Adolescent Obesity's Impact on Urological Disease
Obesity is a major national health concern, according to the Centers for Disease Control and Prevention (CDC).1 More than one-third of American adults are obese, and related medical costs reached $147 billion in 2008 — and the problem is not limited to adults. The number of obese children has more than tripled in the past three decades, with nearly 20% of children falling into the obese category in 2008, according to the CDC.2 While people often think of cardiovascular risks and diseases such as diabetes when it comes to obesity, there are other potential health problems, such as an increased risk of renal disease, that are now being linked to obesity in adolescence. Below, Dr. Christopher Saigal, MD, MPH, associate professor of urology at UCLS Santa Monica, talks about the potential risks and treatment issues related to obese adolescents.
A few recent journal articles have noted connections between obesity in adolescence and health problems (e.g., lower testosterone levels, increased risk for urological disorders).3,4 What types of cases are you increasingly seeing in your practice related to adolescent obesity?
One condition that we have seen is an increased incidence of kidney stones in younger individuals. The development of kidney stones is clearly linked to lifestyle choices (such as excessive meat consumption), obesity, and the metabolic changes that occur in obese patients.
Statistics show that the number of younger people with kidney stones has increased 4% each year for the past 25 years. That represents a real problem, and I'm sure it's related to increasing rates of obesity.
Obesity also affects hormone levels, namely the sex hormone-binding globulin (SHBG), which can reduce the availability of testosterone within the body. Reduced testosterone can lead to sexual dysfunction. With an increasing number of obese adolescents, it's likely that we will begin to see individuals suffering from sexual dysfunction at younger ages than in the past.
With obesity comes high blood pressure, diabetes, and hypercholesterolemia, which can lead to renal damage later in life. Obese adolescents may also have a higher risk of renal and prostate cancers later in life. Fat is an endocrine organ — it produces a milieu of endocrine hormones that promote inflammation and potentially cancers.
Should urologists work with primary care physicians and/or pediatricians on this issue to identify at-risk patients earlier? What should that process ideally look like?
The medical profession is increasingly focusing on patient-centered care — specialists working together with primary care providers to maintain the patient's health. Urologists should seek opportunities for cross-disciplinary collaborations.
Pediatric urologists who work with adolescent patients might want to consider e-mailing the primary care physicians of their patients to make sure they are on the same page. There are not many transdisciplinary clinics where the surgeons and medical specialists work together, but care is moving in that direction. And that may be the way medicine is practiced in the future.What challenges do obese patients with urological disorders present, and how do you handle them? Are there specific conditions that should be treated differently?
The biggest problem for urologists is really related to surgery. We need to use special equipment and tools for the morbidly obese. It's more difficult to open the abdomen of obese patients, and they are more at risk for wound complications, infections, and incisional hernias. They are also at risk for complications, such as cardiac issues, during the surgery itself.
There is also the issue of medical imaging. Urologists rely heavily on CT scans and MRIs, but often morbidly obese patients won't fit into the scanner, which makes it very difficult for the physician and embarrassing for the patient. In extreme cases, we've had to send patients to veterinary facilities for imaging because they are better equipped to handle their size.
When it comes to treatment, physicians working with obese patients shouldn't jump right to medication for problems, such as sexual dysfunction. Often these patients don't need a prescription for drugs like Viagra; they simply need to lose weight and exercise to manage their disease. There is also some evidence that for men with low-risk prostate cancer, which is under surveillance, lifestyle changes may prevent changes to their condition, such as the detection of fewer suspicious PSA levels.
For patients suffering from kidney stones, dietary changes are critical in preventing a recurrence. But it can be challenging to encourage people to make lifestyle changes to improve their health. In adult men, sexual dysfunction risk is a nice carrot that physicians can use to lead a patient to take his weight issues seriously. In adolescents who have actually suffered a painful kidney stone, they may gain motivation for lifestyle changes to prevent another.
1. Centers for Disease Control and Prevention. Adult Obesity Facts. Available at http://www.cdc.gov/obesity/data/adult.html. Accessed on Nov. 27, 2012.
2. Centers for Disease Control and Prevention. Childhood obesity facts. Available at: http://www.cdc.gov/healthyyouth/obesity/facts.htm. Accessed on Nov. 27, 2012.
3. Mogri M, Dhindsa S, Quattrin T, et al. Testosterone Concentrations in Young Pubertal and Post-Pubertal Obese Males. Clin Endocrinol. 2012 Sep 13. [Epub ahead of print].
4. Vivante A, Golan E, Tzur D, et al. Body Mass Index in 1.2 Million Adolescents and Risk for End-Stage Renal Disease. Arch Intern Med. 2012;172(21):1644–1650.