Saudi Journal of Gastroenterology
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Year : 1999  |  Volume : 5  |  Issue : 2  |  Page : 85-88
Childhood obesity: Referred cases to a tertiary health center in Riyadh, Saudi Arabia


1 Department of Pediatrics, College of Medicine & KKUH, King Saud University, Riyadh, Saudi Arabia
2 Department of Medicine, College of Medicine & KKUH, King Saud University, Riyadh, Saudi Arabia

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Date of Submission06-Jun-1998
Date of Acceptance06-Feb-1999
 

   Abstract 

Objective: To show the pattern of etiology of childhood obesity referred to our endocrinology clinic between December 1989 and December 1994. Subject and Methods: All the children referred to our clinic at the above stipulated dates were studied. This is a retrospective medical records review of these patients. The patients' height and weight were measured by trained staff of the clinic. The Quetelet index also known as Body Mass Index (BMI) was calculated as weight (kg)/height (m)2 for each patient. Laboratory data as well as results of clinical investigations were also obtained from the records of the patients. Results: 52 patients with ages ranging between 2 years and 16 years (median 8 years) were studied. Male : female ratio was 1:1. 35 (67.3%) of the patients were Saudis while 17 (32.7%) were non-Saudis. The etiology of obesity among the series were nutritional 46 (88.5%), Prader-Willi Syndrome 3 (5.8%), Laurence-Moon-Biedl Syndrome 1 (1.9%), pseudohypoparathyroidism 1 (1.9%) and hypothyroidism 1 (1.9%). The study showed that the majority of the patients had simple nutritional obesity.

How to cite this article:
Al Herbish AS, Al Jurayyan N, Olasope A, Abdullah AM, Al Nuaim AA. Childhood obesity: Referred cases to a tertiary health center in Riyadh, Saudi Arabia. Saudi J Gastroenterol 1999;5:85-8

How to cite this URL:
Al Herbish AS, Al Jurayyan N, Olasope A, Abdullah AM, Al Nuaim AA. Childhood obesity: Referred cases to a tertiary health center in Riyadh, Saudi Arabia. Saudi J Gastroenterol [serial online] 1999 [cited 2020 Jan 21];5:85-8. Available from: http://www.saudijgastro.com/text.asp?1999/5/2/85/33516


At present, there is no generally accepted objective definition of obesity for children and adolescents [1] Obesity could be defined as excessive accumulation of fat in the body and it is also accepted as weight greater than 120% of the ideal body weight; or a body mass index (BMI) greater than the 95th percentile for age and sex. Obesity has been associated with many diseases like hypertension, diabetes mellitus, coronary artery disease, and skeletal system disease [2],[3] . Saudi Arabia has witnessed a tremendous and an unprecedented economic boom in several sectors. This led to a change in the dietary intake and lifestyle of the population which may have led to evolution of obesity as a medical problem. Paediatricians as well as family physicians have a critical role to play in the promotion of cardiovascular health and also to adult diseases that have their origins in childhood [4] . This paper retrospectively reviews the medical records of 52 obese children referred to the paediatric endocrinology clinic of King Khalid University Hospital, Riyadh, between December 1989 and December 1994, for management. Pattern of the etiology of this clinical problem was explored.


   Patients and methods Top


We retrospectively reviewed the medical records of all children referred for assessment of obesity in the paediatric endocrinology clinic over a period of 5 years (December 1989 - December 1994). The patients height and weight were measured by the trained staff of the clinic. The lever balance was made by SECA. The data collected includes age, sex, nationality, and family history of obestiy. The Quetelet Index also known as body mass index (BMI) were calculated as:



Comparison of the BMI of each patient with the reference values of the 95th percentile on the adapted Table was made [5] . Laboratory data which included haemoglobin (Hb), erythrocyte sedimentation rate (ESR), sodium (Na), potassium (K), glucose (glu), cholesterol (choles), triglycerides (TG), calcium (Ca), phosphorous (Ph), alkaline phosphatase (Alk. phosph.), thyroid stimulating hormone (TSH), free thyroxine (FT 4 ) were obtained. The records of adrenal ultrasonography as well as computed tomography of the pituitary gland and hypothalamus were also obtained in those patients whose condition warranted it. The data was fed into a microcomputer and analysed using the StatPac Gold statistical analysis package programme.


   Results Top


The total number of patients referred to the clinic was 56 but 52 of them satisfied our criterion as cases of obesity. The median of their ages was 8 years. 15(28.8%) of the patients were less than 5 years while 37 (71.2%) were above [Table - 1]. 35 (67.3%) were Saudis. 26 (50%) were males. 12 (23.1%) of our cases had a family hisory of obesity, 7 (13.5%) had a family history of diabetes mellitus while 1(1.9%) had a family history of hypertension. 50(96.2%) of them volunteered a history of increased appetite and 37 (71.2%) agreed to have had decreased activity. 3 (5.8%) of the patients agreed to history of skin application of corticosteroids.

Ultrasound of the abdomen was normal in the 23(44.2%) of the 52 patients whose condition warranted the investigation. Computed tomographic scan of the brain was also normal in the 16 (30.8%) of the 52 patients whose condition also warranted the investigation. Bone age was appropriate in all subjects. The mean of the birth weight was 4 kg. The electrolytes were all within normal limits. The mean blood glu was 5 mmol/L, mean choles was 4.3mmol/L and that of Tg was 1.5 mmol/L. All were within normal limits. The bone profile was normal in all the children except one who had pseudohypoparathyroidism. The mean cortisol level was 8.8 µg/dl within a range of (6.5 - 35.5). TSH, T3 and T4 were within normal range with the exception of the one with hypothyroidism. ACTH was not elevated in the 10 children whose condition indicated its measurement. From the etiological diagnosis, we were not able to diagnose pathology in 46 (88.5%) of the patients whom we labelled to have simple nutritional obestiy while 3 had Prader - Willi syndrome, 1 had Laurence - Moon - Biedl syndrome, 1 had pseudohypoparathyroidism and 1 with hypothyroidism [Table - 2].


   Discussion Top


The use of BMI as a measure of adiposity or obesity in adult has been well established. A BMI of 25 to 29.99 is grade 1 overweight, a BMI of 30 to 39.99 is grade 2 overweight while 40 or greater constitutes grade 3 obesity [6] . Other methods like triceps skinfold thickness measurements are difficult to establish and reliability decreases as body fat increases. Inter-observer and intra-observer reliability is also difficulP. Underwater weighing or dual photon absorptiometry are methods that are cumbersome and cannot be used in clinical setting to measure adiposity. A lot of debate as to get a very reliable measure of childhood obesity is still going on but suggestion from the European Childhood Obesity Group and current practices of the National Centre for Health Statistics recommended that BMI greater than the 95th percentile for age and sex represents a reasonable index of adiposity in children and adolescents. This is what was used in this study [5],[8],[9]. There was a household survey which showed a high prevalence of overweight and obesity among Saudi subjects [10] . Some authors have suggested that there are two or possibly three critical periods for the development of obesity and its complication. These are early infancy, the period of rebound between 5 and 7 years and adolescence [11] . In our study, 15 (28.8%) of our subjects were less than 5 years while 37 (71.2%) were above that age. Parents may show gratification to their children by giving them food. In a survey of eating behaviour within families, 25% of mother reported that they used food as a reward for their children [12]. It is widely believed that this community is an affluent one. Obesity is the hallmark of affluence and since the socio-economic condition of the Saudi community has witnessed a tremendous growth over the last 2-3 decades, obesity is expected. This is similar to the report from Singapore where a significantly greater proportions of their cases were in the upper and middle social classes [13] . Genetic factors has also been strongly associated with obesity [14] . Higher birth weight and family history of the problem has been associated. The mean birth weight of our series was 4.0 kg.

Some chronic diseases of adults have been associated with childhood obesity. These are non­insulin dependent diabetes mellitus, hypertension and other cardiovascular diseases [15],[16],[17] . Thus, the need for careful management of childhood obesity is clearly indicated. Obese children are usually subjected to teasing among their peers. This further leads to withdrawal from play groups and then there is further inactivity and perpetuation of the obese state. This could give rise to internal psychological conflict, lower self-esteem and interpersonal sensitivity as they approach adulthood [18],[19],[20] . Unfortunately, we have no facility to assay the level of the hormone leptin in this hospital. The role of the hormone and how it affects children is still not very clear. Studies on the hormone is going on in many parts of the world. It has also been shown that congenital leptin deficiency is associated with severe early-onset obesity in humans [21] . Another study also showed that obese girls have higher leptin levels than boys. These authors also claimed that puberty further increased leptin levels in obese girls [22] .

Saudi Arabia is a country where almost all families possess television. Some workers have also associated television viewing with childhood obesity [23],[24],[25] . This habit prevents energy expenditure and increases the tendency to take chocolates and other food materials at rest. Some children regard this as the only way of recreating. Childhood obesity should be regarded as a public health problem in Saudi Arabia as it leads to approximately 30% of adult obesity [26].

In conclusion, this study showed that simple nutritional disorder was found in 46 (88.5%), 3 (5.8%) had Prader - Willi syndrome while Laurenc Moon - Biedi syndrome, pseudohypoparathyroidism and hypothyroidism were diagnosed in the other three patients respectively. Nutritional (simple, non pathological) obesity is therefore the most common form of obesity in childhood. Endocrine assessment is necessary to rule out pathological causes. Food intake of children should be carefully monitored and outdoor activities should be encouraged as preventive measures of the disease in the Kingdom. Successful weight control is very much challenging and extensive effort needs to be made to help prevent and treat this form of obesity [27].

 
   References Top

1.Flegal KM. Defining obesity in children and adolescents: epidemiological approaches. Crit Rev Food Sci Nutr. 1993;33:307-12.  Back to cited text no. 1    
2.Bray GA. The obese patient. Major problem in internal medicine. Philadelphia: WB Saunders. 1976;219-21.  Back to cited text no. 2    
3.Van Ittalie TB. Health implications of overweight and obesity in the United States. Ann Intern Med. 1985;103:983-8.  Back to cited text no. 3    
4.Bronfin DR, Urbina EM. The role of pediatrician in the promotion of cardiovascular health. Am J Med Sci. 1995;310 (Suppl 1):S42-7.  Back to cited text no. 4    
5.Schwartz MW. Pediatric primary care: A problem oriented appraoch, 2nd edn. Chicago: Year Book Medical Publishers. 1990:114.  Back to cited text no. 5    
6.World Health Organization: Report of an Expert Committee. Physicial status: The use and interpretation of anthropometry. Geneva: World Health Organization: 1995.  Back to cited text no. 6    
7.Dietz WH, Robinson TN. Use of the body mass index (BMI) as a measure of overweight in children and adolescents. J Paediatr.1998;132:191-3.  Back to cited text no. 7    
8.Poskitt EME. Defining childhood obesity: The relative body mass index (BMI). Acta Paediatr. 1995;84:961-3.  Back to cited text no. 8    
9.Troiamo RP, Flegal KM, Kuczmarski RJ, et al. Overweight prevalence and trends for children and adolescents: The National Health and Nutrition Surveys. 1963 to 1991. Arch Paediatr Adolesc Med. 1995; 149:1085-91.  Back to cited text no. 9    
10.Al-Nuaim AR, Al-Rubeaan K, Al-Mazrou Y, et al. High prevalence of overweight and obesity in Saudi Arabia. Int J Obes Relat Metab Disord. 1996;20:547-52.  Back to cited text no. 10    
11.Dietz WH. Critical periods in childhood for the development of obesity. Am J Clin Nutr. 1994;59:955-9.  Back to cited text no. 11    
12.Bryan MS, Lowenberg ME. The father's influence on young childrens's food preferences. J Am Diet Assoc. 1958;34:30-5.  Back to cited text no. 12    
13.Ho TF, Yip WC, Tay JS, et al. Social class distribution of obese Chinese children. J Singapore Paediatr Soc. 1991;33:55-8.  Back to cited text no. 13    
14.Klish WJ. Childhood obesity: Pathophysiololgy and treatment. Acta Paediatr Jpn. 1995;37:1-6.  Back to cited text no. 14    
15.Rocchini AP. Adolescent obesity and hypertension. Paediatr Clin North Am. 1993;40:81-92.  Back to cited text no. 15    
16.Harris SB, Perkins BA, Whalen-Brough E. Non-insulin­dependent diabetes mellitus among First Nations children. New entity among First Nations people of northwestern Ontario. Can Fam Physician. 1996;42:869-76.  Back to cited text no. 16    
17.Bronnet- YL. Nutritional status outcomes for children: ethnic, cultural and environmental contests. J Am Diet Assoc. 1996;96:891-903.  Back to cited text no. 17    
18.Mills JK, Andrianopoulos GD. The relationship between childhood onset obesity and psychopathology in adulthood. J Psychol. 1993;127:547-51.  Back to cited text no. 18    
19.Mills JK. A note on interpersonal sensitivity and psychotic symptomatology in obese adult outpatients with a history of childhood obesity. J Psychol. 1995;129:345-8.  Back to cited text no. 19    
20.French SA, Story M, Perry CL. Self-esteem and obesity in children and adolescents: A literature review. Obes Res. 1995;3:479-90.  Back to cited text no. 20    
21.Montague CT, Sadaf Faroogi 1, Whitehead JP, et al. Congenital leptin deficiency is associated with severe early­onset obesity in humans. Nature. 1997;387:903-8.  Back to cited text no. 21    
22.Lahlou N, Laudais P, De-Boissiey D, et al. Circulating leptin in normal children and during the dynamic phase of juvenile obesity. Relation to body fatness, energy metabolism calorie intake and sexual dimorphism. Diabetes. 1997;46:989-93.  Back to cited text no. 22    
23.Gupta RK, Saini DP, Acharya U, et al. Impact of television on children. Indian J Pediatr. 1994;61:153-9.  Back to cited text no. 23    
24.Klesges RC, Shelton ML, Klesges LM. Effects of television on metabolic rate: Potential implications for childhood obesity. Pediatric. 1993;91:281-6.  Back to cited text no. 24    
25.Dietz W. Factors associated with childhood obesity. Nutrition. 1991;7:290-1.  Back to cited text no. 25    
26.Dietz WH. Therapeutic strategies in childhood obesity. Horm Res. 1993;39(Suppl 3):86-90.  Back to cited text no. 26    
27.Epstein LH. Exercise in the treatment of childhood obesity. Int J Obes Relat Metab Disord. 1995;19(Suppl 4):Sl 17-21.  Back to cited text no. 27    

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Correspondence Address:
Abdullah S Al Herbish
P.O. Box 90533, Riyadh 11623
Saudi Arabia
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Source of Support: None, Conflict of Interest: None


PMID: 19864750

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