Children with severe obesity may be at higher risk for heart disease and diabetes

A new study led by researchers in the UNC Department of Pediatrics identifies a direct correlation between more severe forms of obesity in children and elevations in related risk factors for developing heart disease and diabetes—particularly in boys. The study was published in the October 2015 edition of the New England Journal of Medicine.

Children with severe obesity may be at higher risk for heart disease and diabetes click to enlarge Drs. Skinner and Perrin

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Thursday, Oct. 1, 2015

More than 3 million children in the United States who are severely obese may be at a higher risk of developing heart disease and diabetes than overweight children, according to a new study by researchers at the University of North Carolina and Wake Forest Baptist Medical Center. The study, published in the New England Journal of Medicine on Oct. 1, found that children with the more severe forms of obesity showed early signs of heart disease and diabetes, with the differences most notable in boys and young men.

“About 16 percent of U.S. children have obesity, but there are health differences in kids just over the cutoff for obesity versus those with very severe obesity,” said the study’s lead investigator, Asheley Cockrell Skinner, PhD, an associate professor of pediatrics at the UNC School of Medicine and of Health Policy at the UNC Gillings School of Global Public Health. “We found the greater the severity of obesity, the higher the prevalence of markers for heart disease and diabetes. Kids with very severe obesity are about twice as likely as those with lower levels of obesity to display risk factors.”

Researchers analyzed data from the National Health and Nutrition Examination Survey of children with overweight or obesity, ages 3 to 19, assessing the prevalence of cardiometabolic risk factors—such as blood pressure and cholesterol and blood sugar levels—according to the severity of obesity using classifications developed in recent years. The more severe forms of obesity were defined as a body-mass index (BMI) greater than 120 percent of the 95th percentile (class II) and greater than 140 percent of the 95th percentile (class III).

For perspective on the obesity classifications, a 10-year-old boy of average height (4 and a half feet tall) would be considered obese (class I) at a weight of 95 pounds. He would meet criteria for class II obesity at 115 pounds and class III obesity at about 130 pounds.

Among 8,579 children with a BMI at the 85th percentile or higher, 46.9 percent were classified as overweight, 36.4 percent had class I obesity, 11.9 percent had class II obesity, and 4.8 percent had class III obesity. The study showed that the greater the severity of obesity, the higher the risks of a low HDL cholesterol level, high systolic and diastolic blood pressures, and high triglycerides and hemoglobin A1C levels—all markers for heart disease and diabetes.

“Understanding elevated risk of disease in children and adolescents with more severe obesity is important, because it can help us more appropriately and cost-effectively target testing and interventions,” said Skinner. “For example, we see boys with more severe obesity at greater risk than girls, so this may be a relevant group to target for early screening and treatment.”

“For kids with less severe obesity, perhaps it may not be necessary to put them through drawing blood and testing cholesterol, and instead only screen those at higher levels of obesity and focus treatment on the children at greatest risk,” added Joseph Skelton, MD, an associate professor of pediatrics at Wake Forest Baptist and senior author of the study.

With groups like the American Heart Association and American Diabetes Association in need of evidence-based research to support recommendations for treating children with obesity, the study findings have real implications for public policy around screening and treatment of obesity and related risk factors. In the meantime, Skinner and her collaborators empower clinicians and parents to advocate for the children in their care.

“Clinicians should be looking at prevention and intervention strategies to help reduce obesity early in life, particularly in those children most at risk, not waiting until the risk factors lead to disease,” said study co-author, Eliana Perrin, MD, MPH, a professor of pediatrics at the UNC School of Medicine and general pediatrician at N.C. Children’s Hospital. “It’s also important that we find ways to address the health effects without stigmatizing children with obesity—addressing obesity by putting health first.”

“Parents should ask their pediatrician if their child is above the 95th percentile on the growth charts and, if so, work with their pediatrician on strategies to improve the child’s weight over the long term,” added Skinner. “Any improvement in weight may reduce risk.”

Leslie A. Moss, MHA, of the UNC School of Medicine, also co-authored the study.

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