Severe obesity associated with cardiovascular deconditioning, high prevalence of cardiovascular risk factors, diabetes mellitus/hyperinsulinemia, and respiratory compromise

Objective To determine the extent and severity of obesity-related cardiorespiratory morbidity in children with body mass index (BMI) ≥40 kg/m². Study design Cross-sectional analysis of a cohort comprised of 48 boys and girls aged 8 to 17 years with BMI ≥40 kg/m². Cardiorespiratory fitness (graded cycle exercise test), left ventricular (LV) mass (echocardiography), blood pressure, fasting lipid profile, fasting insulin, fasting glucose, HbA1c, and pulmonary function (spirometry and sleep studies) were measured. Results The cohort averaged 14.2 ± 2 years of age with mean BMI of 45.5 kg/m². Only 2 patients had normal fitness; 37 of 48 had peak oxygen consumption <20 mL O₂/minute. Hypertension was present in 10 of 48 patients. Mean lipid values were: triglycerides 103 ± 48 mg/dL, HDL cholesterol 41 ± 10 mg/dL, and LDL cholesterol 108 ± 26 mg/dL. Type II diabetes mellitus was diagnosed in 6 patients. Mean fasting insulin was 31 ± 19 μU/mL. Asthma treatment, small airways disease by pulmonary function testing, or both were present in 35 of 48 patients; upper airway obstruction was present in 7 patients. LV hypertrophy was present in 8 patients, with a mean LV mass of 43 ± 11 g/m^2.7. Conclusions Children and adolescents with BMI ≥40 kg/m² have substantial cardiorespiratory morbidity including severe physical deconditioning.