Running head: CHILDHOOD OBESITY AND COMORBIDITIES

Childhood Obesity and Comorbidities

Gail L Luskin
NURS 351-002
Ferris State University

CHILDHOOD OBESITY AND COMORBIDITIES

Childhood Obesity and Comorbidities

Childhood obesity is a problem that is consistently on the rise in youth both in the United
States and in other developed countries. Along with obesity, children can develop other health
complications including dyslipidemia, hypertension, type 2 diabetes (T2DM), orthopedic and
psychosocial problems (Maggio et al., 2014, p.1). These health issues will only bring on other
health concerns later in life and thus, we need to make a conscious effort on changing the
lifestyles of children at risk for developing obesity. To be better suited to take care of these
children when we are nurses, we must know how common it is for comorbidities to develop
alongside obesity.
In a 2014 study conducted by Maggio et al., the researchers aimed at determining the
prevalence of these complications in a population of children and adolescents with body weight
excess (p.1). The researchers wanted to study this subject because children with body weight
excess are an important high risk group for health complications (Maggio et al., 2014, p.1) and
they will potentially experience higher health risks and medical care costs as they age. They felt
the need to study this subject because disparities in epidemiological data, depending on where
the studies were performed, the selected populations and the clinical settings (Maggio et al.,
2014, p.1) have been found in previous research. Without proper research, we cannot conclude
appropriate results.
This was a cohort study including 774 subjects with excessive body weight (BMI zscore above one SD for age and gender), aged 1.7 to 17.9 years, attending our Pediatric Obesity
Care Center between January 2008 and August 2012 (Maggio et al., 2014, p.2). The children
studied were referred to the clinic by their school nurse, general practitioner, or by the Child and
Adolescent Department of the Geneva University Hospital. The measures that the researchers

CHILDHOOD OBESITY AND COMORBIDITIES

used include previous medical history, a physical examination, and laboratory tests (e.g., fasting
glucose, total cholesterol, HDL and LDL levels, triglycerides, and alanine aminotransferase
levels). It is important to note that during the initial interview, each school aged child was
assessed for experiences with bullying, preoccupation with physical appearance, and self-esteem.
Since this was a quantitative study, the statistical analysis of the population was performed using
the SPSS software 18.0 and ANOVA.
Maggio et al. found that most of the children studied had at least one of the comorbidities mentioned previously in this paper. Orthopedic pathologies were the most frequent
(54%), followed by metabolic (42%) and cardiovascular disturbances (31%)non-medical
conditions related to well-being, such as bullying, psychological complaints, shortness of breath
or abnormal sleeping patterns, were present in the vast majority of the children (79.4%)
(Maggio et al., 2014, p.1). This evidence shows that children who are overweight and showing of
signs leading to obesity have a higher risk for serious health complications. What is very
concerning is that most of these children have shown signs of issues that relate to their
psychological/psychosocial health. It will be beneficial for nurses and other healthcare providers
to understand these results so that they can be better prepared to develop appropriate care.
We cant exclude a selection bias, as the children attending our care center may be the
most affected by their condition, making generalization difficult (Maggio et al., 2014, p.7).
There were four limitations experienced during this study: blood tests were probably performed
more early in overweight subjects with a higher risk of comorbidities, which may falsely
increase the prevalence of complication; as the pubertal status was missing in the majority of
the subjects, we couldnt adapt the cut-off point for insulin level; we didnt evaluate the quality
of life using a validated questionnaire due to setting limitation; and missing data may introduce

CHILDHOOD OBESITY AND COMORBIDITIES

a bias in the relative prevalence of each complication in our population (Maggio et al., 2014,
p.7). To address these limitations, it might be better to have chosen a random group of children
from multiple schools to get a more generalized population and assessing both the pubertal status
and quality of life questionnaire during the first interview. Also, they need to limit the amount of
missing data experienced throughout the process by limiting the time of processing of results and
making the interview process more structured instead of semi-structured.
In adult populations, we would certainly see more comorbidities and less non-medical
issues that arise along with obesity. It is reasonable that adults will have more issues with
hypertension, type 2 diabetes, and orthopedic complications because these have been typically
defined with the adult population. Children are not supposed to have hypertension or orthopedic
complications because they are active and typically healthy. If we were to see diabetes in
children it would be type 1 because that type is due to a dysfunction of the pancreas while type 2
can be controlled with diet and exercise. It is very interesting to compare these children at risk
for obesity to children from underprivileged nations. As nurses, we must be prepared for treating
both types of children and be wary when we start to see children getting health issues that were
once only seen in adults.
Future nurses must develop care plans focused to our patients that will help with the
promotion of proper health. One nursing diagnosis for children at risk for obesity is imbalance
nutrition more than body requirements related to excessive intake in relation to metabolic need.
The expected outcomes for this care plan include that the client will identify behaviors that
contribute to weight gain, be willing to design dietary modifications to meet individual long-term
goal of weight control, and incorporate increased exercise requiring energy expenditure into
daily life. The role of the nurse will be to encourage the child to increase the amount of walking

CHILDHOOD OBESITY AND COMORBIDITIES

done per day, recommend that parents do not use food as a reward for good behavior, and
recommend that the child decrease television viewing and playing video games during the day.
These children are at risk for chronic low self-esteem that will affect their psychosocial future.
The expected outcomes for this care plan include that the client will identify personal strengths,
accomplishments, and values; demonstrate improved ability to interact with others (e.g.,
maintains eye contact, engages in conversation, expresses thoughts/feelings); and identify and
work on small, achievable goals. It will be the role of the nurse to actively listen to and respect
the client, encourage journal/diary writing as a safe way of expressing emotions, and provide
bully prevention programs and include information on cyberbullying. A third nursing diagnosis
would be risk for unstable blood glucose level related to weight gain and lack of exercise.
Outcomes for this diagnosis will be that the client will to develop an understanding of what
proper glucose levels are and what complications can occur from high glucose, also to maintain a
glucose level between 70 and 130 mg/dL. It is the responsibility of the nurse to teach the client
and their family the signs and symptoms of both hypoglycemia and hyperglycemia, refer the
client to a dietitian for carbohydrate counting instruction, refer overweight clients to dietitian for
weight loss counseling, and check glucose levels during visits to primary care physician.
Nurses play a big role in the assessment of their patient and finding abnormalities in their
health. All the co-morbidities should be actively screened as they are known to have an impact
on future health. Pediatricians and general practitioners have a major role in this screening as
they can improve quality of care by treating these complications as soon as possible (Maggio et
al., 2014, p.7). With a growing population of children with qualifying BMIs for obesity and
being diagnosed with type 2 diabetes mellitus, this is a serious issue that future nurses and
healthcare providers must be ready for. The biggest challenge would be the prevention of

CHILDHOOD OBESITY AND COMORBIDITIES

excessive weight gain in the general population, as the prevalence of the majority of the comorbidities was directly dependant [sic] on the weight status (Maggio et al., 2014, p.7). We
must not only assess physical health, but focus on the childs mental wellbeing. Children are at
an age where they are experiencing puberty, body changes, bullying, peer pressure, and
increasing demands in school. Almost 80% of children complained about non-medical
conditions affecting their well-being and quality of life, and it is by far the most frequent
complication found in this population (Maggio et al., 2014, p.7). It is our role as nurses to be
always observant in our patients needs and to promote proper health right now so that they may
have a long and healthy future.

CHILDHOOD OBESITY AND COMORBIDITIES

References
Maggio, A. B., Martin, X. E., Saunders-Gasser, C., Gal-Duding, C., Beghetti, M., FarpourLambert, N. J., & Chamay-Meber, C. (2014). Medical and non-medical complications
among children and adolescents with excessive body weight. BMC Pediatrics, 14(232),
1-9. doi:10.1186/1471-2431-14-232