Will Obese Children Become Adults with Metabolic Syndrome?

A question many health care providers have wondered but haven’t received a straightforward answer yet. Spoiler alert: I don’t have the answer but the questionable link between the two has been proven to be related and health care providers do have a legitimate reason to fear for overweight children’s future health.

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Metabolic Syndrome is not a complex condition to break down into causes and effects. It has multiple factors leading up to it, and some may seem more causative than others depending on who you ask. Some may say obesity is the reason for it, while others will say high blood pressure, high cholesterol and obesity equally create the problem. Even though obesity is one of the major players in Metabolic Syndrome, it’s not the only root cause and should not take the full blame.

The significance of childhood obesity on morbidity and mortality risks as adults is well known, but what is being done to prevent these risks? As caregivers we are seeing childhood obesity continue to rise, and soon we will see the prevalence of Metabolic Syndrome rising as well. If no interventions are taken while an overweight patient is still young their risk of Metabolic Syndrome increases dramatically. The hard truth is childhood obesity increases their risk for more than just the development of type 2 diabetes, hypertension, dyslipidemia, and cardiovascular disease. Given the increasing numbers of overweight children, it is critical to understand how severe the consequences of this excess weight may be on the risk of cardiac health in adulthood.

I touched base in a previous article on the clinical conditions that Metabolic Syndrome is associated with including cardiovascular disease, hypertension and type 2 diabetes, but there are more consequences of this disease. To name a few: chronic low-grade inflammation, polycystic ovary syndrome, nonalcoholic fatty liver disease (NAFLD), sleep apnea, Alzheimer’s disease, and certain types of cancer. With all of these known consequences and underlying cause of Metabolic Syndrome, is it safe to intervene early with children who are overweight to avoid these health consequences?

“The rise in the prevalence of obesity in children and adolescents is one of the most alarming public health issues facing the world today.”

In 2007, the International Diabetes Federation (IDF) proposed an age-specific diagnostic criteria to create a definition of pediatric metabolic syndrome. They separated pediatric metabolic syndrome into two categories:

1. Children aged 6–10 years old who are obese, meaning a waist circumference greater than the 90th percentile and have risk factors such as family history of diabetes and cardiovascular diseases.
2. Children aged 10–16 years old who are obese, meaning a waist circumference greater than the 90th percentile and meet the adult metabolic syndrome criteria, i.e. high cholesterol and triglycerides, high blood pressure, and elevated blood glucose levels or insulin resistance.

With this definition and the reality that obesity rates in children will continue to rise, the question is do we as providers let children be children and hope they grow out of their chubby phase, or do we start intervening and try to avoid future health complications now?

“According to national data, 90% of obese adolescents remained obese over a decade later, suggesting a high likelihood that obesity in adolescence persists into adulthood [3].”

Research has found that childhood obesity is a strong predictor of continued obesity along with insulin resistance, high cholesterol, and furthermore cardiovascular risk and because of this, it paves its own path for providers to begin making early interventions. Although we may all want to blame one factor for Metabolic Syndrome, obesity is a nearly a marker not the cause. Other factors that have been shown to contribute to Metabolic Syndrome include genetics, stress, dietary choices and sleep deprivation. While giving advice on diets and exercise may seem like the simplest way to make a difference and help treat childhood obesity, there are more interventions needed. Asking children about their stress levels, favorite hobbies, food choices and sleep patterns can be an important counseling aspect. Engaging parents during these counseling sessions can be vital to guarantee your point on the importance of lifestyle changes and weight loss doesn’t get lost in translation. Starting these interventions sooner rather than later can immensely impact a child’s health, so the sooner providers can have these conversations with their patients makes all the difference.

Overall, the association between a high BMI in children with Metabolic Syndrome and poor cardiovascular health in adulthood has been found, but there is still more to be investigated. The ways providers support their adolescent patients to achieve a healthy weight will improve not only their current health but will decrease their risk of continued obesity and co-morbid conditions in adulthood.

Thank you for taking the time to read my article, I hope it gave you something to think about.

Frances Nixon-Simon

Massachusetts College of Pharmacy PharmD Candidate

Sources:

1. Baker JL, Olsen LW, Sørensen TI. Childhood body-mass index and the risk of coronary heart disease in adulthood. N Engl J Med. 2007;357(23):2329–2337. doi:10.1056/NEJMoa072515
2. Weiss R, Bremer AA, Lustig RH. What is metabolic syndrome, and why are children getting it?. Ann N Y Acad Sci. 2013;1281(1):123–140. doi:10.1111/nyas.12030
3. Gordon-Larsen P, The NS, Adair LS. Longitudinal trends in obesity in the United States from adolescence to the third decade of life. Obesity (Silver Spring). 2010;18(9):1801–1804. doi:10.1038/oby.2009.451