What Childhood Obesity Hides: Adult Diseases in Younger Children

The diagnosis of overweight or obesity in childhood is like opening a Pandora's box.

Excess fat unleashes a string of diseases and health threats that make the child sick from the first moment and, probably, in the long term as well.

Diabetes, hypertension, sleep apnea, skin problems, depression... There are dozens of associated ailments.

But obesity and overweight, which affects 340 million children and adolescents in the world, is not only a risk factor for developing other pathologies;

it is a disease in itself, endocrinologists insist.

And it leaves a mechanical, metabolic and psychological mark that is difficult to erase.

At the foot of the consultation, experts who treat children with obesity warn that adult diseases are already being seen in younger and younger children.

The World Health Organization (WHO) has classified obesity as “the epidemic of the 21st century”.

And, with permission from the covid, the data points to this scenario: according to the latest WHO report, in Europe, one in three children is obese or overweight.

The European Childhood Obesity Surveillance Initiative (COSI) places Spain among the countries with the highest prevalence of these ailments: more than 40% of children between the ages of six and nine are obese or overweight.

More information

Obesity is not just a problem for nutritionists

The trend, moreover, continues to rise and the pandemic has only aggravated a dazzling rise in these clinical pictures.

Albert Goday, an endocrinologist at Hospital del Mar, is blunt: “It is a pandemic and potentially serious disease.

As severe obesity increases in children and adolescents, we see associated diseases that were previously only found in adults, such as type II diabetes.

And that's just the tip of the iceberg."

An obese child is at greater risk of perpetuating excess fat in the long term, and obesity in adulthood is a risk factor for developing a dozen tumors, heart attacks, heart disease, metabolic disorders, cognitive decline, and mental health illnesses.

It worsens the quality and life expectancy.

The diagnosis of childhood obesity or overweight is not a rise in height.

Or not alone.

Excess fat begins to play against it from the moment it is deposited in the body, explains Rosaura Leis, coordinator of the Nutrition and Lactation Committee of the Spanish Association of Pediatrics: "It is not just that the child has a change of body composition.

That fat is a metabolically active organ and produces substances that affect your health.”

Seeing adult diseases in children, she admits, "shocked" them and put the scientific community "on alert."

With the diagnosis, Pandora's box is opened and cardiovascular, musculoskeletal, psychological, metabolic diseases or health problems are discovered.

A study published in the journal

analyzed, from a cohort of American medical records, the potential subtypes of childhood obesity according to the associated pathologies, and found up to eight groups of patients with similar characteristics: namely, a high prevalence of respiratory and sleep disorders, with skin conditions, with seizure disorders, with asthma, with gastrointestinal, neurodevelopmental or physical problems, among others.

Bad health, whichever way you look at it.

Respiratory problems

In practice, in consultations, obesity brings with it, in effect, a very varied pattern of symptoms.

Julio Álvarez Pitti, a doctor at the General Hospital of Valencia and a researcher at the Center for Biomedical Research in the Physiopathology of Obesity and Nutrition Network (Ciberobn), receives between 300 and 400 consultations from children with obesity in his unit every year and warns that the impact on their health is devastating: “There are mechanical consequences because an excess of 20 kilos is an overload for the musculoskeletal system: contractures, bone deformities and pain occur when moving or getting up.

It is a limitation to jump, play or run.

It is like putting a backpack with 20 kilos of stones on the back of a child”, he draws.

But it does not only affect the bones.

Obesity also hides respiratory problems, such as sleep apnea.

“The airway is elastic, but stiff enough to stay open.

At night, when you relax, the fat, which is soft, makes the [respiratory] tube softer and collapses: it is as if, instead of being a hard rubber tube, it is made of soft rubber”, explains Álvarez Pitti.

Thus, breathing stops until the brain detects it and wakes the child up momentarily so that the airways reopen.

All that impact, however, does not stay overnight, but has consequences the next day.

As in a kind of domino effect, those nocturnal awakenings take their toll on the quality of sleep, which plummets and drags fatigue to the rest of the day, affecting other areas of your life, such as school performance, for example.

The more tired, in addition, less movement and more hunger, which accentuates the picture of obesity.

Asthma diagnoses are also present in these children and dermatological problems may also appear, explains Goday, "such as psoriasis, skin infections or hidradenitis suppurativa", which causes painful bumps under the skin.

They also suffer from friction dermatitis and stretch marks.

metabolic effects

Excess fat has other effects, of a metabolic nature, such as the alteration of sugar control.

There are already cases of type II diabetes —which is associated with obesity— in younger and younger children, Álvarez Pitti points out: “It is increasing.

After the pandemic, more children are referred to us, but, above all, we see a worsening of those who were already obese.

If before we had one or two with obesity and diabetes, now we have six or seven”.

Diabetes damages the arteries and causes blood not to reach all the organs properly.

Children with obesity may present an increase in cholesterol or triglycerides in the blood, a condition that, although initially silent and does not alter the children's daily life, can translate into serious long-term cardiovascular problems.

Another common pathology is fatty liver, which involves the accumulation of fat in this organ.

"Over time, this disease will favor steatohepatitis [inflammation of the liver and liver cell damage due to fat accumulation] and liver fibrosis, which leads to liver failure and cancer of this organ," adds Álvarez Pitti.

Beyond all the physical damage, experts warn of the impact on mental health of a diagnosis of obesity or overweight.

Because of the stigma involved in not entering the socially established canons.

For fear of ridicule or rejection, which leads to social isolation.

“The stigma produced by obesity influences self-efficacy, the perception of being less than others, self-image...”, lists the Ciberobn researcher.

And in that vicious circle of communicating vessels, where fatigue due to nocturnal apneas is added to clumsiness in motor skills and social isolation that delays the development of physical and social skills, the disease becomes strong and, with it, the mechanical, metabolic and mental health problems, such as anxiety or depression.

"We are in a society that produces obesity, but stigmatizes you for it," laments Leis, and warns that there are several critical ages to condition the lives of children: the first 1,000 days of life, where the mother's diet in the pregnancy, breastfeeding and complementary feeding is key —a longer period of breastfeeding reduces the risk of babies becoming obese or overweight when they get older—;

also from three to five years;

and in adolescence.

And there are especially vulnerable environments, such as socioeconomically unfavorable families or being the child of obese parents.

A sedentary lifestyle, not sleeping the recommended hours or an imbalance in emotional well-being, also favor obesity.

Excess fat is, at first, difficult to tackle.

Starting with the diagnosis itself because, unlike adults, where the body mass index is measured and some scales are applied, in children percentiles must also be analyzed based on age and sex, experts explain.

Unaware of the disease

There is also a lack of awareness of the disease, both in children and parents, explains Marta Ramon, head of Pediatric Endocrinology at the Sant Joan de Déu Children's Hospital in Barcelona: “Society does not perceive the disease.

Parents are not even aware and see as normal weight something that is not.

And if they don't see the problem, it's harder to address and treat."

According to the study on Food, Physical Activity, Child Development and Obesity in Spain (Aladino), parents have a distorted perception of this phenomenon: 69% of overweight children are perceived by their parents as being within a normal weight.

As the prevalence of overweight is so high, in the street this excess of fat is normalized, and trivialized with a "they will lose weight", lament the professionals.

But the disease, at that time,

Álvarez Pitti points out that "the main thing, first, is to make parents understand that obesity is a disease."

“And all habit modifications are part of a medical treatment: if you do not make those modifications that I explain to you, it is as if a child with diabetes came to the consultation, we prescribed insulin and you did not give it to him”, exemplifies the medical.

And although it is easier to give a pill than to change habits, he assumes that, in childhood obesity, "the first line of treatment is not pharmacological."

The positive part of this ailment is that, although serious and complex, it is reversible.

“If you do early interventions, they get better and we rescue them.

We know that an obese child has a higher risk of obesity and hypertension, but if you manage to reverse it, the risk is 100% corrected”, says Ramon.

Although Leis is more cautious: “There is a metabolic footprint.

Still losing weight, that period affected organs, arteries… ”, she laments.

And there is no such thing as a healthy obese, adds the Ciberobn researcher.

Even if the damage is not visible, even if the markers of other diseases are normal, the disease always takes its toll.

The experts ask for more social awareness on the part of health professionals themselves and more resources to take childhood obesity and all its derivatives seriously.

There are no culprits, neither parents nor children, and it is, emphasizes Goday, "everyone's problem", individual and collective, health, social and economic.

It is not a joke or a minor problem, warns Álvarez Pitti: “The disease, when established, is very difficult to treat.

We must remove the stigma that he who is obese is because he wants to.

Don't you say to anyone: 'and why don't you cure yourself of pancreatic cancer'?

You don't say it because you know it's a complex disease.

Well, obesity too.

They have tried to simplify by saying that it is a disease of lazy and gluttonous and it is not like that”.

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