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Causes of Childhood Obesity
There are various causes of childhood obesity. Currently, the most common cause of childhood obesity is a positive energy balance due to caloric intake that is greater than caloric expenditure combined with a genetic predisposition for weight gain. Other variables that can contribute to childhood obesity are eating in order to suppress negative emotions like stress and depression, parental feeding styles, fast food, and consumption of sugar sweetened beverages. Another factor that can contribute to childhood obesity is sleep. There was a study that found short sleep duration can cause the development of insulin resistance, sedentarism and unhealthy dietary patterns. These all being factors that are known to contribute to obesity. There was a scientific review that found there was an association between non-parent childcare settings and childhood obesity. It was found there was a particular association between children who were being parented by grandparents and being afflicted with childhood obesity. On a genetic level, mutation of the melanocortin 4 receptor is the most common gene defect in cases of childhood obesity.
Comorbidities of Childhood Obesity
In 2016 the Mayo Clinic did a systematic review of childhood obesity. They reviewed literature from 1994 to 2016. In their review they found there are a number of comorbidities associated with childhood obesity. What they found is of concern because many of the comorbidities seen in youth with obesity were once considered to be adult only comorbidities. They also found there seemed to be an association between the level of obesity and the severity of comorbidities. The following is a list and brief description of the various types of comorbidities that the Mayo Clinic found to be associated with childhood obesity.
-Cardiometabolic and Cardiovascular: Childhood obesity is associated with increases in risk of hyperinsulinemia, insulin resistance, prediabetes, and subsequently T2DM. The effects of childhood prediabetes and T2DM are worsened as obesity becomes more severe. Children with T2DM during their adolescence seem to have a more rapid deterioration of glycemic control and progression of other diabetes-related complications. Childhood obesity also increases the risk of developing cardiometabolic risk factors such as elevated blood pressure, low levels of high-density lipoprotein cholesterol, and elevated levels of triglycerids.
-Endocrine: Obesity in girls can lead to early onset of sexual maturation, with accelerated growth and advanced skeletal maturation. These girls are also at higher risk of developing hyperandrogenism and polycystic ovary syndrome. Polycystic ovary syndrome can be seen in the form of menstrual irregularities, acne, and hirsutism.
-Pulmonary: Obese children have a higher prevalence of OSA, and asthma. Severely obese children may sometimes have hypoventilation which causes severe oxygen desaturation.
-Gastrointestinal: There is a strong association between childhood obesity and nonalcoholic fatter liver disease. NAFLD is currently the most common cause of liver disease in children.
-Musculoskeletal: There are some various musculoskeletal problems associated with childhood obesity which include impairment in mobility, increased prevalence of fractures, lower extremity joint pain, and lower extremity malalignment. It can also be a cause of unilateral or bilateral slipped capital femoral epiphysis and tibia vara.
-Psychosocial: Psychosocial consequences of childhood obesity include poor self-esteem, anxiety, depression, and a decrease in health-related quality of life. Obese children are also more likely to become victimized by bullying and discrimination. Later in the lives of obese female children there is greater likelihood they will have lower family incomes, lower marriage rates, and higher rates of poverty than their non obese peers.
-Dermatologic: There are numerous skin issues related to childhood obesity. Acanthosis nigricans is common and is related to insulin resistance. Some other skin issues related to childhood obesity are inertrigo, hidradentis, suppurative, furunculosis, and stretch marks.
-Neurologic: There is an association between childhood obesity and a higher risk of idiopathic intracranial hypertension. Symptoms of idiopathic intracranial hypertension are headache, vomiting, retro-ocular eye pain, and visual loss.
-Long-Term Risk: There is a significant increase in risk of T2DM, hypertension, and carotid-artery atherosclerosis with childhood obesity. Higher BMI in childhood has also been associated with increased risk cardiovascular events that can be fatal and nonfatal.
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