Childhood Obesity and Disrupted Puberty

See our Podcast

You can listen to a longer discussion on obesity in children and its effects on puberty on episode 1 of our podcast, Dr Schwartz and Mr Power. 

Increasing Childhood Obesity

The incidence of childhood obesity has been steadily increasing in middle- and high-income countries for the past 30 year. In fact, a recent (UNICEF) report showed that children with obesity outnumber those who are underfed for the first time. This is partly a good news story, as this statistic is the result of a steady decrease in the number of underfed children, not just the increase in the incidence of obesity. But even with this silver lining the fact remains that more children currently suffer from obesity than ever before.

Obesity in children is associated with a wide range of negative health effects including diabetes, metabolic syndrome, sleep disruption, joint pain, decreased vascular health, and low self-esteem and depression. What's perhaps less widely known is the potential effect of childhood obesity on normal development.

Disrupted Puberty

Obesity in children can also lead to disrupted puberty in adolescents. Interestingly, the way it does this is different in boys versus girls. In the case of girls, it can lead to early onset of puberty. In boys, it's the opposite, with obesity being linked to the late onset of puberty. This disruption to puberty is more than just a timing issue, and has been linked to negative health effects in both boys and girls.

In girls, childhood obesity is associated with early (or precocious) puberty. This early onset of puberty is linked with:

• lower adult height
• metabolic syndrome
• some cancers
• psychosocial effects

Firstly, don't panic. These are obviously serious potential outcomes, but they're also not inevitable. Importantly, the increased relative risk of cancer (the most alarming item on the list for most people) is low. That said, these are real concerns and childhood obesity should be taken seriously. 

In boys, childhood obesity is linked with delayed onset of puberty. This late onset is associated with:

• lower adult height
• metabolic syndrome 
• low fertility and poor sperm motility
• psychosocial effects

As with girls, this is an alarming list. And again, there's no need to panic. The point is to take is seriously and take action. 

Not Just "Baby Weight"

It's important to understand that there's a strong link between childhood obesity and adult obesity. According to a systematic review and meta-analysis by Simmonds and colleagues:

• approximately 55% of children with obesity became adolescents with obesity
• approximately 80% of adolescents with obesity became adults with obesity
• overall, children and adolescents with obesity were 5 times more likely to become adults with obesity

It's clear from this data that contrary to the idea of children with obesity merely carrying "baby weight", obesity can be considered "sticky". Once you have it, it's hard to get rid of it.

What to do bout it

There are a number of strategies to address childhood obesity, but the best is prevention. As stated above, obesity is sticky. Once a child (or adult) has obesity, it's much more difficult to deal with; but not impossible. Creating an environment that supports healthy eating patterns, food choices and activity levels is key.

But what if it's too late for prevention? The well informed reader might point out that lifestyle interventions alone have a poor track record for resolving obesity, and they're right. However, lifestyle interventions have a positive impact on health and still have in important role in managing weight, body composition, and health. 

And of course no discussion on obesity would be complete without mentioning GLP-1 agonists such as Ozempic and Wygovy. As we discuss below, these therapeutics can be a powerful tool in managing childhood obesity. 

When to Talk to a Physician

There are actually two questions here. When to talk to a physician about childhood obesity, and when to talk to a physician about early or late puberty. Historically, there wasn't much a physician could do to help you with obesity. That's all changed with the advent of GLP-1 agonists like Ozempic/Wygovy/mounjaro. Check out our article on training considerations on GLP-1 agonists here.

It's hard to overstate the impact GLP-1 agonists have had on the treatment of obesity. They truly are life-saving for some people. What's less well known is that they're also a viable option for use in children. At the time of writing this, GLP-1 agonists have been approved for children as young as 12 years. To be clear, these drugs aren't an argument against lifestyle intervention. In fact, lifestyle intervention combined with pharmaceutical intervention has been found to be more effective than either alone.

So what about disrupted puberty? When we talk about early or late puberty, we mean significantly earlier or later than average. In the case of early puberty we're talking about outward signs of puberty as early as 8 in girls, or 9 in boys.

For late-onset puberty, girls who haven't had a period by 16 years might be experiencing late onset. For boys, late onset puberty could be an issue if there's no testicular enlargement by 14 years.

So the answer to both questions is to consult a physician when you're concerned. This might sound like a vague answer, but I hope the above information can inform when you should be concerned.

Wrapping it up

Childhood obesity is a serious health concern with unique implications for boys and girls, but there's no need to panic. It's not necessarily easy, be effective tools and strategies are available. If you're looking for effective nutrition, exercise, and lifestyle strategies send us a message here. 

If you or your child are pursuing a medically assisted strategy like GLP-1 agonists, we can help there too. Research has shown that combining lifestyle with pharmaceutical intervention is more effective than pharmaceutical intervention on its own.