This post was written with content provided by Mohammed Ghazali, MD, PPG – Pediatric Cardiology.
When we look at the population worldwide, almost 40% of adults are considered overweight or obese based on their body mass index (BMI). We know that this isn’t a condition that develops overnight. It might have started in an individual’s teens, 20s or 30s. So, let’s look at the statistics for those age groups. Anyone under the age of 20 is considered a pediatric patient. The data suggests that, in the United States, 20% of the pediatric population is overweight or obese. These numbers have tripled over the last 20 years, indicating we have a significant problem on our hands, for the entire body and, specifically, for the heart.
A prevalent problem
By looking at the data, I can tell you that by the age of 30, 50% of adults are at risk for coronary artery disease. This will present as a heart attack, angina, stroke or other cardiovascular disease in the forthcoming years. But we know the problems didn’t start when the individual turned 29, so we have to work backwards to identify the problem.
We can start by looking at markers for heart disease as early as age 2 years. Researchers can use autopsy data of children who died from causes other than heart disease. At this very young age, we are seeing fatty streaks and atherosclerotic plaques in children, signs of coronary heart disease. This is obviously extremely alarming.
We can look at causes other than obesity, including connective tissue disorders, previous heart surgeries, patients who had previously been exposed to chemotherapy and other congenital abnormalities, but the largest subcategory of disease is diseases of maladaptation, including the child being overweight or obese, hypertension, diabetes and metabolic syndrome.
I see a lot of children in my practice who have hyperlipidemia and/or hypertension. Sometimes this is tied to obesity and in other cases it is not. In fact, a good portion of my patients, approximately one-third, look healthy but are at risk for cardiovascular complications. Typically, something is developing. It might be that they are borderline overweight or, from a social point of view, they live a sedentary lifestyle that puts them at risk down the road. We often see teenagers who loved sports when they were younger, but aren’t interested anymore and so their activity level has dropped dramatically.
When a patient comes in, we explore all potential cardiovascular heart disease and screen for comorbidities like diabetes, hypertension, high cholesterol (familial or not familial) and connective tissue disease, which can cause cardiovascular involvement. We identify these issues and address the things we can. Often we can help prevent these children from becoming overweight/obese.
Central obesity, or excess fat around the abdomen, is the most concerning. The two biggest contributors to this issue are diet and exercise. The good news is, these are also two areas of life we can alter. Prevention is more important than treatment, because lifestyle modifications can reduce future burden of cardiovascular disease in the adult population.
If I see a 12-year-old patient, and he’s 300 pounds and complaining of chest pain, the answer is there. But the child didn’t become overweight overnight. Often we see the same challenges for others in the family. And we can’t blame only the child. He isn’t doing the grocery shopping or cooking or selecting what his school provides for lunch. Sometimes there are financial issues at play. Maybe the only meals that child gets are the free ones provided by the school for breakfast and lunch, and those aren’t always nutritious options. We have to be aware as a population that this is a problem for all of us to help solve. Not just the patient and not just the patient’s family.
Food challenges are different depending on a patient’s culture as well. A Hispanic family is typically going to eat differently than a South Asian family or an American family. If you look at carbohydrates, Americans gravitate toward pasta and bread, while Hispanic families often enjoy eating more rice and bread, and Asian families consume more noodles and rice. These are all refined carbs being used as a source of energy. They are a major source of calories. We have to help them understand how they can substitute complex carbohydrates for simple carbohydrates to sustain energy and feel full. That takes time and attention, but they will see results.
There are so many factors that put us at risk, but when you look at the lifestyle the general population has adopted, we can start to see where the problems begin. Look at how society has changed over the last 30 years. When I grew up, I walked to school, came home and played outside until dusk. Now, parents are too busy working or getting things around after work to go outside and supervise their children, but they’re too scared to let them be outside unattended. So they stay in, often on technology, where they connect with their friends who enjoy similar activities. They are less active. It used to be that communities took care of each other. If a child was in danger, a grownup kept an eye out and made sure they were safe. If a family wants to go somewhere and get exercise or do an activity together inside, they have to drive there. And it costs money to belong to group sport or exercise facilities. This isn’t a problem for just one or two families. This is an issue for our society in general.
The magnitude of the issue
Heart disease is the No. 1 killer of people everywhere. Many other developed or developing countries look to the western world as their example. They mimic our actions. In a third world country, an obese child might be viewed as “well fed”. They aren’t even considering the risks associated with obesity. We have a substantial number of immigrants, so the problem impacts our incoming population as much as it does our existing. We’re dealing with a worldwide problem. Obesity doesn’t have boundaries, and it will only grow worse in the years to come. We’re just seeing the tip of the iceberg now.
Signs of trouble
Parents should be looking at their child’s BMI. It’s also important to note if a child is experiencing fatigue easily. Are they tired all the time? Sometimes we think our son or daughter is being lazy, but there might be an organic reason, such as hypothyroidism, which can lead to weight gain. If we can first recognize the problem, then we can start to explore causes and resolutions.
Weight is a sensitive topic for a lot of people. Sadly, we usually shove it under the rug and not talk about it. But it develops into a big problem when a child becomes obese. This isn’t about guilt or blame. It’s about making healthier choices. If a child is 50 pounds overweight, let’s talk about how we can realistically lose 2 pounds a week and get back on track. Let’s set attainable, achievable goals.
Where do we go from here?
We’re all responsible for this epidemic. If we have one child like this, we as a society have to respond. Blame doesn’t get us anywhere. It’s more important that we recognize the problem and find solutions. By the time a patient comes to an adult cardiologist, or even to see me before they turn 20, their symptoms have been going on for a long time. Somewhere these kids fell through the cracks. We have resources and the ability to make a difference, but we have to address this issue now and implement changes.
We have a great opportunity to impact change now. If we don’t stop or reduce instances of obesity now, it will become exponentially more concerning 20-30 years down the road. We have to ask ourselves, “What is my responsibility here?” and give the gift of our time and attention to help these children.