More on the Weird World of Childhood Obesity

ball of string

Lousy math grades, bra size, snoring, mushrooms, the U.S. armed forces, and a theory that bigger clothes might be causing bigger kids… What all these things have in common is a connection with the childhood obesity epidemic, in some way that may seem bizarre or even frightening, depending on point of view.

Snoring seems humorous at first glance, but a second look reveals it to be serious as a heart attack. No kidding. Dr. Lisa Shives says:

We are seeing pre-teens who have what we use to think of as adult diseases such as high blood pressure, pulmonary hypertension, heart disease and congestive heart failure.

Why does a child snore? Because the airway gets blocked. Sometimes they just make a funny noise, and sometimes they stop breathing for a spell, and abruptly wake up — that’s the apnea part. Apparently, it can change the entire metabolism for the worse, or so concluded a study performed at Children’s Hospital in Los Angeles.

Dr. Sally Davidson Ward explained that being aroused from sleep can activate the body’s fight-or-flight reflex. After that happens enough times, there can be strange effects on a child’s insulin sensitivity and ability to metabolize glucose. This is the pathway to diabetes and obesity.

Snoring not only can eventually cause obesity, it is caused by obesity, in another of those vicious cycles for which the entire childhood obesity is so well-known. That was in fact the very phrase used by Dr. Lisa Shives as title of her article, “Vicious cycle of sleep apnea and obesity in kids.”

She makes the point that obstructive sleep apnea (OSA) is one of those conditions that used to be seen almost exclusively in adult patients, and some skinny kids whose problem was usually solved by a tonsillectomy. Nowadays, there are a lot of obese children, and more than half of them have sleep apnea. Dr. Shives says:

Overweight or obese children are not such an easy fix. They usually present with loud snoring and significant daytime sleepiness. In obese children, the tonsils often become enlarged due to fatty tissues in the upper airway. Fat deposits in the neck and chest also add to the collapsibility of the upper airway during sleep. Unfortunately, a tonsillectomy/adenoidectomy is curative in only about 50% of overweight kids who have OSA.

Sleep deprivation, such as that caused by OSA, also messes with ghrelin and leptin, the hormones that influence hunger and satiety. Even when a child stays in bed for what seems like a sufficient time each night, the constant partial awakenings caused by the apnea have about the same effect on the body as if the child were only allowed four or five hours of sleep. It’s a lot of wear and tear.

As far back as 2006, researchers at the National Center for Biotechnology were tossing around a theory about the “shared etiologic pathways” found among a large number of seemingly unrelated health conditions:

[…] different manifestations of the same underlying dysfunction, a phenomenon we term environmental oversampling syndrome… Environmental oversampling syndrome may represent an even more inclusive concept that encompasses various metabolic, inflammatory, and behavioral conditions.

Apparently disparate conditions such as insulin resistance, diabetes, hypertension, syndrome X, obesity, ADHD, depression, psychosis, sleep apnea, inflammation, autism, and schizophrenia may operate through common pathways, and treatments used exclusively for one of these conditions may prove beneficial for the others.

What first made these scientists curious was the counter-intuitive relationship between childhood obesity and attention deficit hyperactivity disorder (ADHD). Seemingly, those two things would not be expected in the same child. According to common sense, all that hyperactivity would work off the calories and keep the child slim. Only, it doesn’t work that way. The research team says:

Instead, obesity and ADHD demonstrate significant comorbidity… Moreover, the pathogenic mechanisms of these conditions may overlap such that nutritional excess contributes to ADHD and cognitive hyperstimulation contributes to obesity.

In other words, obesity and ADHD feed off each other, just like sleep apnea and obesity feed off each other. It’s all like a big tangled ball of string, with cause and effect intertwined, and the important thing right now is to find a loose end and start pulling.

Your responses and feedback are welcome!

Source: “Study links snoring with childhood obesity,” NBC Latino, 11/01/12
Source: “Vicious cycle of sleep apnea and obesity in kids,” The Chart, 02/17/12
Source: “Obesity and ADHD,” PubMed, 2006
Image by cliffchen 1973.

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OVERWEIGHT: What Kids Say explores the obesity problem from the often-overlooked perspective of children struggling with being overweight.

About Dr. Robert A. Pretlow

Dr. Robert A. Pretlow is a pediatrician and childhood obesity specialist. He has been researching and spreading awareness on the childhood obesity epidemic in the US for more than a decade.
You can contact Dr. Pretlow at:


Dr. Pretlow’s invited presentation at the American Society of Animal Science 2020 Conference
What’s Causing Obesity in Companion Animals and What Can We Do About It

Dr. Pretlow’s invited presentation at the World Obesity Federation 2019 Conference:
Food/Eating Addiction and the Displacement Mechanism

Dr. Pretlow’s Multi-Center Clinical Trial Kick-off Speech 2018:
Obesity: Tackling the Root Cause

Dr. Pretlow’s 2017 Workshop on
Treatment of Obesity Using the Addiction Model

Dr. Pretlow’s invited presentation for
TEC and UNC 2016

Dr. Pretlow’s invited presentation at the 2015 Obesity Summit in London, UK.

Dr. Pretlow’s invited keynote at the 2014 European Childhood Obesity Group Congress in Salzburg, Austria.

Dr. Pretlow’s presentation at the 2013 European Congress on Obesity in Liverpool, UK.

Dr. Pretlow’s presentation at the 2011 International Conference on Childhood Obesity in Lisbon, Portugal.

Dr. Pretlow’s presentation at the 2010 Uniting Against Childhood Obesity Conference in Houston, TX.

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