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.