Children with obesity show signs of liver disease from age nine
SIGNS of liver disease are emerging in Irish children with obesity as young as nine, according to one expert.
Dr Grace O’Malley, who runs the Obesity Service in Children’s Health Ireland at Temple Street Hospital, said liver disease was one of the silent and distressing conditions linked to childhood obesity.
Other complaints include incontinence, painful joints and gynaecological issues, and mental health conditions linked to stigma and bullying.
New figures also show that the number of children under 12 attending the nation’s only specialist paediatric service has jumped from 40pc in 2016 to 66pc last year.
While society often blamed parents, Dr O’Malley said it had become increasingly difficult for mothers and fathers to figure out which foods were healthy in supermarkets due to marketing by big industry.
The W82Go Service at Temple Street offered nearly 3,000 patient appointments to children in 2017 and 2018 with the majority treated for morbid obesity — 227 were new patients.
But young patients can face long waits to be referred to paediatric care before a further referral to the clinic for specialised treatment.
Dr O’Malley said: “From the numbers from our own clinic the time waiting for a general paediatric appointment for obesity in Temple Street is between 12 and 24 months based on those we have seen over the past two years.”
Also the leader of a research team at the Royal College of Surgeon of Ireland, Dr O’Malley said cases were becoming more complex. “We are seeing more non-alcoholic fatty liver disease. We see this from nine years of age.
“It’s known as a silent disease because it’s unchecked for a long time and can lead to scarring of the liver and liver problems further down the line. We didn’t see this in children until the last maybe 15 or 20 years.
“Sometimes parents aren’t aware of this, they are aware of the breathing difficulties or the pain or the bullying but the other conditions can be more silent. The good news is that we can have a good effect on non-alcoholic fatty liver disease with treatment.”
She said early intervention was vital for children with morbid obesity: “There is a bit of a crisis to be honest. Access to paediatric dietetics is one issue and psychology is another, particularly [in relation] to meeting the acute mental health difficulties.”
Growing Up In Ireland data suggests that around 7pc of adolescents, or around 70,000 young people, are classified as being obese. While data from the World Health Organisation COSI study led in Ireland by UCD suggests that nearly 2pc or 20,000 children are estimated to be severely obese.
Dr O’Malley said youngsters can suffer other conditions related to obesity.
“There are also risks of gynaecological difficulties like polycystic ovary syndrome and incontinence issues for children with more severe obesity, particularly for girls.
“Research suggests that polycystic ovary syndrome can affect fertility into adulthood. It’s very important that these girls can access assessment and treatment,” she said.
“With incontinence it is very challenging because the child won’t want to move or play because then they leak. More often than not it’s because the muscles don’t have the endurance to work against the weight but there can also be other causes.”
Muscle and bone problems in children are another feature of childhood obesity.
“Due to inadequate nutrition kids may have poor bone health and if they fall they are more likely to fracture, there can be underlying inflammation and they can also have painful joints. Because the bones are just developing in the early years there can be bowing of the tibia bone which can need surgery.”
The biggest concern for Dr O’Malley was the undercurrent of stigma and discrimination. “It is sowing seeds that obesity it is the child’s fault, the family’s fault or a particular community’s fault.”