Approximately one-third of American children are either overweight or obese. (The percentage is higher in adults.) We’ve explored the reasons that lead to this troubling statistic many times previously on The PediaBlog. We’ve also discovered simple ways parents can change their children’s diets and encourage exercise, preventing or reversing this trend towards abnormal weight gain.
A new review article published this month in Pediatrics summarizes important physical examination findings pediatricians look for when identifying a child who has a body mass index (BMI) of 85-95%tile (overweight) or >95%tile (obese). Abnormalities in vital signs include:
- Hypertension — High blood pressure is more common in children who are obese. Complications which occur later in life include early coronary artery disease, strokes, and end-stage kidney disease — even though the damage to end-organs begins in childhood
- Tachycardia (Elevated resting heart rate).
- Increased height velocity — Children who become obese before the onset of puberty experience peak height velocity earlier than children of normal weight. If puberty starts earlier than expected in these children, they may start out taller than their peers but end up shorter in the long run. This is especially true in girls, where overweight and obesity is associated with earlier onset of puberty. In boys, a new study, published last month in Pediatrics, says overweight boys are at greatest risk of early puberty; for reasons that may be related to excess estrogen production, obese boys tend to have delayed puberty.
Abnormal physical exam findings can involve the head and neck…:
- Papilledema — Also called pseudotumor cerebri, where high intracranial pressure (seen more often in obese girls than boys) causes swelling of the disc surrounding the optic nerves of the eye.
- Tooth decay — Dental cavities are strongly associated with obesity. Decreases of protective salivary enzymes and salivary flow occur in obese children. Tooth eruption occurs earlier in obese children, leading to dental crowding and malpositioning of teeth. Foods which lead to overweight and obesity — sticky foods, sugar-sweetened beverages, and diet beverages with citric acid — also lead to dental caries.
- Enlargement of tonsils and adenoids — The severity of obstructive sleep apnea is greater in obese children with adenotonsillar hypertrophy, along with other sleep-related disturbances:
Obese children with tonsillar hypertrophy are more likely to have noisy breathing, restless sleep, behavior difficulties, snoring, and daytime sleepiness.
… chest and back…:
- Gynecomastia — Enlargement of breast tissue in boys and men, due to the conversion of testosterone to estrogen in fat tissue, occurs in 40% of obese teenage boys.
- “Buffalo hump” — Located just below the posterior neck, this midline collection of fat tissue is present in the majority of obese adults and, though benign, can be cosmetically bothersome.
… gastrointestinal tract…:
- Liver enlargement — Hepatomegaly in obese children and teenagers is the hallmark of non-alcoholic fatty liver disease (NAFLD):
NAFLD is a spectrum of disease from fatty infiltration, inflammation, nonalcoholic steatohepatitis, cirrhosis, and end-stage liver failure. NAFLD is present in 13% of the general pediatric population but in >50% of adolescents who are overweight or obese.
… and male genitalia:
- “Buried penis” — This can begin in early childhood when an otherwise normal-length penis becomes hidden under an enlarged fat pad in the pubic area. Infections and adhesions of the foreskin can occur as a result.
Tomorrow, we will consider other physical findings correlated with high BMI’s in children.