Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Pediatric Original Article
  • Published:

Obesity predicts persistence of pain in children with functional gastrointestinal disorders

International Journal of Obesity volume 35, pages 517–521 (2011)Cite this article

Subjects

Abstract

Objective:

The possible effect of obesity in the outcome of treated children with abdominal pain-related functional gastrointestinal disorders (FGIDs) has not yet been studied. We hypothesized that obesity is associated with a poor long-term prognosis in children with FGIDs.

Study design:

Prospective cohort study in an outpatient clinic-based sample of patients diagnosed with abdominal pain-related FGIDs. Principal outcome measured was persistence of pain at long-term follow-up (12–15 months). Frequency of pain, intensity of pain, school absenteeism and disruption of daily activities were compared between obese and non-obese subjects.

Results:

The group mean age was 13.27±3.84 years, distribution of diagnosis was 32% (functional abdominal pain), 42.5% (irritable bowel syndrome) and 25.5% (functional dyspepsia). Overall, 20.2% of patients were obese. A total of 116 patients (61.7%) reported abdominal pain and 72 (38.3%) were asymptomatic at long-term follow-up. Obese patients were more likely to have abdominal pain (P<0.0001), higher intensity of pain (P=0.0002), higher frequency of pain (P=0.0032), school absenteeism (P<0.0001) and disruption of daily activities (P<0.0001) at follow-up than non-obese patients.

Conclusion:

Obesity is associated with poor outcome and disability at long-term follow-up in children with abdominal pain-related FGIDs. Our novel findings could have important implications in the prognosis and management of FGIDs.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1

Similar content being viewed by others

References

  1. Nurko S, Di Lorenzo C . Functional abdominal pain: time to get together and move forward. J Pediatr Gastroenterol Nutr 2008; 47: 679–680.

    Article  PubMed  Google Scholar 

  2. Starfield B, Hoekelman RA, McCormick M, Benson P, Mendenhall RC, Moynihan C et al. Who provides health care to children and adolescents in the United States? Pediatrics 1984; 74: 991–997.

    CAS  PubMed  Google Scholar 

  3. Saps M, Sztainberg M, Di Lorenzo C . A prospective community-based study of gastroenterological symptoms in school-age children. J Pediatr Gastroenterol Nutr 2006; 43: 477–482.

    Article  PubMed  Google Scholar 

  4. Ogden CL, Carroll MD, Curtin LR, Lamb MM, Flegal KM . Prevalence of high body mass index in US children and adolescents, 2007–2008. JAMA 2010; 303: 242–249.

    Article  CAS  PubMed  Google Scholar 

  5. CDC. Obesity prevalence among low-income, preschool-aged children—United States, 1998–2008. In: Morbidity and Mortality Weekly Report. CDC: USA, 2009. p769–796.

  6. Wang G, Dietz WH . Economic burden of obesity in youths aged 6 to 17 years: 1979–1999. Pediatrics 2002; 109: E81–E91.

    Article  PubMed  Google Scholar 

  7. Talley NJ, Howell S, Poulton R . Obesity and chronic gastrointestinal tract symptoms in young adults: a birth cohort study. Am J Gastroenterol 2004; 99: 1807–1814.

    Article  PubMed  Google Scholar 

  8. Delgado-Aros S, Locke III GR, Camilleri M, Talley NJ, Fett S, Zinsmeister AR et al. Obesity is associated with increased risk of gastrointestinal symptoms: a population-based study. Am J Gastroenterol 2004; 99: 1801–1806.

    Article  PubMed  Google Scholar 

  9. Malaty HM, Abudayyeh S, Fraley K, Graham DY, Gilger MA, Hollier DR . Recurrent abdominal pain in school children: effect of obesity and diet. Acta Paediatr 2007; 96: 572–576.

    Article  PubMed  Google Scholar 

  10. Teitelbaum JE, Sinha P, Micale M, Yeung S, Jaeger J . Obesity is related to multiple functional abdominal diseases. J Pediatr 2009; 154: 444–446.

    Article  PubMed  Google Scholar 

  11. Caplan A, Walker L, Rasquin A . Development and preliminary validation of the questionnaire on pediatric gastrointestinal symptoms to assess functional gastrointestinal disorders in children and adolescents. J Pediatr Gastroenterol Nutr 2005; 41: 296–304.

    Article  PubMed  Google Scholar 

  12. Caplan A, Walker L, Rasquin A . Validation of the pediatric Rome II criteria for functional gastrointestinal disorders using the questionnaire on pediatric gastrointestinal symptoms. J Pediatr Gastroenterol Nutr 2005; 41: 305–316.

    Article  PubMed  Google Scholar 

  13. Balluz L, Ahluwaia IB, Murphy W, Mokdad A, Giles W, Harris VB . Surveillance for certain health behaviors among selected local areas—United States, Behavioral Risk Factor Surveillance System, 2002. MMWR Surveill Summ 2004; 53: 1–100.

    PubMed  Google Scholar 

  14. van Tilburg MA, Chitkara DK, Palsson OS, Turner M, Blois-Martin N, Ulshen M et al. Audio-recorded guided imagery treatment reduces functional abdominal pain in children: a pilot study. Pediatrics 2009; 124: e890–e897.

    Article  PubMed  Google Scholar 

  15. Vlieger AM, Menko-Frankenhuis C, Wolfkamp SC, Tromp E, Benninga MA . Hypnotherapy for children with functional abdominal pain or irritable bowel syndrome: a randomized controlled trial. Gastroenterology 2007; 133: 1430–1436.

    Article  PubMed  Google Scholar 

  16. Aro P, Ronkainen J, Talley NJ, Storskrubb T, Bolling-Sternevald E, Agreus L . Body mass index and chronic unexplained gastrointestinal symptoms: an adult endoscopic population based study. Gut 2005; 54: 1377–1383.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Vos MB, Kimmons JE, Gillespie C, Welsh J, Blanck HM . Dietary fructose consumption among US children and adults: the Third National Health and Nutrition Examination Survey. Medscape J Med 2008; 10: 160.

    PubMed  PubMed Central  Google Scholar 

  18. Decaluwe V, Braet C, Fairburn CG . Binge eating in obese children and adolescents. Int J Eat Disord 2003; 33: 78–84.

    Article  PubMed  Google Scholar 

  19. Horvath TL, Diano S, Sotonyi P, Heiman M, Tschop M . Mini review: ghrelin and the regulation of energy balance—a hypothalamic perspective. Endocrinology 2001; 142: 4163–4169.

    Article  CAS  PubMed  Google Scholar 

  20. Tschop M, Weyer C, Tataranni PA, Devanarayan V, Ravussin E, Heiman ML . Circulating ghrelin levels are decreased in human obesity. Diabetes 2001; 50: 707–709.

    Article  CAS  PubMed  Google Scholar 

  21. Cummings DE, Weigle DS, Frayo RS, Breen PA, Ma MK, Dellinger EP et al. Plasma ghrelin levels after diet-induced weight loss or gastric bypass surgery. N Engl J Med 2002; 346: 1623–1630.

    Article  PubMed  Google Scholar 

  22. Hansen TK, Dall R, Hosoda H, Kojima M, Kangawa K, Christiansen JS et al. Weight loss increases circulating levels of ghrelin in human obesity. Clin Endocrinol (Oxf) 2002; 56: 203–206.

    Article  CAS  Google Scholar 

  23. Guneli E, Gumustekin M, Ates M . Possible involvement of ghrelin on pain threshold in obesity. Med Hypotheses 2009.

  24. Fabricatore AN, Wadden TA . Psychological aspects of obesity. Clin Dermatol 2004; 22: 332–337.

    Article  PubMed  Google Scholar 

  25. Strauss RS . Childhood obesity and self-esteem. Pediatrics 2000; 105: e15.

    Article  CAS  PubMed  Google Scholar 

  26. Huertas-Ceballos AA, Logan S, Bennett C, Macarthur C . Dietary interventions for recurrent abdominal pain (RAP) and irritable bowel syndrome (IBS) in childhood. Cochrane Database Syst Rev 2009; CD003019.

  27. Schurman JV, Hunter HL, Friesen CA . Conceptualization and treatment of chronic abdominal pain in pediatric gastroenterology practice. J Pediatr Gastroenterol Nutr 50: 32–37.

    Article  PubMed  Google Scholar 

  28. Ballem N, Yellumahanthi K, Wolfe M, Wesley MM, Clements RH . Gastrointestinal symptom improvement after Roux-en-Y gastric bypass: long-term analysis. Surg Obes Relat Dis 2009; 5: 553–558.

    Article  PubMed  Google Scholar 

  29. Kaltenbach T, Crockett S, Gerson LB . Are lifestyle measures effective in patients with gastroesophageal reflux disease? An evidence-based approach. Arch Intern Med 2006; 166: 965–971.

    Article  PubMed  Google Scholar 

  30. Austin GL, Dalton CB, Hu Y, Morris CB, Hankins J, Weinland SR et al. A very low-carbohydrate diet improves symptoms and quality of life in diarrhea-predominant irritable bowel syndrome. Clin Gastroenterol Hepatol 2009; 7: 706–708 e1.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Pediatric Gastroenterology, Hepatology and Nutrition, Children's Memorial Hospital, Northwestern University, Chicago, IL, USA

    S Bonilla & M Saps

  2. Biostatistics Research Core, Children's Memorial Research Center, Northwestern University, Chicago, IL, USA

    D Wang

Authors
  1. S Bonilla
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. D Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M Saps
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M Saps.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Bonilla, S., Wang, D. & Saps, M. Obesity predicts persistence of pain in children with functional gastrointestinal disorders. Int J Obes 35, 517–521 (2011). https://doi.org/10.1038/ijo.2010.245

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/ijo.2010.245

Keywords

This article is cited by

Search

Advanced search

Quick links