Childhood Obesity Greatly Increases Likelihood of a Cranial Disorder that may Cause Blindness

PASADENA, Calif. – Children who are overweight or obese – particularly older, non-Hispanic white girls – are more likely to have a neurological disorder known as idiopathic intracranial hypertension, a rare condition that can result in blindness, according to a new Kaiser Permanente study published in The Journal of Pediatrics.

In a cross-sectional, population-based study of 900,000 young people ages 2–19 years old, researchers found 78 cases of pediatric idiopathic intracranial hypertension. The condition occurred most frequently in overweight or obese, non-Hispanic white teenage girls – 85 percent of the children with IIH were girls 11–19, nearly half were non-Hispanic white, and 73 percent were overweight or obese.

Importantly, the study also found a strong association between IIH and increasing weight class: extremely obese adolescents were 16 times more likely than normal weight children to have IIH; moderately obese children, six times more likely; and overweight children, 3.5 times more likely.

Childhood obesity has again been shown to be associated with a serious disease, said study lead author Sonu M. Brara, MD, of the Kaiser Permanente Los Angeles Medical Center Neurology Department. This research is the strongest evidence to date that obesity is associated with IIH in children – it also suggests that the childhood obesity epidemic is likely to lead to increased morbidity from IIH, including blindness.

This study adds to the growing evidence base about data on the prevalence of obesity and prevention of it among children. Earlier this month, the Institute of Medicine released its Accelerating Progress in Obesity Prevention offering recommendations, strategies and action steps for stakeholders and sectors to accelerate progress in preventing obesity.

In adults, IIH is a relatively rare disorder that predominately affects overweight or obese women ages 20 to 44 with an incidence rate of 15–19 per 100,000 individuals. The disorder is characterized by increased pressure around the brain in the absence of other diseases, with symptoms including headache, blurred vision, nausea and eye-movement abnormalities. The ailment can lead to blindness in up to 10 percent of patients, particularly when not recognized and treated promptly.

The children and adolescents in the study were enrolled in the Kaiser Permanente Southern California integrated health plan from 2007 to 2009. The study included measured height and weight and diagnosis of IIH.

Our findings may help improve the early diagnosis and treatment of IIH in young patients, said Dr. Brara. Overweight and obese children appear to have more IIH symptoms at onset than normal weight children. We suggest that clinicians carefully screen adolescents who are overweight or obese and present with symptoms of IIH, such as headache, blurred vision and eye-movement abnormalities.

According to recent Centers for Disease Control and Prevention recommendations, extreme obesity is defined as more than 1.2 times the 95th percentile, which is based on body mass index. Obesity is defined as more than the 95th percentile, while overweight is defined as more than the 85th percentile. Body mass index is a reliable indicator of body fatness and calculated based on height and weight. BMI percentiles are the most commonly used indicator to assess the size and growth patterns of individual children. The percentile indicates the relative position of the child’s BMI number among children of the same sex and age.

This study was funded by the National Institute of Diabetes and Digestive and Kidney Diseases. It is part of the Kaiser Permanente Southern California Children’s Health Study and its ongoing work to identify and treat childhood obesity through research and community programs.

Researchers at Kaiser Permanente announced in February study findings that the prevalence of asthma among children and adolescents who are overweight or obese varies widely by race and ethnicity. The study also found that the association between childhood asthma and increasing BMI is strongest in Hispanics and weakest in African Americans.

In 2011, Kaiser Permanente announced a study that used electronic health records of more than 700,000 patients to determine that children who are overweight or obese have a significantly higher prevalence of psoriasis, a chronic inflammatory disease of the skin.

Other study authors included Corinna Koebnick, PhD, of the Kaiser Permanente Southern California Department of Research & Evaluation; Amy H. Porter, MD, of the Kaiser Permanente Baldwin Park Medical Center; and Annette Langer-Gould, MD, PhD, of the Kaiser Permanente Southern California Department of Research & Evaluation and Southern California Permanente Medical Group, Los Angeles Medical Center, Neurology Department.

Kaiser Permanente Southern California Department of Research & Evaluation
The Department of Research & Evaluation (R & E) conducts high quality, innovative research into disease etiology, prevention, treatment and care delivery. Investigators conduct epidemiology, health sciences, and behavioral research as well as clinical trials. Areas of interest include diabetes and obesity, cancer, HIV/AIDS, cardiovascular disease, aging and cognition, pregnancy outcomes, women’s and children’s health, quality and safety, and pharmacoepidemiology. Located in Pasadena, Calif., the department focuses on translating research to practice quickly to benefit the health and lives of Kaiser Permanente Southern California members and the general population. Visit www.kp.org/research.

About Kaiser Permanente
Kaiser Permanente is committed to helping shape the future of health care. We are recognized as one of America’s leading health care providers and not-for-profit health plans. Founded in 1945, our mission is to provide high-quality, affordable health care services and to improve the health of our members and the communities we serve. We currently serve more than 9 million members in nine states and the District of Columbia. Care for members and patients is focused on their total health and guided by their personal physicians, specialists and team of caregivers. Our expert and caring medical teams are empowered and supported by industry-leading technology advances and tools for health promotion, disease prevention, state-of-the-art care delivery and world-class chronic disease management. Kaiser Permanente is dedicated to care innovations, clinical research, health education and the support of community health. For more information, go to: www.kp.org/newscenter.