Medical Consequences of Obesity
in Children and Adolescents
WILLIAM H. DIETZ
Childhood obesity is associated with a variety of adverse effects on psychosocial function, skeletal growth, and cardiovascular risk factors. Although several periods in childhood appear critical for the development of obesity, it is not yet clear whether these periods are also associated with an increased risk for the complications of obesity in either childhood or adulthood.
The psychosocial consequences of obesity are among the most widespread adverse effects of the disease (see Chapters 20, 70, 71, and 72). Children in kindergarten have already learned to associate obesity with a variety of less desirable traits, and rank obese children as those they like the least. College acceptance rates for obese adolescent girls are lower than those for nonoverweight girls of comparable academic background. Adult women who are obese as adolescents or young adults earn less, more frequently remain unmarried, complete fewer years of school, and have higher rates of poverty than their nonobese peers. Few of these effects occur among obese men. These results persist when controlled for the income and educational level of the young women’s parents, their IQ, or their self-esteem at baseline. The social effects of obesity in young adult women therefore appear related to an extension of the discrimination that begins in early childhood (see Chapter 20).
Obesity has multiple effects on growth and function in children and adolescents. For example, obese children tend to be taller, their bone ages are advanced, their fat-free mass is