CHAPTER 8

Adding to the Burden

PART 1 Bone and Joint Problems

Even though overweight kids tend to have denser bones, they have more bone fractures than nonoverweight children. This may be because being overweight interferes with balance and also because overweight children fall with greater force. READ MORE

Obese kids also experience more leg joint pain as well as joint abnormalities. Excess weight can cause hip, knee, and ankle joints to be misaligned. This may make many types of physical activity uncomfortable for the child, so that he or she is less active, and therefore gains more weight—a vicious circle. LESS

PART 2 Sleep Disorders

About 7% of obese children have obstructive sleep apnea, in which their upper airway closes partially or completely during sleep. If your child snores loudly, sleeps restlessly or wakes up often, gasps or stops breathing when sleeping, or wets the bed, he or she may have sleep apnea. READ MORE

Sleep apnea is dangerous, so it’s important to take it seriously. More and more, scientists are finding out that sleep plays a vital part in a child’s growth and development. Children who don’t get enough restful sleep may not grow properly because growth hormone is released when children sleep at night. Also, shallow or impeded breathing may cause a lack of oxygen in the blood, leading to learning difficulties. Children with sleep apnea may have problems paying attention and remembering things. What’s more, if sleep apnea goes untreated, it can lead to hypertension, pulmonary hypertension (high blood pressure in the lungs), and heart failure (in very severe cases).

If you think your child may have sleep apnea, your doctor can evaluate his or her medical history and sleep history, review any behavioral or developmental problems, and do a physical exam. This may be all that’s required for diagnosis, or your doctor may suggest an overnight sleep study. The first steps in treating sleep apnea are usually losing weight and treating any allergies. If the sleep apnea doesn’t improve, then your child may need an adenotonsillectomy (surgical removal of the adenoid tissue and tonsils). LESS

PART 3 Early Puberty in Girls, Delayed Puberty in Boys

In girls, there’s a strong association between being overweight and entering puberty early. Being overweight at just 3 years of age increases the likelihood of early puberty. Obese girls have an 80% chance of developing breasts before the age of 9 and starting menstruation before age 12. READ MORE

It’s not clear why many girls are entering puberty younger, but it’s likely that the powerful hormones produced by excess fat cells play a major role. Hormones may not be the only cause, however. Chemicals commonly found in the environment, such as Bisphenol A (BPA) and phthalates, both used to make plastics, have estrogenlike effects and may be responsible as well.

The social impact of entering puberty early can be devastating. Girls who mature early are more likely to smoke, drink, take drugs, begin dating, and have sex than their classmates. They tend to miss more days of school and to have lower self-esteem, poorer coping skills, and disruptive behavior disorders. They are also more likely to attempt suicide.

In boys, the opposite is true: obesity can delay puberty. Researchers found that twice as many obese boys had not entered puberty by the age of 11-1/2 as nonoverweight boys. Just as entering puberty early can create social issues for girls, reaching puberty late can cause social problems for boys, including being teased, bullied, and stigmatized. LESS

PART 4 Gastrointestinal Disorders

Overweight and obese children are more likely to have gastrointestinal (digestive) disorders, including nonalcoholic fatty liver disease, constipation, gastroesophageal reflux disease (GERD), and gallstones. READ MORE

Nonalcoholic fatty liver disease. About half of all obese kids are thought to have nonalcoholic fatty liver disease, in which fat accumulates in the liver cells. In itself, the condition usually presents no problems. However, approximately 25% of children with fatty liver develop hepatitis as children. Of these, about 20% will go on to develop cirrhosis of the liver as young adults, with a life expectancy after that of just 7 years. People who develop cirrhosis after they have nonalcoholic fatty liver disease have the same risk of developing liver cancer as people who develop cirrhosis as a result of having hepatitis C.

Gastroesophageal reflux disease (GERD). GERD occurs when acidic liquids from the stomach back up into the esophagus. If GERD isn’t treated, the esophagus can become chronically inflamed, and, more rarely, develop scars and ulcers. GERD that continues into adulthood raises the risk of esophageal cancer, the fastest-growing cancer in the US. Moderately to severely obese children have a 30-40% higher risk of GERD than normal-weight kids.

Constipation. About twice as many obese children have constipation as normal-weight children. It’s not clear why obesity causes constipation.

Gallstones. Cholesterol stones, the most common type of gallstone, are formed when bile from the liver become supersaturated with cholesterol and crystallizes. Up to half of all gallstones diagnosed in children are diagnosed in obese kids.

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PART 5 Respiratory Problems

Obese kids have a harder time breathing than normal-weight kids. Abdominal fat makes breathing more difficult by increasing the amount of weight on the wall of muscle and bone that surrounds the lungs. Obesity also raises the chances that a child will have asthma, possibly because it increases the level of inflammation in the lungs. In asthma, the airways of the lungs are constricted, either because inflammation causes their linings to swell or because tightening of the muscles that surround the airways reduces their diameter.

PART 6 Emotional Issues, Behavior Problems, and the HPA Axis

Obesity can cause behavioral and learning problems. There can be substance abuse issues, too: obese adolescents are more likely to smoke and drink than nonobese adolescents. READ MORE

Behavior and Learning Problems
Behavior problems and overweight are linked. Kids who are overweight are more likely to have significant behavior problems. Conversely, children with behavior problems are five times more likely to become overweight later in their lives. This points up the importance of treating both the child’s mind and body when dealing with behavior and weight issues.

Behavioral issues can translate into learning problems as well. Anxiety and stress may cause overweight children to act out in class, or, conversely, to withdraw socially. Either response can make learning more difficult and lead to poor academic performance—further increasing the child’s stress level. Chronic stress often leads to depression.

The HPA Axis
Obesity, depression, and behavioral disorders have all been linked to abnormal functioning of the hormonal pathway called the hypothalamic-pituitary-adrenal (HPA) axis. The HPA axis is not a physical entity. It is a complex set of chemical communications and interactions between the hypothalamus, the pituitary gland, and the adrenal glands. These interactions regulate many of the body’s processes, including digestion, emotional reactions, and energy storage and use. The HPA axis works to maintain chemical balance when you’re under stress. One of the ways it does this is by releasing cortisol, the “stress hormone.” Cortisol causes the body to deposit fat around the abdomen. Unfortunately, this is an especially unhealthy place to carry extra weight. LESS

PART 7 Bullying and Low Self-Esteem

Obese children are more likely to be bullied than normal-weight kids. Bullying (which reaches a peak during ages 6-9), taunting, and teasing can be major factors in low self-esteem. But they’re not the only ones. In a society that’s overly concerned with appearance, kids are constantly getting negative messages about being overweight from television shows, ads, films, and other media. READ MORE

Overweight kids may maintain a healthy level of self-esteem through childhood but become painfully self-conscious about their physical appearance in adolescence. Girls in particular are likely to have significantly lower levels of self-esteem by 13-14 years of age. LESS

PART 8 Depression

Obesity puts kids at risk for depression, and the negative emotional fallout of obesity can start early. One study found that boys and girls who were overweight from kindergarten through third grade were more depressed, anxious, and lonely than kids who had never been overweight. Their negative feelings got worse over time as well. This is to be expected, because the longer a child is overweight, the more he or she is at risk for depression and other mental health disorders. READ MORE

Kids who are depressed may have a major change in eating or sleeping patterns, cry frequently, or lose interest in activities that they used to enjoy. They may feel hopeless, like things will never get any better for them. They might be irritable and lash out at times, and they may also mask their sadness with an appearance of emotional flatness. Their performance at school may get worse, and they might find it difficult to concentrate. If your child has any symptoms of depression, take the matter seriously. Talk to your child about how he or she is feeling, and speak to your child’s doctor about your concerns as well. LESS

Photo credit: Young boy looking down
Copyright 2008 Steven Fruitsmaak

Photo credit: Boy with liver anatomy
Copyright 2008 Mike Baird