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Pathophysiology of Obesity in Children
Obesity is worth the discussion because it is arguably the rifest nutritional order amongst the young American generation. About 23 percent of American children, including adolescents, are overweight. An extra 17 percent are obese. Specific ethnic groups bear the brunt of this endemic. According to research, childhood obesity predisposes to hypertension, type 2 diabetes and insulin resistance, liver and renal illness, hyperlipidemia, and also reproductive dysfunction. Such condition increases the risk of further cardiovascular disease and adult-onset obesity. Chambers & Wakley (2002) view that, obesity’s prevalence has increased tremendously amongst children over recent years, posing a major health concern to the developed nations. A number of factors, including environment, genetics, metabolism, eating habits, and lifestyle, are believed to play a role in the development of this complex disorder. Nonetheless, most of the cases are idiopathic; only a few are linked to genetic or hormonal causes.
According to Dalton (1997), excess energy intake during childhood, which exceeds energy expenditure, usually ends in the accumulation of excess fat. Such an imbalance is as a result of insufficient physical activity and accrued energy intake. Furthermore, dysfunction of the gut-brain-hypothalamic axis through the leptin/Ghrelin hormonal pathway amongst obese individuals has been said to play a role in accrued energy intake and anomalous appetite control. DeFelice & DeFelice (2002) state that, a number of studies show that hormonal axis dysfunction can cause an approximate 10 percent of obese cases. In such families, reports point out a vivid, weight loss response in patients experiencing leptin deficiency and undergoing hormonal replacement therapy. Reductions in the use of energy are common in deficiency states such as growth hormone deficiency and hypothyroidism, while increased energy intake is a characteristic in syndromes like drug-induced obesity, crushing syndrome and Prader-Willi syndrome.
Hormonal and genetic disorders on their own cannot explicate the excessive weight gain seen in many obese patients. While most overweight children can be linked to familial type of obesity, excessive weight gain in these children clearly depends on both environmental and genetic factors. Nonetheless, evidence from family, twin, and adoption studies point out that genetic factors have a considerable role to play in the spread of childhood obesity.
Fat accumulation, especially in visceral distribution, minimizes insulin sensitivity in adipose tissue, liver tissue, and skeletal muscle. Low levels of HDL (high-density lipoprotein) in inactive and genetically linked lifestyle highly contribute to impulsive coronary artery illness common in obese adults. In another study by D’Adamo et al, fatty liver, devoid of ICML (intramyocellular lipid content) and visceral fat, plays a major role in resistance of insulin among adolescents who are obese.
Severe complications of childhood obesity, according to Loehr (2008), include hypertension, type 2 diabetes, hyperlipidemia, fast bone maturation, ovarian gynecomastia and hyperandrogenism, pancreatitis, cholecystitis, as well as pesudotumor cerebri. It is rare for patients to develop renal disease or cirrhosis; however, fatty liver is prevalent. Obese children can be linked to a number of orthopedic disorders including tibia vara, genu valgum, and capital femoral epiphysis. Excess weight gain can also lead to bowing of the femurs and tibia. Additionally, there is a link to endocrine and cardiovascular complications, gallbladder and liver dysfunction, and also psychologic complications. Long-term complications associated with obesity can include cardiovascular disease, diabetes, psychosocial dysfunction, gout and colorectal cancer.
Treatment procedures for overweight and obesity include psychological and pharmacologic therapies, lifestyle and surgical adjustments. However, the key to a successful and long term loss of weight remains in individualized treatment. Surgical intervention is a successful treatment for procedures such as the new adjustable gastric banding and Roux-en-y Bypass. Poskitt & Edmunds (2008) state that, obese patients have to be sufficiently evaluated to ensure lack of secondary causes of gain in weight including steroid and hormone deficiencies, steroid metabolism, hypothyroidism and severe use of medication. It should involve extensive laboratory testing of other sources of weight gain like overeating or smoking. As stated above, they have to be individually evaluated because the condition has no single and ideal procedure. The lap-band can be reversed easily and has a low operative mortality. BPD (biliopancreatic duodenal diversion) and GB (Gastric Bypass) forms of treatment have ended in high operative mortality.
Surgical procedures, however, have brought superior results compared to the rest of the medical therapies. Hopefully, improvements in future selection of patients will lead to better treatment choices and effective matching procedures. Medical treatment, including surgery will continue to undergo rapid developments and changes due to recent improvements in surgery, pharmacology, technology and psychosocial procedures.
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