In fact, extremely obese children have up to a 40 percent higher risk of GERD, while those who are moderately obese have up to a 30 percent higher risk of developing it, compared with normal weight children, researchers say.

“Although we know that childhood obesity, especially extreme obesity, comes with risks for serious health conditions, such as diabetes, cardiovascular disease and cancer, our study adds yet another condition to the list, which is GERD,” said study lead author Corinna Koebnick, a research scientist at Kaiser Permanente Southern California’s Department of Research and Evaluation in Pasadena.

While the causes of the chronic digestive disease are not known, obesity appears to be one of them, she noted. “With the increasing epidemic of childhood obesity, GERD may become more and more of an issue,” she added.

GERD can undermine quality of life, Koebnick said, noting that the disease can cause chronic heartburn, nausea and the potential for respiratory problems such as persistent cough, inflammation of the larynx and asthma.

GERD has already been linked to obesity in adults, many of whom are familiar with its intermittent heartburn resulting from liquid containing stomach acid that backs up into the esophagus. Untreated, GERD can result in chronic inflammation of the lining of the esophagus and, more rarely, to lasting damage, including ulcers and scarring.

About 10 percent of GERD patients also go on to develop a precancerous condition known as Barrett’s esophagus, which in a small minority will develop into cancer. Kaiser researchers noted that GERD that persists through adulthood increases the risk for esophageal cancer later in life.

Cancer of the esophagus is the fastest growing cancer in the United States, and is expected to double in frequency over the next 20 years. This increase may be partly due to the obesity epidemic, Koebnick said.

The report is published in the July 9 online edition of the International Journal of Pediatric Obesity.

For the Kaiser study, Koebnick’s team collected data on more than 690,000 children aged 2 to 19 years old. These children were members of the Kaiser Permanente Southern California integrated health plan in 2007 and 2008.

The researchers found 1.5 percent of boys and 1.8 percent of girls suffered from GERD. Among these children, obese children were much more likely to have GERD compared with normal-weight children.

This finding held true for those children 6 to 11 years old and those 12 to 19, but not for children 2 to 5, the researchers noted. The study did not find an association between GERD and BMI in young children.

The association between obesity and GERD remained even after taking race and ethnic background into account, Koebnick’s group found.

Across the United States, gastroesophageal reflux disease may affect 2 percent to 10 percent of children, according to other studies, and in one school-based study, 40 percent of teens 14 to 18 reported at least one symptom of esophageal GERD.

“Knowing that GERD is associated with obesity in children, pediatricians can counsel those children to report symptoms of GERD and make lifestyle changes that target not only obesity, but target GERD,” Koebnick said.

These changes include eating smaller meals, which will help reduce acid reflux, Koebnick said. “Whether losing weight will help isn’t known, “but we can guess that it will,” she said.

Dr. Aymin Delgado, assistant professor of pediatric gastroenterology at the University of Miami Miller School, said that “the findings confirm what we in pediatric gastroenterology have been suspecting, because it is what we see.”

Obesity affects every organ system, Delgado said. “Obesity poses clear risks for the future health of children,” she said. “Many of these risks are ones that occur later in life, and it is hard to show that they are real. However, this study, shows that they are and shows that we need to identify these risks and monitor overweight and obese children and to manage them appropriately.”

Delgado said the key is prevention. “We need to take the risk of overweight and obesity seriously and we need to do something about it now,” she said. “We need to keep the future health risks in mind when we see obese children.”

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The news is even worse for black and Hispanic kids: Among black teenage girls, 11.9 percent were classified as extremely obese, as were 11.2 percent of Hispanic teenage boys. Extreme obesity among children is defined as weighing more than 1.2 times the 95th percentile, or having a body-mass index (BMI) of 35 kilograms per meter squared.

“There is an alarming high frequency of extremely obese children,” said study author Corinna Koebnick, a research scientist at Kaiser Permanente Southern California Department of Research and Evaluation in Pasadena.

Koebnick said the obesity epidemic is driven by a combination of lack of physical activity and poor eating habits. “It’s unhealthy eating habits — fast food versus slow food,” she said.

Parents need to be role models for their children, Koebnick stressed. “There are studies suggesting parent’s weight has a significant influence on the child’s weight,” she noted.

Extreme obesity can lead to serious health problems such as diabetes and heart disease, Koebnick added.

“We need to watch these extremely obese kids more carefully, and we need to try to prevent adverse health effects that may come up in the near future,” she said.

“Children who are extremely obese may continue to be extremely obese as adults, and all the health problems associated with obesity are in these children’s futures. Without major lifestyle changes, these kids face a 10 to 20 years shorter life span and will develop health problems in their 20s that we typically see in 40- [to] 60-year-olds,” Koebnick said in a Kaiser Permanente news release.

Although these findings cover only children in southern California, Koebnick thinks they are representative of what is happening throughout the United States.

The report is published in the March 18 online edition of the Journal of Pediatrics.

For the study, Koebnick’s team collected data on 710,949 children and teens aged 2 to 19 who belonged to Kaiser Permanente Southern California integrated health plan in 2007 and 2008.

Using these data, the researchers found that 7.3 percent of boys and 5.5 percent of girls were extremely obese, which is more than 45,000 extremely obese children among all the children studied.

Obesity peaked at age 10 for boys and age 12 for girls. The most extremely obese were black teenage girls and Hispanic boys. The least extremely obese were Asian-Pacific Islanders and white children, the researchers found.

Samantha Heller, a dietitian, nutritionist and exercise physiologist, said that “the results of this survey are not surprising, but are heartbreaking when you consider the health consequences that these children will be facing, not to mention the social, emotional and psychological repercussions.”

It is critical for parents to learn how to provide healthy food for their families, Heller noted. “Healthy food can be affordable and delicious but consumers are led to believe that fast food, junk food and sweets are the easiest and cheapest way to go,” she said.

The public is bombarded with food advertising that targets children, Heller said. The 2008 Federal Trade Commission Report to Congress found that more than $1.6 billion was spent in 2006 marketing food and beverages to children.

“Imagine if that money, or even a fraction of it, was used to promote healthy foods like vegetables, fruits, whole grains and beans, and nutrition education for the public,” she said. “People would learn how to buy and prepare healthy foods on a budget and we could reduce the prevalence of obesity and chronic diseases like diabetes, heart disease and cancer, in our children,” Heller explained.

“Health professionals, food companies and local and state governments need to find ways to help educate, motivate and empower adults and children to lead healthier lives before it is too late to save our children,” Heller added.

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