Childhood Obesity and Metabolic Syndrome: Causes, Risks, and Prevention Strategies

Globally, the prevalence of childhood obesity has risen in recent years. Overweight and obesity mainly occur as a result of consuming too many calories, getting too little physical activity, or a combination of both. Additionally, a combination of genetic, behavioural, and environmental factors contributes to its development. Childhood obesity frequently leads to metabolic syndrome, physical and mental health problems, respiratory issues, and glucose intolerance, which can continue into adulthood. Developing nations like India face a unique “double burden,” with obesity affecting many children and adolescents on one side, and malnutrition and underweight on the other. The IASO and IOTF estimate that about 200 million school-aged children globally are affected by overweight or obesity. For children and adolescents, overweight and obesity are usually defined using age and gender specific normograms of BMI.

A recent study based on 18,955 school children in Chennai reported the prevalence of overweight to be 17 per cent, while that of obesity was 4.4 per cent among private school children. Conversely, among the government school children, the values were 3.1 and 0.5 per cent, respectively, using the Cole cut-points. Subramanyam et al reported on obesity trends in adolescent girls in private schools in Chennai and showed that in 1981, overweight was present in 9.6 per cent and obesity in 5.9 per cent of the girls, while in 1998, overweight was seen in 9.7 per cent and obesity in 6.2 per cent of the girls. A similar study from the same city in 2002 showed that among children attending private schools, the prevalence of overweight/obesity had almost doubled – 17.8 per cent in boys and 15.8 per cent in girls. This increase was attributed to changes in lifestyle factors

India is a fast-growing economy, currently undergoing major epidemiological, nutritional, and demographic transitions, suggesting that the prevalence of childhood obesity has probably been somewhat constant over the last couple of decades. However, the overweight and combined overweight/obesity prevalence showed an increasing trend. The prevalence of overweight increased from 9.7 per cent prior to 2001 to the value then increased to 17.4 per cent in the 2006-2010 period, finally reaching 19.3 per cent in studies reported after 2010. Hence, there was a trend of an increase in overweight among children/adolescents in India. The WHO has been encouraging pediatricians and governments worldwide to utilize its growth charts to identify underweight and overweight children. De Onis and colleagues developed the WHO 2007 age- and gender-specific BMI cut-offs to serve as a global reference standard. In children selected from across the globe, it was seen that they grew at an astonishingly consistent pattern up to the age of five years, suggesting that there may not be ethnic differences in the growth pattern of babies and children. However, it is likely that the WHO cut-off will result in higher overweight and or obesity rates

Causes

Metabolic syndrome (also called dysmetabolic syndrome or syndrome X) is brought on by the same problems that cause heart disease and type 2 diabetes. A diet high in calories but low in nutrients, along with frequent consumption of fast food and sugary drinks, can increase a child’s risk. Spending long hours in front of screens and lacking physical activity can raise a child’s risk of developing obesity, low HDL cholesterol, high blood pressure, and high blood sugar—all key components of metabolic syndrome.

Risk appears to be highest around puberty. That may be because body fat, blood pressure, and lipids are all affected by the hormones that bring about the many changes of puberty.

Kids who have a family history of heart disease or diabetes are at greater risk for metabolic syndrome. But, as with many things in life, the lifestyle habits a child adopts can push things in one direction or another. So, kids who are active, fit, and eat a lot of fruits and vegetables may drastically decrease their chances of developing metabolic syndrome, even if a close relative already has it.

What Problems Can Happen?

Metabolic syndrome itself often has no noticeable symptoms early on. But when its risk factors are left to snowball for too long, major changes may start to develop in the body. These include:

Arteriosclerosis: This happens when cholesterol hardens and begins to build up in the walls of arteries, causing blockages that can lead to high blood pressure, heart attack, and stroke.

Poor Kidney Function: The kidneys become less able to filter toxins out of the blood, which can also increase the risk of high blood pressure, heart attack, or stroke.

Insulin Resistance: This happens when the body’s cells do not react properly to insulin, the hormone that controls blood sugar, which can cause elevated blood sugar and lead to diabetes.

Polycystic Ovarian Syndrome: Thought to be related to insulin resistance, this disorder involves the release of extra male hormones by the ovaries, which can lead to abnormal menstrual bleeding, excessive hair growth, acne, and fertility problems. It is also associated with an increased risk for obesity, hypertension, and in the long term, diabetes, heart disease, and cancer.

Acanthosis Nigrans: A skin disorder that causes thick, dark, velvet-like patches of skin around the neck, armpits, groin, between the fingers and toes, or on the elbows and knees.

Diagnosis

For a diagnosis of metabolic syndrome, a child must have at least three of the four risk factors. The most common risk factors in teens are hypertension and abnormal cholesterol. Even when just one risk factor is present, a doctor will likely check for the others. This is especially true if a child is overweight, has a family member with type 2 diabetes, or has acanthosis nigricans.

These exams and tests can help doctors make a diagnosis of metabolic syndrome:

Body Mass Index (BMI) and Waist Measurement

Blood pressure – Blood pressure is the measure of the force blood applies to the artery walls each time the heart beats. When this force is at or above the 90th percentile for a child’s age and sex, it is considered a risk factor.

Blood Tests

Lipid profile – This test evaluates the amount of fats present in the bloodstream. Reduced levels of HDL (“good” cholesterol) along with elevated LDL (“bad” cholesterol) or triglycerides are seen as risk factors.

Fasting blood glucose – The fasting blood glucose test checks the blood for glucose levels after a period of fasting, typically lasting eight hours. After several hours without eating, a healthy person’s blood glucose level should not be higher than a certain level. A glucose level higher than this could be a risk factor.

Insulin – A blood insulin test may also be performed in some cases as part of a check for insulin resistance.

Treating Risk Factors

Dropping excess weight: If your child is overweight, losing even a small amount of weight can significantly improve blood pressure, cholesterol levels, and insulin sensitivity.

Getting more exercise: Replacing just one hour of daily screen time with physical activity can help children improve their blood pressure, cholesterol, and insulin sensitivity.

Eating mindfully: A child who learns to see food as fuel and not emotional compensation can start to make better choices at mealtime for example, selecting complex carbs instead of simple carbs (whole-grain instead of white bread, brown rice instead of white); getting more fiber with beans, fruits, and vegetables; choosing “healthy” fats like olive oil and nuts; and avoiding too many empty calories from soda and sweets.

Fiber supplements: If your child might not be getting enough fiber through food, a fiber supplement may provide an added boost to help improve the levels of cholesterol in the blood.

When lifestyle changes aren’t enough, a child takes prescription medicines to treat individual risk factors. So, kids with high blood pressure might be put on antihypertension drugs. Others with high LDL cholesterol might be prescribed statins or other lipid-lowering drugs. Children with high blood sugar, who are on the brink of developing diabetes, may get medicine to decrease insulin resistance.