morenoHello, and please allow me to introduce myself. My name is Cecilia Moreno, and I am a general pediatrician and I just so happen to be Breanna’s new doctor! So I was very happy when Mrs. Bond asked me to write page for Breanna’s website. We have had many conversations regarding the unseen problems associated with obesity, and Mrs. Bond was especially shocked to hear about the effects of body fat and stunted growth. So, naturally Mrs. Bond asked me to describe the unseen problems with obesity so that parents can be better informed! I am not an expert in endocrinology, gastroenterology or nutrition but I am very familiar with the short and long term effects of obesity on a child’s body.

I have been a pediatric hospitalist and have cared for hospitalized children with problems directly related to obesity such as type 2 diabetes, high blood pressure, and sleep apnea. As a general pediatrician I have managed children with pre diabetes, fatty liver, and of course type 2 diabetes. This page is not meant to be a medical lecture, and should not take the place of any information given to you by your physician. I can only cover, briefly, and in a hopefully easy to understand format of what I consider to be a few of the essential facts that every parent should know.

So, you have just been informed that your child’s BMI (body mass index) is above the 85%, or maybe way above the 95%, what does this mean? This means that your child is overweight, or obese, or maybe even morbidly obese depending on the graph. Regardless of the category, it usually means the child has too much body fat, unless they are an athlete with lots of muscle mass! So for the purpose of this discussion, let us assume it is body fat, not excessive muscle. Parents are often concerned about the appearance of body fat, and how it can affect their child’s self esteem and peer relationships. What some parents don’t know is that the same body fat is also growing on the inside of their child’s body, around vital organs and sometimes invading them. The liver is especially susceptible. The liver cells can become fatty, and we can see evidence of this on blood work. The liver enzymes ALT and AST will be higher than normal when this happens. In advanced cases, we sometimes can see large deposits of fat surrounding the liver with ultrasound. Sadly, there have been cases of liver failure, with need for liver transplant in children with fatty liver.

What else does extra body fat do to a child’s growing body? Extra fat can cause early puberty in girls and shortened stature in boys and girls. How is this possible?  Not too many parents are aware that fat cells make the hormone estrogen, but it is true. Fat cells convert other hormones that occur naturally in the body into estrogen. Too much estrogen is not a good thing for a growing body. In girls, higher that normal levels of estrogen cause early breast development and earlier than normal puberty. In both boys and girls, extra estrogen acts on the growth plates of bones and causes early fusion of the growth plates and hence shorter than normal stature. So a boy who was supposed to be “tall like his dad” may end up much shorter than expected if he is overweight or obese before his “growth spurt”.

Last but not least, is the long-term consequence of obesity, the growing epidemic of type 2 diabetes and all of its associated complications. It is a complicated topic, but in a nutshell it is all about insulin and sugar. Insulin is made by the pancreas, and released when we eat carbohydrates i.e. breads, pasta, sweets, and even fruits, which are broken down to sugar in the body. Insulin carries the sugar into the cells of the body to be used as energy, and that is all good. However, if a child is eating carbohydrates constantly, the pancreas has to keep pumping out insulin, and eventually it “burns out”. There are other things that happen such as insulin resistance, but in the long run there is not enough insulin to carry the sugar into the cells so it can be used as energy. So what happens to the sugar? It remains outside of the cells, and sugar acts as a toxin to cells, especially the cells of the eye, kidney, brain, and nerves. This is why persons with type 2 diabetes eventually need insulin if they cannot control their blood sugar levels with weight loss, healthy eating, and cardio workouts. It is true that some ethnic groups are more susceptible to type 2 diabetes, such as Native Americans, African Americans, and Latinos. Why? No one is really sure, but type 2 diabetes is problem we will all be dealing with until we can hopefully put an end to childhood obesity. So if we keep our kids active, feed them healthy foods, and keep their BMI at or below the 85 % we won’t have to worry about the unseen consequences of obesity.

Sincerely,

Cecilia C. Moreno, MD FAAP