Being diagnosed with overweight or obesity in childhood is like opening a Pandora’s box. Excess fat triggers a number of diseases and health hazards that make the child ill from the moment they are born and probably in the long term. Diabetes, high blood pressure, sleep apnea, skin problems, depression… There are dozens of comorbidities. However, obesity and overweight, which affect 340 million children and adolescents worldwide, are not only a risk factor for the development of other pathologies; it’s a disease in itself, endocrinologists insist. And it leaves mechanical, metabolic, and psychological marks that are difficult to erase. At the end of the consultation, experts who treat children with obesity warn that adult diseases are appearing in younger and younger children.
The World Health Organization (WHO) has classified obesity as “the epidemic of the 21st century”. And with the permission of the Covid, the data points to this scenario: According to the latest WHO report, one in three children in Europe is obese or overweight. The European Childhood Obesity Surveillance Initiative (COSI) ranks Spain among the countries with the highest prevalence of these diseases: more than 40% of children between the ages of six and nine are obese or overweight.
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The trend is also increasing and the pandemic has only exacerbated a dazzling increase in these clinical pictures. Albert Goday, an endocrinologist at Hospital del Mar, is blunt: “It’s a pandemic and a potentially serious disease. As obesity becomes more severe in children and adolescents, we are seeing comorbidities previously seen only in adults, such as type II diabetes. And that’s just the tip of the iceberg.” An obese child has a greater risk of holding onto excess fat long-term, and obesity in adulthood is a risk factor for developing a dozen of tumors, heart attacks, heart disease, metabolic disorders, cognitive decline, and mental illness It degrades the quality and life expectancy.
A diagnosis of childhood obesity or overweight is not an increase in height. Or not alone. Excess fat starts playing 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 Paediatrics: “It is not just because the child has a change in body composition . This fat is a metabolically active organ and produces substances that affect your health.” When he saw adult diseases in children, he admitted they “shocked” them and put the scientific community on “alert”.
The diagnosis opens Pandora’s box and discovers cardiovascular, musculoskeletal, psychological, metabolic or health problems. A study published in the journal Plos Digital Health analyzed the potential subtypes of childhood obesity according to the associated pathologies from a cohort of American medical records, and found up to eight patient groups with similar characteristics: namely, a high prevalence of diseases respiratory and sleep disorders, with skin diseases , with seizures, with asthma, with gastrointestinal, neurological or physical problems, among others. Poor health any way you look at it.
breathing problems
In practice, in the consultation, obesity actually brings with it a very diverse range of symptoms. Julio Álvarez Pitti, doctor at the General Hospital of Valencia and researcher at the Center for Biomedical Research in the Network Physiopathology of Obesity and Nutrition (Ciberobn), receives between 300 and 400 consultations of children with obesity every year in his department and warns that the impact on their Health are devastating: “There are mechanical consequences, because being overweight by 20 kilos is an overload for the musculoskeletal system: contractures, bone deformation and pain occur when moving or standing up. It is a limitation to jumping, playing or running. It’s like putting a backpack with 20 kilos of stones on the back of a child,” he draws.
But it’s not just about the bones. Obesity also masks breathing problems like sleep apnea. “The airways are elastic but stiff enough to remain open. At night, when you relax, the soft fat forms the tube [respiratorio] it softens and collapses: it’s as if it weren’t a hard rubber tube but soft rubber,” explains Álvarez Pitti. Therefore, breathing stops until the brain recognizes this and wakes the child for a moment to allow the airway to open again.
However, all these effects do not stay overnight, but have consequences the next day. Like a kind of domino effect, these nighttime awakenings take their toll on sleep quality, which plummets, dragging the fatigue to the rest of the day and affecting other areas of your life, such as academic performance. The more tired, the less exercise and more hunger, which reinforces the picture of obesity.
These children also have diagnoses of asthma and may also have dermatological problems, Goday explains, “like psoriasis, skin infections or hidradenitis suppurativa,” which cause 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: B. the change in sugar control. There are already cases of type II diabetes – which is associated with obesity – in younger and younger children, emphasizes Álvarez Pitti: “It’s increasing. More children are being referred to us after the pandemic, but mostly we are seeing a deterioration in those who were already overweight. If before we had one or two with obesity and diabetes, now we have six or seven.” Diabetes damages the arteries and prevents blood from reaching all organs properly.
Children with obesity may exhibit increases in blood cholesterol or triglycerides, a condition which, although initially silent and does not alter children’s daily lives, can lead to serious long-term cardiovascular problems. Another common pathology is fatty liver, in which fat accumulates in this organ. “Over time, this disease will favor steatohepatitis [inflamación del hígado y daño de las células hepáticas a causa de la acumulación de grasa] and hepatic fibrosis, leading to liver failure and cancer of this organ,” adds Álvarez Pitti.
Beyond all the physical harm, experts warn of the mental health implications of being diagnosed with obesity or being overweight. Because of the stigma attached to not entering into the socially established canons. For fear of ridicule or rejection, leading to social isolation. “The stigma generated by obesity affects self-efficacy, the perception of being less than others, self-image…” lists the Ciberobn researcher.
And in this vicious circle of communicating vessels, in which motor clumsiness and social isolation are combined with fatigue from nocturnal apneas, which delays the development of physical and social skills, the disease grows 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 it for it,” Leis laments, warning that there are several critical ages that determine children’s lives: the first 1,000 days of life, when the mother’s diet is in the Pregnancy, breastfeeding and complementary feeding are key – prolonged breastfeeding reduces the risk of babies becoming obese or overweight as they age –; also from three to five years; and in puberty. And there are particularly vulnerable environments, like socio-economically disadvantaged families or being the child of overweight parents. A sedentary lifestyle, not having the recommended sleep times, or an imbalance in emotional well-being also contribute to obesity.
Excess fat is difficult to fight at first. Starting with the diagnosis itself, because unlike adults, where body mass index is measured and some scales are used, children also need to have percentiles analyzed by age and sex, experts say.
unaware of illness
There is also a lack of awareness of the disease, both among children and parents, explains Marta Ramon, Head of Pediatric Endocrinology at the Sant Joan de Déu Children’s Hospital in Barcelona: “Society is not aware of the disease. Parents are not even aware of this and see normal weight as something that does not exist. And if they don’t see the problem, it’s more difficult to address and treat.” According to the study on Nutrition, 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 of normal weight. Because the prevalence of obesity is so high, this excess fat is normalized on the street and trivialized with a “they will lose weight,” the pros complain, but the disease is already damaging the body at this point .
Álvarez Pitti points out that “the most important thing first is to make parents understand that obesity is a disease”. “And all habit changes are part of a medical regimen: if you don’t make these changes, which I’m going to explain to you, it’s like a child with diabetes comes in for a consultation, we prescribed insulin and you didn’t give it to them.” illustrates the medical. And while it’s easier to pop a pill than change a habit, he reckons that for childhood obesity, “the first line of treatment isn’t pharmacological.”
The positive part of this disease is that although it is serious and complex, it is reversible. “If you intervene early, they get better and we save them. We know that an obese child has a higher risk of obesity and high blood pressure, 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 decreasing, this time affected organs, arteries…” he laments. And there are no 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 call for more social awareness on the part of healthcare professionals themselves and more resources to take childhood obesity and all its consequences seriously. There are no culprits, neither parents nor children, and it is, stresses Goday, “everyone’s problem”, individually and collectively, health-wise, socially and economically. It’s not a joke or a minor problem, warns Álvarez Pitti: “The disease, once established, is very difficult to treat. We need to remove the stigma that those who are obese have because they want to be. Don’t tell anyone, “So why don’t you cure your pancreatic cancer?” You don’t say it because you know it’s a complex disease. Well, obesity too. They tried to simplify by saying it’s a disease of laziness and gluttony, and it’s not like that.”
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