve a healthy weight. The identification of additional comorbidities can also build increased awareness and motivation in the patient and family to make healthy lifestyle changes.

Medical Knowledge: This chapter will help the pediatric health care provider apply knowledge about pathophysiology, comorbidities, epidemiology, psychosocial and behavioral factors influencing disease development and maintenance to patient care and research.

Childhood obesity affects all aspects of a child’s health. It is associated with psychosocial concerns such as attention deficit hyperactivity disorder (ADHD), disordered eating, depression and anxiety, low self-esteem, and lowered quality of life as well as with a constellation of chronic illnesses, traditionally thought to only affect adults. These include, but are not limited to, prediabetes and T2DM, hypertension (HTN), PCOS, nonalcoholic fatty liver disease, obstructive sleep apnea, hyperlipidemia, and acanthosis nigricans. There are also comorbidities of obesity found only in childhood such as Blount disease, slipped capital femoral epiphysis, premature adrenarche, and early puberty. Childhood obesity also increases the risk of adult obesity with all of the associated comorbidities including renal complications and cancer.¹

In children, as in adults, the combination of genes, environment, age, and lifestyle choices can act synergistically leading to unhealthy weight gain. The societal impact of the obesity epidemic is already palpable. The medical care costs of obesity in the United States were a staggering $147 billion in 2008.² It is expected that as the increasing population of children with obesity become adults with obesity, health care costs will continue to increase. We are still learning about the epidemiology, etiology, identification, and treatment of the many obesity-related disorders previously rarely diagnosed during childhood.

PSYCHOLOGICAL COMORBIDITIES FOUND IN CHILDREN WITH OBESITY

Attention deficit hyperactivity disorder

It should not be surprising that there is a significant relationship between obesity and ADHD. Core features of ADHD such as poor self-regulation, decreased ability to delay gratification, and impulsivity have been implicated as possible mechanisms underlying overeating and decreased physical activity. However, only a few studies have examined this relationship. A small study³ found in a sample of 26 children hospitalized for ...