Modifying Cardiovascular Risk in Adolescent Obesity

Abstract

Obesity affects at least 1 in 6 children and adolescents in this country and should be considered the most common chronic disease in childhood. The complications of obesity also represent a group of chronic conditions that pediatricians must face and should be identified by their persistence over time and not at a single visit. Guidelines for hypertension, another complication of obesity, recommend that a diagnosis should be made after multiple elevated measurements taken over at least 3 visits.1 Diabetes mellitus guidelines also recommend repeat testing for confirmation of elevated fasting blood glucose in asymptomatic patients. Article p 2316 Expert recommendations for identification and management of childhood obesity endorse regular tracking of body mass index (BMI) and medical assessment for complications of obesity.2 They recommend the collection of information on history, symptoms, and physical findings, as well as a screening for abnormalities in lipids, glucose, insulin, and liver enzymes. The ubiquitous nature of childhood obesity (17%) contrasts with the rarity of severe complications such as type 2 diabetes mellitus (<0.5%), which suggests that a group of obese youth exists with additional abnormalities that elevate their risk for future cardiovascular disease (CVD) and/or type 2 diabetes mellitus. Obese youth who persistently have multiple, moderately abnormal cardiovascular risk factors should be identified for aggressive lifestyle counseling as an essential part of primordial prevention.3 Pediatric studies have modeled the adult metabolic syndrome (MetS) definition to describe the epidemiology and generate hypotheses for obese children, and the studies have found associations with other adult CVD risk factors such as C-reactive protein and smoking.4–6 A recent article by Jolliffe et al used a statistical technique on a national database of adolescents to develop a growth curve approach for MetS.7 This definition has an advantage over previous definitions because it translates abnormal …