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Today in the United States, studies estimate that 34
percent of U.S. adults are overweight and an additional 31 percent
(approximately 60 million) are obese. Combined, approximately 127 million
Americans are overweight or obese. Some 42 years ago, 13 percent of Americans
were obese, and in 1980 15 percent were considered obese.
Alarmingly, the number of children who are
overweight or obese has doubled in the last two decades as well. Currently, more
than 15 percent of 6- to 11-year-olds and more than 15 percent of 12- to
19-year-olds are considered overweight or obese.
What is the difference between designated
“obese” versus “overweight?”
Unfortunately, the words overweight and obese are
often interchanged. There is a difference:
- Overweight: Anyone with a
body mass index (BMI) (a ratio between your height and weight) of 25 or above
(e.g., someone who is 5-foot-4 and 145 pounds) is considered
overweight.
- Obesity: Anyone
with a BMI of 30 or above (e.g., someone who is 5-foot-4 and 175 pounds) is
considered obese.
- Morbid obesity:
Anyone with a BMI of 40 or above (e.g., someone who is 5-foot-4 and 233
pounds) is considered morbidly obese. "Morbid" is a medical term indicating
that the risk of obesity related illness is increased dramatically at this
degree of obesity.
Obesity can present significant health risks to the
young child. Diseases are being seen in obese children that were once thought to
be adult diseases. Many experts in the study of children’s health suggest that a
dysfunctional metabolism, or failure of the body to change food calories to
energy, precedes the onset of disease. Consequently, these children are at risk
for Type II Diabetes, fatty liver, elevated cholesterol, SCFE (a major hip
disorder), menstrual irregularities, sleep apnea, and irregular metabolism.
Additionally, there are psychological consequences; obese children
are subject to depression, loss of self-esteem, and isolation from their
peers.
Pediatric obesity and otolaryngic
problems
Otolaryngologists, or ear, nose, and throat
specialists, diagnose and treat some of the most common children’s disorders.
They also treat ear, nose, and throat conditions that are common in obese
children, such as:
- Sleep
apnea: Children with sleep apnea literally stop breathing
repeatedly during their sleep, often for a minute or longer, usually ten to 60
times during a single night. Sleep apnea can be caused by either complete
obstruction of the airway (obstructive apnea) or partial obstruction
(obstructive hypopnea—hypopnea is slow, shallow breathing), both of which can
wake one up. There are three types of sleep apnea—obstructive, central, and
mixed. Of these, obstructive sleep apnea (OSA) is the most common.
Otolaryngologists have pioneered the treatment for sleep apnea; research shows
that one to three percent of children have this disorder, often between the
age of two-to-five years old.
Enlarged
tonsils, which block the airway, are usually the key factor leading to this
condition. Extra weight in obese children and adults can also interfere with
the ability of the chest and abdomen to fully expand during breathing,
hindering the intake of air and increasing the risk of sleep apnea.
The American Academy of Pediatrics has
identified obstructive sleep apnea syndrome (OSAS) as a “common condition in
childhood that results in severe complications if left untreated." Among the
potential consequences of untreated pediatric sleep apnea are growth failure;
learning, attention, and behavior problems; and cardio-vascular complications.
Because sleep apnea is rarely diagnosed, pediatricians now recommend that
all children be regularly screened for snoring.
- Middle ear infections:
Acute otitis media (AOM) and chronic ear infections account for 15 to 30
million visits to the doctor each year in the U.S. In fact, ear infections are
the most common reason why an American child sees a doctor. Furthermore, the
incidence of AOM has been rising over the past decades. Although there is no
proven medical link between middle ear infections and pediatric obesity there
may be a behavioral association between the two conditions. Some studies have
found that when a child is rubbing or massaging the infected ear the parent
often responds by offering the child food or snacks for comfort.
When a child does have an ear
infection the first line of treatment is often a regimen of antibiotics. When
antibiotics are not effective, the ear, nose and throat specialist might
recommend a bilateral myringotomy with pressure equalizing tube placement
(BMT), a minor surgical procedure. This surgery involves the placement of
small tubes in the eardrum of both ears. The benefit is to drain the fluid
buildup behind the eardrum and to keep the pressure in the ear the same as it
is in the exterior of the ear. This will reduce the chances of any new
infections and may correct any hearing loss caused by the fluid buildup.
Postoperative vomiting (POV) is a
common problem after bilateral myringotomy surgery. The overall incidence is
35 percent, and usually occurs on the first postoperative day, but can occur
up to seven days later. Several factors are known to affect the incidence of
POV, including age, type of surgery, postoperative care, medications,
co-existing diseases, past history of POV, and anesthetic management. Obesity,
gastroparesis, female gender, motion sickness, pre-op anxiety, opiod
analgesics, and the duration of anesthetic all increase the incidence of POV.
POV interferes with oral medication and intake, delays return to normal
activity, and increases length of hospital stay. It remains one of the most
common causes of unplanned postoperative hospital admissions.
- Tonsillectomies: A
child’s tonsils are removed because they are either chronically infected or,
as in most cases, enlarged, leading to obstructive sleep apnea. There are
several surgical procedures utilized by ear, nose, and throat specialists to
remove the tonsils, ranging from use of a scalpel to a wand that emits energy
that shrinks the tonsils.
Research conducted by otolaryngologists
found that:
Morbid obesity was a contributing factor for
requiring an overnight hospital admission for a child undergoing removal of
enlarged tonsils. Most children who were diagnosed as obese with sleep apnea
required a next-day physician follow-up.
A study from the University of Texas found that
morbidly obese patients have a significant increase of additional medical
disorders following tonsillectomy and adenoidectomy for obstructive sleep apnea
or sleep-disordered breathing when compared to moderately obese or overweight
patients undergoing this procedure for the same diagnosis. On average they have
longer hospital stays, a greater need for intensive care, and a higher incidence
of the need for apnea treatment of continuous positive airway pressure upon
discharge from the hospital. The study found that although the morbidly obese
group had a greater degree of sleep apnea, they did benefit from the procedure
in regards to snoring, apneic spells, and daytime somnolence.
What you can do
If your child has a weight problem, contract your
pediatrician or family physician to discuss the weight’s effect on your child’s
health, especially prior to treatment decisions. Second, ask your physician
about lifestyle and diet changes that will reduce your child’s weight to a
healthy standard.
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