Dr Macklin Talks About the Medical Consequences of Childhood Obesity

Childhood obesity rates are spiraling out of control. It is not uncommon to find young obese adults afflicted with Type 2 Diabetes, high blood pressure, cholesterol abnormalities, fatty livers, heart disease and stroke. It is becoming more common to find children afflicted with these conditions, that previously only occurred in adults, and my colleague pediatricians are dealing with chronic illnesses once regarded exclusively as adult diseases. The following is a primer on the psychological and medical complications of childhood obesity.

Psychological Damage

Perhaps the most damaging consequences of childhood obesity are psychological.  Obese kids become targets of unyielding discrimination, that is founded in the playground as well as in the culture outside the playground. A number of studies show that a preference for thinness develops at a young age. Studies called “preference studies” show that 10 and 11 year old boys and girls prefer children with a variety of handicaps as a friend over obese children. Obese children rank at the bottom of the “who you would like as a friend” lists. Children categorize obese kids as “lazy” and “sloppy”. 

Physical Implications

The medical consequences of childhood obesity are broadly categorized as metabolic or mechanical.  Examples of mechanical consequences are obstructive sleep apnea and deformity’s of the knees and other joints, as well as accelerated osteoarthritis. 

The medical complications of childhood obesity bring up a simple but tricky question: Why is obesity associated with so many diseases in children and adults such as diabetes and heart disease? When I ask patients this question, the common answers include that their heart has to work more or fat gets trapped in their arteries, but the true answer is much more elegant. The remaining complications of obesity are metabolic complications that happen because of fat. But not just any fat. 

Different Types of Fat

All metabolic consequences of obesity are the result of chemicals that are secreted from the fat cells that collect within our abdominal cavity.  Fat lies in two places in our body. One, as a blanket under our skin, this is called subcutaneous fat, or under the skin fat. We can have as much of this fat as we want. The Inuit in Northern Canada have massive fat pads under their skin, but very infrequently suffer from diseases of obesity. 

The second location fat lies in our body is within the abdominal cavity, the cavity in our body that holds all our organs. This fat collects there and is abilogically active fat - which secretes chemicals of inflammation called “adipokines”. These chemicals and inflammation are responsible for the list of diseases associated with obesity. 

That's right. Heart disease is caused by inflammation in the lining of our arteries. It works like this: The inner wall of our arteries becomes inflamed and rough from the chemicals released from abdominal fat cells, just like a cut on our hand becomes red, swollen and misshapen. Blood flows quickly in arteries and the pressure of flowing blood causes small breaks in the inflamed and irregular artery wall. Breaks get fixed by trapping cholesterol and white blood cells. The good news is this process fixes the breaks. The bad news is that the fix causes a narrowing. Fixes of torn and inflamed artery walls happen over and over again, narrowing the artery until eventually no blood can flow. This is called a heart attack if it happens in our heart, or a stroke if it happens in our head.

This should clarify why childhood obesity is so dangerous. Childhood obesity causes these changes to happen early, and it is now not uncommon for 30-year-olds to present their first symptoms of heart disease.

The Diabetes Connection

Type 2 Diabetes happens the same way. Normally, millions of insulin receptors throughout our body stand tall and fit perfectly with circulating insulin, and when the two meet, sugar is allowed into our muscle and organs to be used as fuel. When fat collects within the abdomen, inflammation chemicals are released - we already talked about that. These “adipokines” cause the insulin receptor to become inflamed and insulin no longer fits and sugar cannot get into our muscle and our organs. This is called Type 2 Diabetes. What is miraculous is that when children or adults with Type 2 Diabetes lose weight, the inflammation goes away and the receptor pops back, and in most cases Type 2 Diabetes disappears. I have personally seen this in my work literally hundreds of times. 

Type 2 Diabetes in children did not even exist 20 years ago and it is now epidemic. Early Diabetes means early Diabetes complications such as blindness, heart attacks, kidney failure and amputations in 20 and 30-year-olds as they enter their 2^nd or 3^rd decade of Type 2 Diabetes.

Other metabolic consequences of childhood obesity in addition to heart disease, stroke and Type 2 Diabetes include high blood pressure, cholesterol abnormalities, fatty liver, menstrual abnormalities, osteoarthritis, gallstones, breast cancer, uterine cancer, prostate cancer and colon cancer.

David Macklin MD CCFP