1118 AJR:188, April 2007 AJR 2007; 188:1118–1130 0361–803X/07/1884–1118 © American Roentgen Ray Society Choudhary et al. Childhood Obesity and Disease Pediatric Imaging • Pictorial Essay Diseases Associated with Childhood Obesity Arabinda K. Choudhary 1 Lane F. Donnelly Judy M. Racadio Janet L. Strife Choudhary AK, Donnelly LF, Racadio JM, Strife JL Keywords: obesity, pediatric radiology, practice of radiology DOI:10.2214/AJR.06.0651 Received May 15, 2006; accepted after revision December 6, 2006. 1 All authors: Department of Radiology, Cincinnati Children’s Hospital Medical Center, University of Cincinnati Medical Center, 3333 Burnet Ave., Cincinnati, OH 45229-3030. Address correspondence to J. L. Strife (janet.strife@cchmc.org). CME This article is available for CME credit. See www.arrs.org for more information. OBJECTIVE. Radiologists can play an active role in children’s health by increasing aware- ness of diseases associated with obesity. This article reviews key imaging findings in obesity- related diseases, current issues in imaging obese children, and treatment strategies. CONCLUSION. There has been a well-documented pediatric obesity epidemic and a dramatic increase in clinical diseases associated with it. These serious health consequences af- fect nearly every organ system. Despite the increasing prevalence of obesity and the associated health hazards, pediatric obesity as a diagnosis is often overlooked by health care providers. besity is a major threat to children’s health today. The prevalence of obesity has been steadily increas- ing; over the past 25 years, the num- ber of obese children has nearly tripled [1–3]. By body mass index (BMI) criteria (≥ 95th per- centile for age and sex), approximately 15% of children 6–19 years old are obese [4]. Longitudinal studies now show that 60% of children who are overweight during pre- school years are overweight at the age of 12 years [2]. Data regarding trends show that children who are overweight anytime during childhood are more likely to continue to gain weight and to reach overweight status by ad- olescence. Multiple other studies have shown that overweight during adolescence is a good predictor of overweight in adulthood. Some have claimed that pediatric obesity has emerged as a new chronic disease [5]. Obesity is a disease that can lead to myr- iad comorbid conditions. It has been shown to substantially increase years of life lost [6], mortality [7], and health care costs [8, 9]. An American Academy of Pediatrics policy statement described the significant health and financial burdens of pediatric obesity and the need for strong and comprehensive prevention efforts [4]. However, despite the gravity of the disease and its rising preva- lence, primary care givers do not consis- tently diagnose obesity in children and miss significant opportunities for intervention [10, 11]. In addition, pediatric radiologists usually do not include obesity as a diagnosis on imaging reports [12]. Childhood is a critical time for physicians to act as child advocates by attempting to pre- vent, identify, and treat obesity before these obese children become obese adults and the associated morbidity worsens. The serious complications associated with obesity occur in nearly every organ system. The purpose of this article is to increase awareness among radiologists of the diseases associated with pediatric obesity and of the need to use the radiology report to note obesity or large body habitus in order to increase awareness of referring physicians. Another way to emphasize the radiographic finding is to state that likely the specific condition is associ- ated with pediatric obesity. When clinicians treat the comorbid disease such as hyperten- sion or gallstones and do not address the under- lying disease of obesity, an opportunity to pre- vent other comorbid diseases is lost. Diseases Associated with Childhood Obesity Metabolic Syndrome Pediatric metabolic syndrome is a group of risk factors in one person that includes obe- sity, insulin resistance, hypertension, and other metabolic abnormalities; it is present in nearly half of all severely obese children and it worsens with increasing body mass index or insulin resistance [13]. Children have abnor- mal results of glucose tolerance tests, high triglycerides, and low HDL (high-density li- poprotein) cholesterol concentrations [13]. Childhood obesity has been accompanied by an increase in the prevalence of type 2 di- O Downloaded from www.ajronline.org by 52.73.204.196 on 05/17/22 from IP address 52.73.204.196. Copyright ARRS. For personal use only; all rights reserved