August 28, 2008

Children in Hospitals: Obesity: Thief of Childhood

By Monaco, John E

For a decade I have committed myself to raising the consciousness of one of the greatest public health crises ever to face the children of this country and much of the industrialized world. Not only is this problem still with us, but also it has actually worsened, to the point that overweight kids now have become the "new normal." Illnesses related to obesity have increased in frequency, new complications have been revealed, and for the first time in modern history, the life span of today's children may be shorter than their parents. I was reminded of this trend recently when we cared for a ten-year-old girl who presented to the emergency room with abdominal pain, fever and intermittent vomiting. The pain was located primarily in the right lower quadrant of the abdomen and the ER doc appropriately suspected appendicitis. I should also mention that this young lady was significantly overweight. Her belly fat made her physical exam difficult since it was hard to localize the pain and accurately assess its character and severity.

So before he consulted the surgeons, the ER doc obtained a CT scan of the abdomen to hopefully help him make the diagnosis. The study was inconclusive and the comment was made that the degree of her obesity may have contributed to the inconclusive test results.

The surgeon was consulted and also experienced difficulty examining this chubby patient. The decision was made to admit her to pediatrics and watch her closely for the evolution of her abdominal pain. So for two days she languished on the pediatric floor, in and out of severe pain, the diagnosis difficult because of her obesity. When she was finally taken to the operating room mainly out of frustration, after yet another inconclusive scan, the surgeon found that not only did she have appendicitis, but also the appendix had ruptured and she now had severe peritonitis, or infection of the abdominal cavity. What had initially been a localized infection was now much worse and generalized throughout her abdomen.

After a week in the hospital with intensive IV antibiotics, she was released, only to be readmitted five days later, having developed an abscess within her abdominal cavity, the result of the initial appendix rupture. She required another operation, and, as I write this narrative, she remains in the hospital with IV antibiotics and intensive hospital care. Essentially, this young lady endured two operations, two weeks in the hospital, days of antibiotics, pain and emotional trauma primarily because of her obesity. Even though she will most likely fully recover, the costs and the trauma this patient and her family have experienced have been extraordinary.

What further haunts me is that if this adolescent does not turn her life around and combat her obesity, she is in for so much more trouble. Will she be the next teenage girl, like so many I have seen over the last few years, who will need gall bladder surgery - a procedure once considered common in fat, forty-year-old women? Will she develop hypertension and early coronary artery disease? Will she develop arthritis much earlier than her mother and hip problems that require surgery before the age of 35? Will the asthma that runs in her family suddenly become much worse due to the strain of the many pounds of extra weight on her lungs? Will she develop diabetes in college, the kind her grandmother was diagnosed with at the age of 67?

These possible - probable - conditions are the scope of the problem we now face with the state of childhood obesity, and the fact that it gets worse every day. There are solutions, but they will take time. And they will take the dedication of families, schools, churches and the government. That's right, this problem is just that important. Yet, aside from an occasional Oprah episode, or the YouTube video I recently saw of a 400-pound five year old, shamelessly little attention is given to this problem.

My ten-year-old patient will get better, she will go home and her family will be relieved that her present health crisis has been met and successfully defeated. But while they may have won this battle, they are still at a horrible disadvantage in the overall war. And they have no chance of winning that war without the cooperation of all of us. So I ask you, don't we owe this girl our support, research and understanding? After all, she is the future. She is our future.

By John E. Monaco, MD

John E. Monaco, MD, is board certified in both pediatrics and pediatric critical care. He has published two books: Moondance to Eternity and Slim and Fit Kids: Raising Healthy Children in a Fast Food. He lives and works in Tampa, Florida. He welcomes your comments, suggestions, and thoughts on his observations.

Copyright Pediatrics for Parents, Inc. Jul 2008

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