Inadequate iron intake may results in symptoms of fatigue and iron deficiency anemia. Iron needs increase during growth spurts, which is why teens are more likely to suffer from iron deficiency anemia. Teenage girls are especially prone to anemia. Student athletes are also vulnerable to inadequate iron intakes, severely restrictive eating patterns, and use of inappropriate nutritional and vitamin supplements. Adolescents should be counseled on specific and healthy dietary choices (see Chapter 70).
Childhood obesity is an epidemic in the United States. Data indicate that approximately 17% of children in the United States ages 2 to 20 are obese (body mass index of ≥95th percentile) and more than 30% of U.S. adults are obese. Many obese children become obese adults, and the risk of remaining obese increases with age and degree of obesity. Obesity runs in families and is rarely related to genetic influences. The largest increases in the prevalence of obesity are seen in the most severely overweight classifications and in certain ethnic groups, such as African-American and Mexican-American children. In 2008, obesity cost the nation $147 billion in medical costs. The associations between obesity and television watching and excessive dietary intake as well as the different rates of obesity observed in urban versus rural areas support the important influence of environment. One important risk factor is maternal obesity during pregnancy. Children born to obese mothers are three to five times more likely to be obese in childhood. Women who gain much more weight than recommended during pregnancy have children who have a higher BMI than normal in adolescence. Also, some small for gestational age (SGA) newborns have higher risks for abnormal postnatal weight gain and diabetes.
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Complications of obesity in children and adolescents can affect virtually every major organ system. High BMI increases the risk of metabolic and cardiovascular diseases and some cancers; it is also the most important modifiable risk factor for glycemia and diabetes. The history and physical examination should screen for many potential complications noted among obese patients (Table 29-1), in addition to specific syndromes associated with obesity (Table 29-2). Medical complications are often related to the degree of obesity and usually decrease in severity or resolve with weight reduction. Obesity is associated with the presence of precursors of coronary heart disease that are already evident in 12and 13-year-old children. Type 2 diabetes is also increasing in children.
The diagnosis of obesity depends on the measurement of excess body fat. Actual measurement of body composition is not practical in most clinical situations.
Psychosocial Peer discrimination, teasing, reduced college acceptance, isolation, depression, eating disorders (binge-eating), reduced job promotion*
Growth Advance bone age, increased height, early menarche
Cardiovascular Hypertension, cardiac hypertrophy, arrhythmias, ischemic heart disease,* sudden death*
Orthopedic Slipped capital femoral epiphysis, Blount disease
Metabolic Insulin resistance, type 2 diabetes mellitus, hypertriglyceridemia, hypercholesterolemia, gout,* hepatic steatosis, polycystic ovary disease, cholelithiasis *Complications unusual until adulthood.