Obesity side-effects in children worse than first feared

Dr Grace O’Malley, who treats obesity at Temple Street children’s hospital

Lynne Kelleher

Worrying new complications are being diagnosed in Irish children with severe obesity to add to an already long list of devastating side-effects.

High blood pressure, joint pain, breathlessness, liver problems, high blood sugar levels, anxiety, constipation and incontinence are all known health issues in children with the condition.

But chronic headaches, self-harm, and physical or learning disabilities are among the side effects too.

These are being noted by health professionals at Temple Street children’s hospital, Dublin, at the country’s only clinical multi-disciplinary service for youngsters with obesity.

Around 320 children aged two to 16 are being treated for obesity at the W82GO Child and Adolescent Weight Management Service but there are usually around 250 on the waiting list.

Dr Grace O’Malley, who heads up the service, said the complications can affect all facets of a child’s life.

“High blood pressure can lead to headaches or difficulties with vision, which can make movement and play difficult and lead to children not wanting to participate in the daily tasks of childhood like playing and having fun”, the specialist physiotherapist said.

“If these complications are not picked up and managed the child is more likely to have a reduced quality of life and for his or her options in the future to be narrowed, for example if they withdraw from school.

“A difficult cycle of pain, reduced function and progression of obesity can occur which can then lead to higher risk of early heart disease, stroke, arthritis, certain cancers and disability into adulthood.

“Other complications including incontinence or poly-cystic ovary syndrome which can affect health and development in our girls with longer-term impacts on well-being, fertility and reproductive health.

“For people who believe these children are not deserving of treatment or that it might be a waste of money it’s important to remember the cost of failing to care for these children will be far greater in adulthood.”

Children have started to attend the clinic at Temple Street again after substantial numbers of appointments were postponed or cancelled last year due to the pandemic.

“It does seem like families really struggled throughout 2020”, said Dr O’Malley.

“We have not examined this yet through audit or a research study but on the surface we have seen some children for whom the lack of routine without school or other activities has led to large weight gains and progression of complications including higher levels of anxiety, poorer levels of fitness, more disturbed sleeping.

"Eating behaviours have been affected including disrupted meal routines, more take-aways and more snacking.”

Some children became more worried about their health while some families benefited from being able to spend more time with their children.

Referrals to the clinic increased by 30pc from 2019-2020 as the three children’s hospitals amalgamated and the clinic can now accept from all Children’s Health Ireland consultants.

“At the moment, we have 1.8 full-time clinical staff, which is totally inadequate as our service is currently the only clinical multi-disciplinary service for children and adolescents with obesity in Ireland”, Dr O’Malley said.

“It is absolutely crazy that we only have enough funding to support a paediatric dietitian working part-time in our national service.

"Hopefully, the model of care for obesity will soon be implemented and we will see investment on the ground in order to support these very vulnerable children.

“We need to better understand that severe obesity is not something that can be addressed overnight or with short-term interventions.

"There is no one-size-fits-all approach to this and each child has a right to access healthcare in order to have a holistic clinical assessment and appropriate treatment.

“In the case of healthcare for children it is certainly never the child’s fault that treatment does not work as we hope it will.”

She said the State needed to invest in health interventions to prevent the development of overweight and progression of obesity for all children.

“These might include increasing breast-feeding and early-feeding support for mothers and fathers, restricting advertisement and marketing of energy-dense edible products and beverages,” she said.

Other tactics include ensuring drinkable water in public spaces and schools, ‘normalising’ growth monitoring for children, ring-fencing funding for public health nurses in child-health, and ensuring early intervention for overweight children.

“For those children and adolescents already diagnosed with obesity, we need to offer treatment and ongoing care following a chronic-care model,” she said.