Morbidity

Obesity in childhood is a major public health problem as it increases the risks of developing a number of health conditions and diseases (Table 1). These comorbidities have been associated with the increased mortality rates attributed to obesity. The number of deaths associated with obesity in the United States has been reported to be as high as over 430,000 per annum, a number that exceeds that attributed to smoking (20), though others reported a lower death rate, 112,000 of obesity-attributable deaths (21). The actual death rate prevalence of obesity continues to be debated (22-24) though there is a general agreement that the impact of this disease is enormous. Recently, Olshansk et al. suggested that in the 21st century, American obese children may die before their parents due to a potential decline in life expectancy (22).

Obesity decreases longevity, a 7- to 8-year loss of lifespan in 40-year-old nonsmoker individuals and a 13- to 14-year less lifespan in smokers (25); when obesity occurred by 20 to 30 years of age there was a 22% reduction in longevity, 17 to 20 less lifespan (26). Thus it could be expected that the impact of obesity starting earlier in life, beginning during childhood, would be more dramatic and lifespan would be further impaired. In a study by Must et al., long-term morbidity and mortality of overweight adolescents were examined (27). They demonstrated that obesity in adolescent subjects was associated with an increased risk of mortality from all causes and disease-specific mortality among men, but not among women. The risk of morbidity from coronary heart disease and atherosclerosis was increased in both men and women who had been obese in adolescence. However, in a study by Freedman et al., childhood overweight was related to adverse risk factors among adults, but associations were weak and were attributable to the strong persistence of weight status between childhood and

Table 1 Comorbidities Associated with Obesity in Children

Insulin resistance syndrome

Type 2 diabetes mellitus

Hypertension

Dyslipidemia

Cardiovascular disease

Renal alterations and hyperuricemia

Early puberty

Polycystic ovary syndrome Cholecystitis Fatty liver disease Sleep apnea

Respiratory infections and asthma Orthopedic alterations Dermatologic alteatios Nutritional deficits Birth defects in offsprings Increased risk of cancer Psychosocial problems Eating disorders Depression adulthood (28). This suggested that body weight reduction in the young may decrease the risks for many of the obesity-related health disorders.

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