Pediatric Obesity: A Bigger Problem than We Thought

Gregory Weiss, MD

Obesity remains one of the most significant health problems worldwide. It is estimated that one-third of children in the United States are either overweight or obese based on US Centers for Disease Control and Prevention guidelines.¹ It is well known that obesity confers increased risk for the development of multiple comorbid conditions including diabetes, hypertension, and asthma.²

Although a great deal of research has been dedicated to obesity and its comorbidities, it has been unclear whether obesity represents a discreate condition or is composed of subtypes possibly with their own etiologies. In a recent article published in PLOS Digital health, Elizabeth Campbell and colleagues at Drexel University sought to describe the association between childhood obesity and its underlying medical conditions.² Further, the authors present clinically similar subtypes discovered among a population of newly obese pediatric patients.²

Campbell’s team looked at nearly 50,000 pediatric health records in an effort to uncover common pediatric obesity patterns and associated conditions comparing them to children with normal body mass indices.² Ultimately the team identified eight discrete subtypes of childhood obesity characterized by the prevalence of comorbid diagnoses. The eight subtypes they identified, and their associated conditions include:

1. Upper Respiratory and Sleep Disorders.
2. Inflammatory Skin Conditions.
3. Seizure Disorders and Epilepsy.
4. Asthma.
5. Other (no characteristic pattern).
6. Gastrointestinal/Genitourinary Symptoms.
7. Neurodevelopmental disorders.
8. Physical symptoms (Fever, headache, nausea, etc.).

“Obesity is a complex and socially significant health issue that may affect different clinical and demographic subtypes of pediatric patients differently. Grouping all types of overweight and obesity into one clinical condition may conceal associations between risk factors and specific subtypes of obesity, which has implications for improving prevention, recognition, and treatment of pediatric obesity. Our findings can support the work of public health researchers and practitioners who seek to address the social disparities component of the obesity epidemic.”

Campbell and colleagues used temporal patterns to identify when the listed comorbidities appeared in relation to the onset of childhood obesity. Their findings suggested that there could be a bidirectional relationship between these comorbidities and obesity as in some cases the comorbidities preceded the onset of obesity.² This is a key finding of this study and is in keeping with emerging evidence that obesity may be both a cause and result of comorbid disease. When demographic identifiers were examined, some findings were expected while others were not. In keeping with prior research, African Americans, low income, and urban patients were disproportionately affected by asthma and inflammatory skin conditions.² Also expected, there was a strong association between male sex, obesity, and autism spectrum disorders.² However, in the current study, new associations were made between female sex and the gastrointestinal and genitourinary symptoms subclass.² These new findings further support the idea that obesity itself may influence the effect of sex on specific obesity related conditions, in this case gastrointestinal disorders.²

Campbell’s team believes that these findings should be a foundation for future research into pediatric obesity and their methods, utilizing electronic health records, represents an important and useful source of data.² These data tell a story that is becoming clearer with each new investigation into the epidemic of childhood obesity. Obesity does not exist in a vacuum, alone responsible for future cardiovascular disease and a wide range of comorbid conditions. Obesity, especially in children, represents a complex interplay between cause and effect that is only now becoming understood. The startling truth of these results reveal that obesity may be born of prior conditions and then go on to perpetuate the cycle into adulthood.

Although pediatric obesity is of serious concern, early intervention is possible. Reaching children and their caregivers as early as possible creates an opportunity to slow down, halt, and hopefully reverse a trajectory of weight gain and the progression of disease.

References:

1. Skinner AC, Ravanbakht SN, Skelton JA, Perrin EM, Armstrong SC. Prevalence of Obesity and Severe Obesity in US Children, 1999–2016. Pediatrics. 2018; 1; 141(3).
2. Campbell EA, Maltenfort MG, Shults J, Forrest CB, Masino AJ (2022) Characterizing clinical pediatric obesity subtypes using electronic health record data. PLOS Digit Health 1(8): e0000073. https://doi.org/10.1371/journal. pdig.0000073