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Obese Children Twice as Likely to Die Young?

By Kathleen Doheny
WebMD Health News

Reviewed By Louise Chang, MD

Feb. 10, 2010 -- Childhood obesity more than doubles the risk of dying before age 55, according to a new long-term study that followed nearly 5,000 children.

"The bottom line is, obesity in kids is a serious problem that needs to be taken seriously," study co-author William C. Knowler, MD, DrPH, tells WebMD. Although experts have known that for years, he says, the new research is definite confirmation.

"What this particular study shows is, obesity is going to cause excess premature death," says Knowler, chief of the Diabetes Epidemiology and Clinical Research Section of the National Institute of Diabetes and Digestive and Kidney Diseases.

Although recent data suggest a leveling off of obesity in the U.S., one in six teens is obese.

The study is in the New England Journal of Medicine.

Obesity in Childhood, Early Death Linked

Knowler and his colleagues evaluated 4,857 American Indian children who were born between 1945 and 1984, then followed them long-term. Most participants were at least half Pima or Tohono O'odham Indian. They lived in the area of the Gila River Indian Community in Arizona.

The researchers gathered data about the children's body mass index (BMI), glucose tolerance, blood pressure, and cholesterol levels. None of the children had diabetes at the beginning of the study, although 559 developed it during the study.

During a median follow-up period of nearly 24 years (half followed longer, half less), there were 166 deaths from natural causes before age 55. There were 393 deaths from external causes, such as accidents or homicide, before 55.

The researchers divided the participants into four groups, or quartiles, depending on their BMI. In all, 28.7% of the children were obese, according to their BMI.

Higher BMI, Higher Premature Death Risk

The researchers compared the risk of early death for those in the four BMI quartiles. "Those in the top quartile had over twice the rate of death from natural causes before age 55 as those in the lowest quartile of BMI," Knowler says.

Among these natural causes of death were alcoholic liver disease, cardiovascular disease, infections, cancer, diabetes, acute alcohol poisoning, and drug overdose.

"Obesity was not related to external causes of death, such as auto accidents," Knowler says.

Other Risk Factors and Premature Death

Knowler's team also evaluated whether glucose levels, cholesterol levels, or blood pressure during childhood boosted risk of premature death.

Death rates from natural causes among children in the highest group of glucose intolerance (a risk factor for developing diabetes) were 73% higher than among the children in the lowest group of glucose intolerance, the researchers found.

No substantial links were found between cholesterol levels and premature deaths. They did find that high blood pressure in childhood raised the risk of premature death from natural causes by about 1.5 times.

"Obesity was a stronger predictor of premature death than either abnormal glucose, cholesterol, or blood pressure," Knowler tells WebMD.

Childhood Obesity and Risk of Death: Other Opinions

The new study is timely and important, says Marc Jacobson, MD, a Great Neck, N.Y., pediatrician who specializes in caring for children with obesity and cholesterol problems. "It gives us more hard data about the long-term effects of adolescent obesity," he says.

Jacobson serves on the American Academy of Pediatrics' Obesity Leadership Workgroup. The Academy recommends that BMI be measured in all children and that those with a BMI above the 85th percentile be helped to get it below the 85th percentile, which is considered a healthy weight, he says.

The American Academy of Pediatrics has a tool parents can use called 5210, Jacobson says. "It's used to prevent childhood obesity." It stands for:

  • 5 servings of fruits and vegetables daily
  • 2 hours or less of television viewing daily
  • 1 hour of exercise daily
  • 0 or nearly zero sugar-sweetened beverages daily

In an editorial accompanying the new study, Edward W. Gregg, PhD, of the DC, notes that the Pima Indians studied in the research are sometimes viewed as not representative of the U.S. population because their risk of diabetes is especially high.

But, he points out that 4% of the participants in the study had impaired glucose tolerance, a percentage similar to the 3% of U.S. teens overall who have the condition. And the condition affects 9.5% of obese teens, he says.

SOURCES: William C. Knowler, MD, DrPH, chief, Diabetes Epidemiology and Clinical Research Section, National Institute of Diabetes and Digestive and Kidney Diseases.

Marc Jacobson, MD, pediatrician, Great Neck, N.Y.

Gregg, E. The New England Journal of Medicine, Feb. 11, 2010; vol 362: p 548.

Franks, P. The New England Journal of Medicine, Feb. 11, 2010; vol 362: pp 485-493.

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