Weight Gain: Clinical Manifestations, Assessment and diagnosis

Clinical Manifestations

In addition to advanced height, growth, and sexual maturation, obesity in childhood and adolescence is associated with a number of other clinical manifestations (Table 5-24). These problems are more common at the upper extremes of obesity, and most are found in a minority of obese children and adolescents. The more common obesity-associated problems (ie, dyslipidemias, hyperinsulinemia), however, are found in more than half of overweight children and adolescents. In addition, the results of several longitudinal studies suggest that overweight children and adolescents may have increased risks of morbidity and mortality in adulthood regardless of their adult weight status. The greatest risks are associated with persistence of obesity into adulthood or adult-onset obesity. Among obese adults, the clinical manifestations become more prevalent and serious. In addition to the problems noted in Table 5-24, obese adults are at increased risk of overall mortality and death from cardiovascular diseases, cancer, diabetes, and digestive diseases. They also are more likely to suffer from osteoarthritis and have complications of pregnancy. Recent studies suggest that the economic costs of obesity in the United States approach $100 billion per year.

Clinical Manifestations

In addition to advanced height, growth, and sexual maturation, obesity in childhood and adolescence is associated with a number of other clinical manifestations (Table 5-24). These problems are more common at the upper extremes of obesity, and most are found in a minority of obese children and adolescents. The more common obesity-associated problems (ie, dyslipidemias, hyperinsulinemia), however, are found in more than half of overweight children and adolescents. In addition, the results of several longitudinal studies suggest that overweight children and adolescents may have increased risks of morbidity and mortality in adulthood regardless of their adult weight status. The greatest risks are associated with persistence of obesity into adulthood or adult-onset obesity. Among obese adults, the clinical manifestations become more prevalent and serious. In addition to the problems noted in Table 5-24, obese adults are at increased risk of overall mortality and death from cardiovascular diseases, cancer, diabetes, and digestive diseases. They also are more likely to suffer from osteoarthritis and have complications of pregnancy. Recent studies suggest that the economic costs of obesity in the United States approach $100 billion per year.

Table 5-24
While the physical complications of obesity pose significant problems to a minority of overweight children and adolescents, the psychological and social consequences may be much more common. In several studies during the 1960s, diverse samples of children and adults associated negative stereotypes with representations of obese children and ranked them as less likable than representations of children with physical disabilities. Obesity has been associated with lower college acceptance rates, lower desirability to employers, prospective attainment of lower social class, and increased risk for body dissatisfaction and binge eating and purging behaviors among adolescent girls. However, some studies have shown that children's actual rating of liking and disliking are unrelated to the weight status of their peers, and obese children do not score consistently lower than normal-weight peers on formal assessments of social and emotional functioning. Similarly, although low self-esteem and more depressive symptoms have been documented in some clinical samples of obese children, this has not been the case in population-based, nonclinical samples.