Obesity in childhood is not simply a matter of being too fat. In UK and many other countries conditions previously associated with adult obesity are now seen not only in obese adolescents but in quite young children (Pinhas-Hamiel et al. 1996). With many of these children there may be a genetic predisposition to the medical complication (for example an underlying familial hyperlipidaemia or a family history of type 2 diabetes) but the child's obesity precipitates clinical manifestations of disease decades earlier than would have been expected had there been no obesity. Not all studies are so gloomy (Srinivasan et al. 2003; Lawlor et al. 2006) but it has been suggested that a consequence of the high prevalence of obesity and its co-morbidities in childhood, if these persist, will be a fall in the mean lifespan of the current generation of children compared with that expected for their parents (Olshansky et al. 2005). Table 6.1 lists some of the complications which may develop or be exacerbated by obesity in childhood. In Chapter 5 we outlined some specific points in the clinical examination of obese children which included looking for clinical signs of these conditions. Here we elaborate on the conditions that may be found and their implications.

Orthopaedic problems

Non-specific aches and pains are not uncommon amongst obese children. These may be due to the weight of the child putting a strain on joints and ligaments or they may be the consequence of mild exercise in children whose lifestyle has made them unfit and thus uncomfortable with even minor activity.