Medical or Health Consequences of Obesity
Complications of childhood obesity are shown in Table 24-46. These include hyperlipidemia, hypertension, increased incidence of type 2 diabetes mellitus, acanthosis nigricans, slipped capital femoral epiphysis, and obstructive sleep apnea. Advanced skeletal development also occurs, although with this complication children usually are short as adults because puberty occurs at an earlier age. The relatively early time of menarche is associated with an increased incidence of breast cancer later in life, and obesity is associated with development of hirsutism and irregular menses (ovarian hyperandrogensism). Hepatic steatosis, sometime associated with fibrosis is increasingly recognized among obese children, as is cholelithiasis. Orthopedic disorders, including slipped capital femoral epiphysis and Blount disease of the tibia also have been associated with obesity.

Thirty percent of obese adults were obese as children, and 50% were obese as adolescents. Obesity starting at a young age causes more serious consequences among adults than does obesity that starts in adulthood. A 50-year follow-up survey as part of the Harvard Growth Study of 1922-1935 showed increased risk of mortality from all causes (1.8 times) and morbidity from coronary heart disease (2.3 times), atherosclerotic cerebrovascular disease (13.2 times), and colorectal cancer (9.1 times) among men but not among women who had a BMI greater than the 75th percentile during adolescence. Overweight in adolescence was a more powerful predictor of mortality than weight in adulthood. A British study also showed a twofold increase in all causes of death after 57 years of follow-up study (1.9 times for ischemic heart disease and 1.6 times for generalized cardiovascular disease) among persons with a BMI above the 97th percentile compared with those between the 25th and 29th percentiles, at 7 years of age. Mean levels of fasting glucose, systolic and diastolic blood pressure, type 2 diabetes mellitus, and cardiovascular disease were greatest among adults who were classified in the highest childhood weight category at 9 to 13 years of age. In the Bogalusa Heart Study, being overweight during adolescence was associated with a statistically significant increase in prevalence of elevated cholesterol, LDL, and HDL levels in adulthood.

Psychological and Social Consequences of Obesity
From an early age, society stigmatizes obese persons as lazy, stupid, slow, and self-indulgent. Children express negative attitudes toward their obese peers as early as kindergarten and even prefer a playmate who uses a wheelchair or has a major physical disability to one who is obese. Adults, including physicians, inappropriately ascribe personal failings such as poor self-control and hedonism as the main cause of obesity. Because of these societal attitudes, almost all obese children are teased at some point. Obese children and adolescents have lower levels of self-esteem than do their nonobese counterparts. This likely explains their increased risk of smoking and drinking alcohol. A school-age child is at a critical period for the development of body image and self-esteem. Initiation of weight management at 6 to 9 years of age can improve the chance of overall sucess. Socioeconomic complications of obesity among teenage girls include persistent and severe disturbances in body image, lower likelihood of marriage, fewer years of education, low income, and a high incidence of poverty. Overweight men are less affected in these ways.