High Blood Pressure and Obesity in Children and Teens
By Dr. Cheryl Cammock
In my office at Wake Forest Baptist Medical Center I see children and teenagers referred to me for high blood pressure by pediatricians throughout the region. Their parents are often surprised. “How can my child have high blood pressure?” they ask. “That’s not a childhood condition.”
Until recently they were correct. High blood pressure in children was rare, caused by other underlying medical conditions, such as heart or kidney disease or a birth defect that affects circulation. But the epidemic in obesity among children and teenagers means that today young people suffer the health problems of middle-aged adults.
Most of the children and almost all of the teenagers I see in my clinic for high blood pressure are obese. Many of them also have high cholesterol and show signs of early diabetes. The high blood pressure may not cause any symptoms. That’s why in adults it’s known as the silent killer. But we know that left untreated, high blood pressure puts young people at risk for heart disease later in life.
In adults, we’ve known for years that high blood pressure often leads to heart disease and stroke. We don’t know exactly what high blood pressure in a child means for his long-term health. Will he develop heart disease as a 30-year-old man, a stroke at 35? But I do know that in many of my patients I can already see that the heart wall has thickened, a condition known as hypertrophy, which develops when the heart pumps against the higher blood pressure.
Let’s start with the facts.
According to figures published by the Centers for Disease Control and Prevention, 17 percent of children and teenagers are now considered obese, which means that their weight puts them in the 95th percentile or above for other children of their age and height. Obesity rates have tripled in the last 30 years. We don’t have good records on high blood pressure in children, but those of us in pediatric cardiology know that every year we see more children with high blood pressure.
Public health officials track obesity rates by age, race and other demographic factors. For example, low-income children often have higher rates of obesity than children in more affluent families. In North Carolina, more than 20 percent of children in low-income families are obese, which worries me because I’m sure many of them have untreated high blood pressure. It also worries me that obesity starts at such a young age. Across the state, more than 15 percent of 2-to-4-year-olds are obese, with rates as high as 20 percent in Surry County, 18 percent in Wilkes and nearly 18 percent in Yadkin.
As part of my work as a pediatric cardiologist, I run a clinic for a condition we now call “metabolic syndrome,” which includes high blood pressure, abnormal cholesterol and blood fat content, diabetes and other conditions caused by childhood obesity.
I start treatment by talking with my patients and their parents about diet and exercise. Many have heard the advice before. Cut down on soft drinks. Eat fruits and vegetables. Avoid fast food and processed foods. Drink plenty of water. Limit TV and computer time to less than two hours a day. Get outside and play. Join a sports team. Take a walk. Dance.
After working with overweight children and their families for several years now, I understand that the hardest thing about losing weight is making lifestyle changes and children can’t make those changes on their own. Their parents and brothers and sisters need to commit to a better diet too, and someone needs to encourage that child or teenager to exercise.
In most cases, my patients can’t make the changes they need to lower their blood pressure without medication. We use the same medicines in children that we use in adults. These include ace inhibitors, beta blockers and calcium channel blockers.
I’ve learned too that it’s hard to get a teenager to think about the effect their weight may have on their heart 20 years from now. They don’t see their high blood pressure as an immediate danger. They don’t feel any symptoms and they don’t understand why we bother treating it.
Some time ago I asked one of my patients, a 13-year-old girl, what she saw as the benefit of treating her high blood pressure and obesity. She didn’t say anything about preventing heart disease or protecting her kidneys. Her concerns were more immediate. “I guess I can get better clothes,” she said.
After that, I stopped talking with my patients as much about heart disease and stroke. Now I ask them how controlling their blood pressure and losing weight will change their lives. If they don’t have an answer, I talk about things I think will resonate with them. Do you think losing weight will give you more energy? Or help you do better in sports. Or maybe you’ll be able to get those jeans you like so much.
I’m happy to talk about clothes and sports if that’s what it takes to motivate my young patients to lose weight. They may not care yet about their health 20 years from now. But I do. And I know that controlling high blood pressure in children and teenagers will improve their health over their lifetimes.
Dr. Cheryl E. Cammock is an assistant professor of pediatrics at Wake Forest Baptist Medical Center. She may be reached at firstname.lastname@example.org.
Learn more about our pediatric cardiology services at Brenner Children's Hospital.