June 2, 2004 -- Health risks usually associated with middle-age spread can be seen in obese children as young as age 4, and new research suggests these problems occur with more frequency and severity depending on the degree of obesityobesity.
According to a study in this week's New England Journal of Medicine, components associated with metabolic syndromemetabolic syndrome -- a cluster of risk factors that raise heart diseaseheart disease and diabetesdiabetes risks -- steadily increase with the more weight obese kids carry.
What this means is that obese children, some not yet attending elementary school, are already displaying warning signs of chronic diseases that in past generations took years to develop.
Metabolic syndrome affects nearly one in four American adults, greatly raising their risk of diabetes, heart disease, and stroke. Generally, adults with metabolic syndrome have at least three of the following traits:
- Waist more than 40 inches around in men or 35 inches in women
- Triglyceride (a fat associated with poor blood sugar control) levels in the blood of 150 or greater
- HDL levels, or "good" cholesterol, less than 40 in men or less than 50 in women
- Blood pressure of 130/85 or higher
- Fasting blood sugar of 100 or higher
More Weight Means More Problems
In this study, researchers found that about 40%-50% of children who were moderately to severely obese had metabolic syndrome.
In practical terms, children with a body mass index, or BMI, (a gauge of body fat determined by height and weight) of greater than 95% of children their age and sex are considered overweight or obese.
"We know that obesity opens the door for many complications, even in children, but what is surprising is that the more obese a child becomes, the greater the cluster of problems these children face," says senior researcher Sonia Caprio, MD, of Yale University School of Medicine.
"The message of this finding is that while it's very hard for obese children to lose weight, it's essential that they don't gain any more weight," she tells WebMD.
Health Risks Before Elementary School
Caprio and her colleagues tracked 20 normal-weight children, 31 overweight children, and 439 obese children between the ages of 4 and 20.
Across the board, the heavier the children were, the more likely they were to have high blood pressurehigh blood pressure, high cholesterolhigh cholesterol, and insulin resistanceinsulin resistance, a factor that often leads to type 2 diabetes. Researchers found lower levels of "good" HDL cholesterolHDL cholesterol and higher blood markers of inflammation associated with heart disease in the heaviest children.
"We saw these problems in children as young as ages 4 to 6, and found that about one in three developed significant health risks very quickly -- especially high blood pressure," she says. "We will now investigate how we can reverse these problems with weight lossweight loss and other factors."
Interestingly, despite previous research that suggests metabolic syndrome occurs more frequently in minorities, especially Hispanics, the study shows obese white children had slightly higher rates of metabolic syndrome.
"We found no differences depending on ethnicity," she says. "Being obese is dangerous for children and adults, no matter who you are."
Help Kids Slim Down Before Puberty
These findings stress the need for treating childhood obesity as early as possible -- ideally, before children reach puberty.
"Work that we've funded has shown that it's easier to treat obese children than to treat adults," says Gilman Grave, MD, chief of the Endocrinology, NutritionNutrition and Growth branch of the National Institute of Child Health and Human Development, an agency of the NIH.
"Pre-pubertal treatment of obesity lasts longest in terms of keeping weight off, so it would be behoove parents of obese children to try to do something before rather than after they reach puberty.
"People used to say children will grow out of obesity as they get older and taller, but unfortunately, this isn't proving to be true for 15% of kids who, by definition, are obese," he tells WebMD.
Grave calls Caprio's study "very powerful and exciting" because it demonstrates the magnitude of dangers associated with higher levels of obesity.
"It's very surprising how there is a dose-response effect, really," he says. "For each step increase in body weight and obesity, you get an increase in all of the cardiovascular risk factors.
"The take-home message of this study is that we've known about the epidemic of obesity in children, and we've known about the epidemic of diabetes in adolescents, but here we are able to predict a third wave of cardiovascular disease."
SOURCES: Weiss, R. The New England Journal of Medicine, June 3, 2004; vol 350; pp 2362-2374. Sonia Caprio, MD, associate professor of pediatrics and endocrinology, Yale University School of Medicine, New Haven, Conn. Gilman Grave, MD, chief of the Endocrinology, Nutrition and Growth branch, National Institute of Child Health and Human Development, Bethesda, Md.