Urinary incontinence in obese adolescent girls

ObjectiveUrinary incontinence is an established complication of obesity in adult women. We examined the prevalence, severity, and impact of incontinence in obese compared to non-obese girls.MethodsSubjects aged 12–17 years each completed a 29-item questionnaire assessing urinary symptoms and their impact. Clinically significant urinary incontinence was defined as involuntary urine leakage at least once weekly.Results40 obese adolescent girls and 20 non-obese control girls were recruited. Among the obese girls, five (12.5%, 95% confidence interval: 4–28%) reported incontinence, and two of these five reported daily leakage. None of the 20 non-obese subjects reported leakage meeting the definition of incontinence. Incontinence severity scores (leakage frequency multiplied by leakage volume) averaged 1.3 in the obese group and 0.3 in the non-obese group (P = 0.009) and were associated with symptom impact (P < 0.001). Eleven (55%) of non-obese and 17 (43%) of obese subjects reported no urinary leakage, while infrequent, low-volume urine leakage was reported by 45% of both obese and non-obese subjects.ConclusionsUrinary incontinence affects more than 10% of obese adolescent girls. Frequency and volume of urine loss are directly related to the impact that incontinence has on the sufferer. Results highlight the importance of screening for symptoms of urinary incontinence in obese girls.     

Management of the obese adolescent.

Obesity as a health problem appears to be increasing in incidence. Adolescent obesity is generally exogenous in type. The teenagers are basically healthy with advanced sexual and bone maturation. They suffer from peer ridicule and exclusion from activities. The weight problem bars them from successful adult adjustment in their social lives and career choice. To the physician who treats the obese adolescent, it would be wise to review the pitfalls of previous programs. The multidisciplinary approach is an attempt to combine dietary restriction and increased physical activity to gradually mobilize fat stores and provide psychologic support. Motivation is reinforced by a committed staff and by the patients' own obese peers with whom they meet weekly. Despite the repeated record of failure in adolescent weight reduction programs, it is hoped that the challenge of obesity management spurs the interest of physicians to increase their knowledge of nutrition and to intervene with early effective preventive measures.     

Headache and diplopia in an extremely obese adolescent

BACKGROUND: The prevalence of idiopathic intracranial hypertension is increased in overweight children and adolescents. CASE REPORT: In a fifteen-year old, extremely obese adolescent with a history of headache and diplopia treatment with acetazolamide resulted in relief of the neurological symptoms.     

Laparoscopic gastric plication in the morbidly obese adolescent patient

Childhood obesity is a significant problem. Due in part to suboptimal weight loss with lifestyle intervention alone, bariatric surgery, combined with ongoing lifestyle changes, has become a favorable approach in adolescents with severe obesity and weight-related comorbidities and is associated with effective weight loss and reducing weight-related comorbidities. Laparoscopic greater curvature plication is a promising new bariatric surgical procedure that has been shown to be effective in adults with severe obesity but has not been evaluated in the adolescent population. Gastric plication may be a particularly attractive approach for the adolescent patient as it is potentially reversible, does not involve the surgical removal of tissue, and is without a significant malabsorptive component. Our team has obtained approval from our Institutional Review Board to perform a laparoscopic greater curvature plication on 30 adolescent patients with severe obesity and study its effect on weight loss, metabolic effects, and psychological functioning in the setting of a multidisciplinary program. Results of this study, including comprehensive clinical and psychological data collected over a 3.5-year span, will inform larger prospective investigations comparing the laparoscopic greater curvature plication and other bariatric operations in the adolescent population.     

Transient pituitary dysfunction, empty sella, pseudotumor cerebri in a morbidly obese adolescent

We report a 16-year-old morbidly obese African-American female who developed pseudotumor cerebri, partially empty sella syndrome and transient central hypothyroidism. After reduction of the increased intracranial pressure by lumbar puncture, normalization of the thyroid function occurred. The mechanism of the transient pituitary dysfunction in relation to the pseudotumor cerebri and empty sella is discussed.     

Effectiveness of weight loss in the treatment of non-alcoholic steatohepatitis in an obese adolescent

Childhood obesity is the most frequent nutritional disorder in developed countries and has been described as a global epidemic by the World Health Organization. In children, as in adults, obesity is the most significant risk factor for the development of non-alcoholic fatty liver disease. Therefore, it may become the most frequent chronic liver disease in children. However, pediatric publications on this disorder, which can progress to severe liver disease with risk of mortality, are scarce, with small series and few histological studies. The present article describes an obese adolescent who presented severe steatosis and steatohepatitis, which responded to weight loss with clinical and histological normalization. The risk of obesity comorbidity is increasing significantly in the pediatric population.     

The hypertensive adolescent

The hypertensive adolescent requires a careful blood pressure evaluation. In most cases, extensive diagnostic studies will not be necessary, particularly if the patient exhibits characteristics of early essential hypertension. On the other hand, further evaluation should not be withheld in the absence of risk factors or the presence of significant hypertension. A management plan that includes patient education is appropriate for all adolescents with hypertension. In some, but not all, hypertensive adolescents, a limited course of medication may be beneficial.     

Nephrotoxicity due to intermediate-dose methotrexate without rescue in an obese adolescent with acute lymphoblastic leukemia

Toxicity from intermediate-dose methotrexate (MTX)is unusual. A severely obese adolescent with acute lymphoblastic leukemia experienced significant, delayed nephrotoxicity from intermediate-dose MTX. Altered MTX disposition may occur as a consequence of other ingestions or conditions such as obesity. The use of radioisotope renography established the diagnosis and followed the resolution of the patient's MTX-induced nephrotoxicity.