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Patient Story

A 13-year-old Hispanic female is brought to her pediatrician with various concerns, including that her neck always appearing dirty no matter how much she washes and scrubs it. The pediatrician notes that the child has acanthosis nigricans of the neck and axillae along with obesity (Figure 194-1). The mother is obese and admits to having type 2 diabetes. A diet history reveals that the mother cooks traditional Mexican cuisine and the daughter is very fond of tortillas. She also loves to eat pizza, french fries, and other fast food. The girl is a good student but does not like to exercise or play sports. The pediatrician is concerned that the girl may have insulin resistance or type 2 diabetes so she plans to send the patient for screening labs including hemoglobin A1c and fasting blood sugar. She also recommends a healthier diet with less calories and increased physical activity. A referral to a nutritionist is offered.

FIGURE 194-1

Acanthosis nigricans of the neck in a 13-year-old obese girl with a family history of obesity and type 2 diabetes. She eats a high-calorie high fat diet and gets little physical activity. (Used with permission from Richard P. Usatine, MD.)


Obesity in children is defined as a BMI greater than or equal to the age- and sex-specific 95th percentiles of the 2000 Centers for Disease Control (CDC) growth charts; a child is considered overweight at the 85th to 95th percentile.


  • Based on the National Health and Nutrition Examination Surveys (NHNS), 12.5 million children and adolescents (16.9%) are obese.1 Slightly more boys (19.3%) were obese than girls (16.8%) of all included ages in the study. Since 1980, the prevalence of obesity in children has tripled.1

  • The direct medical care costs (prescriptions, outpatient visits, and ER visits) for children aged 6 to 19 years for complications of obesity are 14.1 billion dollars annually.2

  • There is an overrepresentation of low-income children in the numbers of obese children, with 1 in 7 lowincome preschool children being obese.3,4 The National Longitudinal Study of Adolescent Health showed that being obese (BMI > 95%) is highly associated with lower household income.4

  • Race and ethnicity are also associated with obesity, with high rates present in American Indian/Eskimo children.3 In the NHNS study (2007 to 2008), Hispanic boys, aged 2 to 19 years, were significantly more likely to be obese than non-Hispanic white males and non-Hispanic black girls aged 2 to 19 years were significantly more likely to be obese than non-Hispanic white girls.5

  • Interestingly, the effect of ethnicity appears to be mediated by income; Caucasian teenage girls from the lowest income quintile had relative risks for obesity of 2.72 compared to teens in the highest ...

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