Childhood Obesity: Issue Analysis

Metabolic disorders of any kind are of major concern to health care providers because of their interference with routine hygienic activities. Certain complications would commence their pathological role since the early childhood days. This could lead to serious consequences in the later stages of life and needs to be curbed. So, the present description is concerned with highlighting a similar case keeping in view of childhood obesity.

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This disorder is believed to be an ever-growing health issue as it is connected to chronic health problems in children and adults, indicating that obesity acquired during childhood would continue till adulthood stage (Mason et al.2008). The obesity problem could also withstand the interventions that might involve recommendations to reduce calorie-induced weight through increased physical activity (Mason et al., 2008). It was revealed that childhood obesity is more prevalent in families that have a history that might serve as a risk factor for many other diseases (Archenti and Pasqualinotto, 2008). Hence, care providers working against childhood obesity may need to understand the psychological attitude of the family as most patients are reported to be strongly dependent on the habits, determination, and flexibility of their family (Archenti and Pasqualinotto, 2008).

However, there is a need to consider clinical conditions that are likely associated with childhood obesity.

It was reported that childhood obesity might contribute to the onset of premature cardiovascular factors like hypertension. (Salvadori et al.2008). This has correlated with childhood overweight. Hence, both may be interrelated and increase the risk of elevated blood pressure. Therefore, it may indicate that the aberrations in cardiovascular function and blood pressure in early childhood could help in understanding the progress of childhood obesity (Salvadori et al., 2008).

One of the anticipated reasons behind the cause of childhood obesity may be that an impaired intrauterine environment that deprives the fetus of optimal nutrient delivery might predispose the fetus to experience cardiovascular and metabolic dysfunction in later life (Strufaldi et al.2008). This may indicate that nutrition or food is playing a role in the episode of childhood obesity. As such, breastfeeding was reported to influence childhood obesity due to its protective effects. This was revealed when breastfeeding reduced the high body mass index (BMI) of children (Beyerlein, Toschke, &von Kries, 2008).

There is a need to consider other problems associated with childhood obesity.

It was reported that orthopedic complications such as slipped capital femoral epiphysis, Blount disease, and acute fractures had been related to being overweight or obese (Wills, 2004).

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So, the management of this disorder could also be made easier by orthopedics who are familiar with the mentioned complications, in addition to general physicians.

Obese children undergoing surgery may be more prone to preoperative morbidities than normal-weight children. Therefore, it may indicate that childhood obesity may influence anesthesia and surgical outcome (Nafiu et al., 2007). This could suggest careful evaluation of obese children while they were recommended for surgical treatment (Nafiu et al., 2007).

Here, it was anticipated that anesthesia could interfere with the outcome of obese children undergoing dental surgery (Setzer and Saade, 2007). To this end, researchers have demonstrated a small increase in minor respiratory complications in obese children who underwent anesthesia, whereas inhalation induction was not associated with an increase in adverse events in this population. (Setzer and Saade, 2007). So, there is a need to focus on this problem because of the unaddressed issues about the proper incidence of anesthesia-induced complications in obese children (Setzer and Saade, 2007).

Childhood obesity is reported to be associated with sleep-disordered breathing (SDB), which is considered as a risk factor for metabolic syndrome (MS), independent of estimates of body fat distribution (Verhulst et al., 2007). This was further strengthened by another report that described that the severity of sleep-disordered breathing (SDB) was associated with increased levels of uric acid in serum, independent of abdominal adiposity. Since an association was believed to exist between uric acid and cardiovascular risk, uric acid levels may contribute to the mechanisms linking sleep-disordered breathing with cardiovascular morbidity in obese children (Verhulst et al.).

Next, obese children were reported to show early signs of insulin resistance syndrome in addition to cardiovascular risk, and hence they were diagnosed with impaired glucose tolerance and type 2 diabetes mellitus (Goran, 2003). There are various risk factors that are likely to facilitate the development of type 2 diabetes and cardiovascular risk in children and youth.

They are increased body fat and abdominal fat, insulin resistance, ethnicity (with greater risk in African-American, Hispanic, and Native American children), and the onset of puberty (Goran, 2003). Therefore, the incidence of type 2 diabetes among children has dramatically increased because of a strong association between obesity and insulin resistance, which, when coupled with relative insulin deficiency, may aggravate the problem (Hannon et al., 2005).

The microvascular and macrovascular complications of type 2 diabetes in children may be more prevalent than adult individuals who develop diabetes, stroke, myocardial infarction, and sudden death, renal insufficiency and chronic renal failure, and other life-threatening disorders (Hannon et al.2005). Obese children with type 2 diabetes mellitus are also at risk of frequent comorbidity, Dyslipidemia. Therefore, lipid-lowering drugs need to be recommended for pediatric diabetic patients who achieve tight glycemic control even when their dyslipidemia persists (Hannon et al., 2005).

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Further, another important association to consider was that between childhood obesity and pediatric liver disease (Mathur, Das, Arora, 2007). Here, non-alcoholic steatohepatitis (NASH) was considered the chief element of non-alcoholic fatty liver disease (NAFLD). NASH was reported to be mainly associated with obesity, diabetes, insulin resistance (IR), and hypertriglyceridemia. Children with NASH may have progressive liver damage, including cirrhosis (Mathur, Das, Arora, 2007).

In view of these risk factors and underlying complications, there is a need to focus on the efficient management of childhood obesity. Firstly, the involvement of family was considered as the potential intervention to aim at childhood obesity (Golan, 2006). This is because it was revealed that targeting only parents as the facilitators have resulted in a better reduction in children’s overweight percentage and improvement in the obesogenic environment and behaviors when compared to a setting in which parents attended sessions with the obese child, or only children attended session (Golan, 2006). It was reported that the evaluation of childhood obesity involves a physical examination and selected laboratory evaluation in addition to a detailed personal and family history (Singhal, Schwenk & Kumar, 2007). As lifestyle interventions and behavioral modification are also proved to be helpful in decreasing caloric intake and increasing caloric expenditure, they are central to the management of childhood obesity (Singhal, Schwenk & Kumar, 2007). In order to better overcome the prevalence of childhood obesity, there is a need to concentrate on recommended criteria set by an authorized health care organization, for example, clinical practice guidelines (CPGs) that help physicians to make valuable decisions during care delivery (Delgado-Noguera, 2008).

These guidelines rely on documents with recommendations on the prevention and treatment of childhood obesity published during a certain period. So, improvements in the methodology and the quality of CPGs on childhood obesity may help clinicians and other decision-makers to control the incidence of this disorder (Delgado-Noguera, 2008).

In view of the above information, childhood obesity appears to be one of the major health concerns. This disorder is primarily indicated to have a good family history. Hence, family members need to be better contacted to determine the exact linkage that may appear pivotal in furnishing the information (Archenti and Pasqualinotto, 2008). The relationship between childhood obesity and cardiovascular risk factors has drawn significant clinical attention.

This has contributed to the risk of elevated blood pressure and hypertension (Salvadori et al., 2008). Impaired intrauterine environment and breastfeeding are reported to influence childhood obesity giving a possible clue for the care providers. Orthopedic complications may serve as good indicators of obesity in children (Wills, 2004).

The risk of preoperative morbidities associated with anesthesia in obese children may be prevented by seeking alternative approaches. The problem of sleep-disordered breathing (SDB) may be better understood by serum uric acid levels and cardiovascular risk (Verhulst et al., 2007). One of the most important clinical signs of childhood obesity is type 2 diabetes mellitus(Hannon et al., 2005). The prevalence of this metabolic disorder has already been on the rise in obese children. As they were reported to show insulin resistance and cardiovascular risk factors, the management of childhood obesity has become a difficult task added to the contribution of dyslipidemia. Non-alcoholic fatty liver disease (NAFLD) is affecting obese children through its connection to insulin resistance (IR) and hypertriglyceridemia (Mathur, Das, Arora, 2007). So, it is reasonable to infer that childhood obesity is manifested by a syndrome of complications. Health care providers should thoroughly review the up to literature to gain better insights on the management of this disorder. Adhering to clinical practice guidelines (CPGs) could minimize the errors and strengthens the evidence-based research. Treatment modalities aimed at metabolic disorders like diabetes need to be tried on obese children with a strong family history. However, therapeutic dosages could also be evaluated due to the likely risk of side effects.

References

Archenti, A and Pasqualinotto, L. “Childhood obesity: the epidemic of the third millenium.” Acta Biomed 79.2(2008):151-5.

Beyerlein, A, Toschke, AM, von Kries, R. “Breastfeeding and Childhood Obesity: Shift of the Entire BMI Distribution or Only the Upper Parts?” Obesity (Silver Spring) 2008. Web.

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Golan, M. “Parents as agents of change in childhood obesity – from research to practice.” Int J Pediatr Obes 1.2 (2006); 66-76.

Goran, MI. “Obesity and risk of type 2 diabetes and cardiovascular disease in children and adolescents.” J Clin Endocrinol Metab, 88.4 (2003); 1417-27.

Hannon, TS, Rao, G, Arslanian, SA. “Childhood obesity and type 2 diabetes mellitus.” Pediatrics 116.2 (2005); 473-80.

Mason, HN, Crabtree, V, Caudill, P, Topp, R. “Childhood obesity: a transtheoretical case management approach.” J Pediatr Nurs 23.5 (2008); 337-44.

Mathur, P, Das, MK, Arora, NK. “Non-alcoholic fatty liver disease and childhood obesity.” Indian J Pediatr 74.4(2007); 401-7.

Nafiu, OO, Reynolds, PI, Bamgbade, OA, Tremper, KK, Welch, K, Kasa-Vubu, JZ. “Childhood body mass index and perioperative complications.” Paediatr Anaesth 17.5(2007); 426-30.

Newfield, RS, Dewan, AK, Jain S. “Dyslipidemia in children with type 2 diabetes vs. obesity.” Pediatr Diabetes 9.2(2008); 115-21.

Salvadori, M, Sontrop, JM, Garg, AX, Truong, J, Suri, RS, Mahmud, FH, Macnab, JJ, Clark, WF.“ Elevated blood pressure in relation to overweight and obesity among children in a rural Canadian community.” Pediatrics 122.4(2008); e821-7.

Setzer, N and Saade, E. “Childhood obesity and anesthetic morbidity.” Paediatr Anaesth 17.4(2007); 321-6.

Singhal, V, Schwenk, WF, Kumar, S. (2007). Evaluation and management of childhood and adolescent obesity. Mayo Clin Proc 82.10(2007); 1258-64.

Strufaldi, MW, Silva, EM, Franco, MC, Puccini, RF. “Blood pressure levels in childhood: probing the relative importance of birth weight and current size.” Eur J Pediatr 2008. Web.

Verhulst, SL, Schrauwen, N, Haentjens, D, Rooman, RP, Van Gaal, L, De Backer, WA, Desager, KN. Sleep-disordered breathing and the metabolic syndrome in overweight and obese children and adolescents. J Pediatr 150.6 (2007); 608-12.

Verhulst, SL, Van Hoeck, K, Schrauwen, N, Haentjens, D, Rooman, R, Van Gaal,L, De Backer, WA, Desager, KN. Sleep-disordered breathing and uric acid in overweight and obese children and adolescents. Chest 132.1(2007); 76-80.

Wills, M. “Orthopedic complications of childhood obesity.” Pediatr Phys Ther 16.4(2004); 230-5.

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