Original ArticlesSevere obesity associated with cardiovascular deconditioning, high prevalence of cardiovascular risk factors, diabetes mellitus/hyperinsulinemia, and respiratory compromise
Section snippets
Methods
Forty eight children and adolescents from a specialized center for the management of obesity were studied. The study entry criterion was the presence of BMI ≥40 kg/m2. The cohort represents approximately 80% of patients with BMI ≥40 kg/m2 currently being followed. All study children underwent a complete laboratory evaluation of the cardiac and respiratory systems. Review of medical records for this report was approved by the Institutional Review Board of the A. I. duPont Hospital for Children.
Results
The cohort was comprised of 48 children and adolescents with a mean age of 14.2 years (range, 8-17.6 years); there were 26 girls and 22 boys. Average BMI was 45.5 ± 4.3 kg/m2. Results of the graded exercise test are presented in Table I, stratified by the presence of a maximal or submaximal effort. The rate of those achieving the anaerobic threshold (26/48 [54%]) is well below that of leaner patients who exercised for other indications in our laboratory, about 80%. Those with a submaximal
Discussion
Obese children with BMI ≥40 presenting to a referral center for clinical management have substantial cardiovascular and respiratory morbidity. Severe physical deconditioning, hyperinsulinemia, dyslipidemia, and respiratory abnormalities were present in the majority of patients. Hypertension, LV hypertrophy, and diabetes mellitus were present in 15% to 20%. The average value for LV mass in this cohort is higher than the value obtained in a recent series of children with chronic hypertension.11
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