The term morbidly obese is generally used to describe people who are at a highly increased risk of developing weight-related health consequences. The following is a description of the many complications for which morbidly obese children are at high risk.

Cardiovascular Complications. The two main cardiovascular complications of childhood obesity are hypertension and dyslipidemia. Hypertension, or high blood pressure, is diagnosed when a child's blood pressure is above the 95th percentile based on their age, height, and sex. Dyslipidemia is characterized by an imbalance of one's cholesterol and triglyceride levels. Most commonly, obese children will have a high level of low-density lipoprotein (LDL, aka "bad") cholesterol and a low level of high-density lipoprotein (HDL, aka "good") cholesterol. Both hypertension and dyslipidemia are significant risk factors for developing atherosclerosis, which is a major cause of heart attacks and strokes later in life.

Endocrine Complications. One of the most common complications of morbid obesity in children is impaired glucose tolerance, which is defined as a blood glucose level between 140 and 199 mg/dl at the two-hour mark of a 75 gram oral glucose tolerance test (in which serial blood glucose levels are measured after the patient drinks a concentrated sugar solution). If no changes are made to the child's lifestyle and weight, this condition may progress to full-blown Type 2 diabetes mellitus. Diabetes is a very serious condition with its own associated complications, including cardiovascular disease, eye disease, kidney disorders, and nerve problems. Because of these severe, yet preventable, health consequences, both the American Academy of Pediatrics and the American Diabetes Association recommend screening certain overweight children (those with other risk factors in addition to their obesity) for Type 2 diabetes every two years starting at age 10.

Endocrine complications of obesity also have an effect on the reproductive system. In males, obesity has been associated with delayed onset of puberty. However, the opposite is true in obese females, who tend to experience an earlier onset of puberty. Obesity is also a significant risk factor for polycystic ovarian syndrome, a condition in females that is associated with infertility and an abnormally high level of androgens in the bloodstream.

Gastrointestinal Complications. Cholelithiasis, or having gallstones, is relatively uncommon in children as compared to adults. Of those children with cholelithiasis, obesity is the most common cause. he presence of gallstones can be completely asymptomatic or can be associated with a number of symptoms including fatty food intolerance, jaundice, and severe abdominal pain. If a patient's gallstones present any health risks or are the source of frequent pain, surgical removal of the gallbladder may be indicated.

Obesity is also associated with the most common liver disease in children, nonalcoholic fatty liver disease (NAFLD). Most children with this condition do not have any symptoms, but undetected liver damage can be severe; if untreated, some children may even progress to liver failure.

Neurologic Complications. Pseudotumor cerebri, or idiopathic intracranial hypertension, is a condition in which the blood pressure in the cranium is elevated for unexplained reasons. Approximately half of the children who present with this condition are obese and obesity is believed to be a risk factor for the disease. Typically presenting with headache, the condition can lead to severe visual impairment or even blindness. Management typically involves both an ophthalmologist and a neurologist.

Orthopedic Complications. One of the most common orthopedic complications of obesity is a slipped capital femoral epiphysis (SCFE). Most common in obese adolescents, this condition involves the displacement of the "cap" of the femur (the portion that contributes the "ball" to the hip's "ball and socket" joint) from the femoral shaft. Typically presenting with hip or leg pain and an altered gait, this condition requires immediate intervention by an orthopedic surgeon to prevent future bone complications.

Tibia vara, or Blount disease, is a condition in which excessive weight bearing on the legs of obese children causes the legs to become bowed and the tibias to become improperly rotated (tibial torsion). This condition also requires management by an orthopedic surgeon.

Pulmonary Complications. The most common pulmonary complication of childhood obesity is obstructive sleep apnea (OSA). Obesity, by decreasing the size of the airway and/or increasing its collapsibility, is a significant risk factor for this condition, which is characterized by "missing breaths" during sleep. OSA is believed to be a risk factor for hypertension and possibly other cardiovascular conditions. Children with OSA may require continuous positive airway pressure (CPAP) during sleep.

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