Abdominal Obesity

 

Complications   Heart disease, asthma, stroke, diabetes

Causes       Sedentary lifestyle, Overeating, Cushing's syndrome, Alcoholism, Polycystic ovarian syndrome, Prader-Willi syndrome

Abdominal obesity, also known as central obesity and truncal obesity, is a condition when excessive visceral fat around the stomach and abdomen has built up to the extent that it is likely to have a negative impact on health. Abdominal obesity has been strongly linked to cardiovascular disease, Alzheimer's disease, and other metabolic and vascular diseases.

 

Visceral and central abdominal fat and waist circumference show a strong association with type 2 diabetes.

 

Visceral fat, also known as organ fat or intra-abdominal fat, is located inside the peritoneal cavity, packed in between internal organs and torso, as opposed to subcutaneous fat, which is found underneath the skin, and intramuscular fat, which is found interspersed in skeletal muscle. Visceral fat is composed of several adipose depots including mesenteric, epididymal white adipose tissue (EWAT), and perirenal fat. An excess of adipose visceral fat is known as central obesity, the "pot belly" or "beer belly" effect, in which the abdomen protrudes excessively. This body type is also known as "apple shaped", as opposed to "pear shaped" in which fat is deposited on the hips and buttocks.

 

Researchers first started to focus on abdominal obesity in the 1980s when they realized it had an important connection to cardiovascular disease, diabetes, and dyslipidemia. Abdominal obesity was more closely related with metabolic dysfunctions connected with cardiovascular disease than was general obesity. In the late 1980s and early 1990s insightful and powerful imaging techniques were discovered that would further help advance the understanding of the health risks associated with body fat accumulation. Techniques such as computed tomography and magnetic resonance imaging made it possible to categorize mass of adipose tissue located at the abdominal level into intra-

 

Health risks

Heart disease

Abdominal obesity is associated with a statistically higher risk of heart disease, hypertension, insulin resistance, and type 2 diabetes (see below).  With an increase in the waist to hip ratio and overall waist circumference the risk of death increases as well.  Metabolic syndrome is associated with abdominal obesity, blood lipid disorders, inflammation, insulin resistance, full-blown diabetes, and increased risk of developing cardiovascular disease. It is now generally believed that intra-abdominal fat is the depot that conveys the biggest health risk.

 

Recent studies have concluded that total and regional body volume estimates correlate positively and significantly with biomarkers of cardiovascular risk and BVI calculations correlate significantly with all biomarkers of cardio-vascular risk. 

 

Diabetes

There are numerous theories as to the exact cause and mechanism in type 2 diabetes. Central obesity is known to predispose individuals for insulin resistance. Abdominal fat is especially active hormonally, secreting a group of hormones called adipokines that may possibly impair glucose tolerance. But adiponectin, an anti-inflammatory adipokine, which is found in lower concentration in obese and diabetic individuals has shown to be beneficial and protective in type 2 diabetes mellitus.

 

Insulin resistance is a major feature of diabetes mellitus type 2, and central obesity is correlated with both insulin resistance and T2DM  Increased adiposity (obesity) raises serum resistin levels,  7 which in turn directly correlate to insulin resistance.  Studies have also confirmed a direct correlation between resistin levels and T2DM. And it is waistline adipose tissue (central obesity) which seems to be the foremost type of fat deposits contributing to rising levels of serum resistin. Conversely, serum resistin levels have been found to decline with decreased adiposity following medical treatment.

                                                                   

Asthma

Developing asthma due to abdominal obesity is also a main concern. As a result of breathing at low lung volume, the muscles are tighter and the airway is narrower. Obesity causes decreased tidal volumes due to reduced in chest expansion that is caused both by the weight on the chest itself and the effect of abdominal obesity on flattening the diaphragms. It is commonly seen that people who are obese breathe quickly and often, while inhaling small volumes of air.[32] People with obesity are also more likely to be hospitalized for asthma. A study has stated that 75% of patients treated for asthma in the emergency room were either overweight or obese.

 

Alzheimer's disease

Based on studies, it is evident that obesity has a strong association with vascular and metabolic disease which could potentially be linked to Alzheimer's disease. Recent studies have also shown an association between mid-life obesity and dementia, but the relationship between later life obesity and dementia is less clear. A study by Debette et al. (2010) examining over 700 adults found evidence to suggest higher volumes of visceral fat, regardless of overall weight, were associated with smaller brain volumes and increased risk of dementia.[34][35][36] Alzheimer's disease and abdominal obesity has a strong correlation and with metabolic factors added in, the risk of developing Alzheimer's disease was even higher. Based on logistic regression analyses, it was found that obesity was associated with an almost 10-fold increase risk of Alzheimer's disease.

 

Other health risks

Central obesity can be a feature of lipodystrophies, a group of diseases that is either inherited, or due to secondary causes (often protease inhibitors, a group of medications against AIDS). Central obesity is a symptom of Cushing's syndrome and is also common in patients with polycystic ovary syndrome (PCOS). Central obesity is associated with glucose intolerance and dyslipidemia. Once dyslipidemia becomes a severe problem, an individual's abdominal cavity would generate elevated free fatty acid flux to the liver. The effect of abdominal adiposity occurs not just in those who are obese, but also affects people who are non-obese, and it also contributes to insulin.

 

Ghroubi et al. (2007) examined whether abdominal circumference is a more reliable indicator than BMI of the presence of knee osteoarthritis in obese patients. They found that it actually appears to be a factor linked with the presence of knee pain as well as osteoarthritis in obese study subjects. Ghroubi et al. (2007) concluded that a high abdominal circumference is associated with great functional repercussion.

 

Causes

Diet

See also: Diet and obesity

The currently prevalent belief is that the immediate cause of obesity is net energy imbalance—the organism consumes more usable calories than it expends, wastes, or discards through elimination. Some studies indicate that visceral adiposity, together with lipid dysregulation and decreased insulin sensitivity, is related to the excessive consumption of fructose. Some evidence shows that in regards to juveniles, when free fructose is present as children's fat cells mature, it makes more of these cells mature into fat cells in the abdominal region. It also caused both visceral fat and subcutaneous fat to be less sensitive to insulin. These effects were not attenuated when compared to similar glucose consumption.[43]

 

Intake of trans fat from industrial oils has been associated with increased abdominal obesity in men and increased weight and waist circumference in women.  These associations were not attenuated when fat intake and calorie intake was accounted for.  Greater meat (processed meat, red meat, and poultry) consumption has also been positively associated with greater weight gain, and specifically abdominal obesity, even when accounting for calories.  Conversely, studies suggest that oily fish consumption is negatively associated with total body fat and abdominal fat distribution even when body mass remains constant.[50][51] Similarly, increased soy protein consumption is correlated with lower amounts of abdominal fat in postmenopausal women even when calorie consumption is controlled.

 

Numerous large studies have demonstrated that eating ultraprocessed food. It has a positive dose-dependent relationship with both abdominal obesity and general obesity in both men and women. Consuming a diet rich in unprocessed food and minimally processed food is linked with lower obesity risk, lower waist circumference and less chronic disease. These findings are consistent among America Canadian,  Latin American, British, Australian, French, Spaniard South Korean. Chinese, and Sub-Saharan African populations.

 

Obesity plays an important role in the impairment of lipid and carbohydrate metabolism shown in high-carbohydrate diets.  It has also been shown that quality protein intake during a 24-hour period and the number of times the essential amino acid threshold of approximately 10 g has been achieved is inversely related to the percentage of central abdominal fat. Quality protein uptake is defined as the ratio of essential amino acids to daily dietary protein.

 

Visceral fat cells will release their metabolic by-products in the portal circulation, where the blood leads straight to the liver. Thus, the excess of triglycerides and fatty acids created by the visceral fat cells will go into the liver and accumulate there. In the liver, most of it will be stored as fat. This concept is known as 'lipotoxicity'.

                                                                                                                                                                                                         

 

Alcohol consumption

A study has shown that alcohol consumption is directly associated with waist circumference and with a higher risk of abdominal obesity in men, but not in women. After controlling for energy under-reporting, which have slightly attenuated these associations, it was observed that increasing alcohol consumption significantly increased the risk of exceeding recommended energy intakes in male participants – but not in the small number of female participants (2.13%) with elevated alcohol consumption, even after establishing a lower number of drinks per day to characterize women as consuming a high quantity of alcohol. Further research is needed to determine whether a significant relationship between alcohol consumption and abdominal obesity exists among women who consume higher amounts of alcohol.

 

A systemic review and meta-analysis failed to find data pointing towards a dose-dependent relationship between beer intake and general obesity or abdominal obesity at low or moderate intake levels (under ~500 mL/day). However, high beer intake (above ~4 L/wk) appeared to be associated with a higher degree of abdominal obesity specifically, particularly among men.

Other factors

The prevalence of abdominal obesity is increasing in Western populations, possibly due to a combination of low physical activity and high-calorie diets, and also in developing countries, where it is associated with the urbanization of populations.

 

Other environmental factors, such as maternal smoking, estrogenic compounds in the diet, and endocrine-disrupting chemicals may be important also.

 

Hypercortisolism, such as in Cushing's syndrome, also leads to central obesity. Many prescription drugs, such as dexamethasone and other steroids, can also have side effects resulting in central obesity,[37] especially in the presence of elevated insulin levels.

 

Diagnosis

 

There are various ways of measuring abdominal obesity including:

 

Absolute waist circumference (>102 cm (40 in) in men and >88 cm (35 in) in women.

 

Overweight teenage boy holding his excess abdominal fat

In those with a body mass index (BMI) under 35, intra-abdominal body fat is related to negative health outcomes independent of total body fat.[76] Intra-abdominal or visceral fat has a particularly strong correlation with cardiovascular disease.

 

BMI and waist measurements are well recognized ways to characterize obesity. However, waist measurements are not as accurate as BMI measurements. Waist measurement (e.g., for BFP standard) is more prone to errors than measuring height and weight (e.g., for BMI standard). BMI will illustrate the best estimate of one's total body fatness, while waist measurement gives an estimate of visceral fat and risk of obesity-related disease.  It is recommended to use both methods of measurements.

 

 

An adult man with abdominal obesity

While central obesity can be obvious just by looking at the naked body (see the picture), the severity of central obesity is determined by taking waist and hip measurements. The absolute waist circumference 102 centimetres (40 in) in men and 88 centimetres (35 in) in women and the waist–hip ratio (>0.9 for men and >0.85 for women are both used as measures of central obesity. A differential diagnosis includes distinguishing central obesity from ascites and intestinal bloating. In the cohort of 15,000 people participating in the National Health and Nutrition Examination Survey (NHANES III), waist circumference explained obesity-related health risk better than BMI when metabolic syndrome was taken as an outcome measure and this difference was statistically significant. In other words, excessive waist circumference appears to be more of a risk factor for metabolic syndrome than BMI. Another measure of central obesity which has shown superiority to BMI in predicting cardiovascular disease risk is the Index of Central Obesity (waist-to-height ratio, WHtR), where a ratio of >=0.5 (i.e. a waist circumference at least half of the individual's height) is predictive of increased risk.  Obesity may also be diagnosed through  the analysis of intra-abdominal fat having the most risk to one's personal health. The increased amount of fat in this region relates to the higher levels of plasma lipid and lipoproteins as per studies mentioned by Eric Poehlman (1998) review. An increasing acceptance of the importance of central obesity within the medical profession as an indicator of health risk has led to new developments in obesity diagnosis such as the Body Volume Index, which measures central obesity by measuring a person's body shape and their weight distribution. The effect of abdominal adiposity occurs not just in those who are obese, but also affects people who are non-obese and it also contributes to insulin sensitivity.

 

Index of central obesity

Index of Central Obesity (ICO) is the ratio of waist circumference and height first proposed by Parikh et al. in 2007[81] as a better substitute to the widely used waist circumference in defining metabolic syndrome.  The National Cholesterol Education Program Adult Treatment Panel III suggested cutoff of 102 cm (40 in) and 88 cm (35 in) for males and females as a marker of central obesity.The same was used in defining metabolic syndrome. Misra et al. suggested that these cutoffs are not applicable among Indians and the cutoffs be lowered to 90 cm (35 in) and 80 cm (31 in) for males and females. Various race specific cutoffs were suggested by different groups. The International Diabetes Federation defined central obesity based on these various race and gender specific cutoffs. The other limitation of waist circumference is that it the measurement procedure has not been standardized and in children there are no, or few, comparison standards or reference data.

 

Parikh et al. looked at the average heights of various races and suggested that by using ICO various race- and gender-specific cutoffs of waist circumference can be discarded.[82] An ICO cutoff of 0.53 was suggested as a criterion to define central obesity. Parikh et al. further tested a modified definition of metabolic syndrome in which waist circumference was replaced with ICO in the National Health and Nutrition Examination Survey (NHANES) database and found the modified definition to be more specific and sensitive.

 

This parameter has been used in the study of metabolic syndrome and cardiovascular disease.

 

Central obesity in individuals with normal BMI is referred to as normal weight obesity.

 

Sex differences

There are sex-dependent differences in regional fat distribution.

 

Males are more susceptible to upper-body fat accumulation, most likely in the belly, due to sex hormone differences. When comparing the body fat of men and women it is seen that men have close to twice the visceral fat as that of pre-menopausal women.

 

In women, estrogen is believed to cause fat to be stored in the buttocks, thighs, and hips. When women reach menopause and the estrogen produced by ovaries declines, fat migrates from their buttocks, hips, and thighs to their belly.

 

50% of men and 70% of women in the United States between the ages of 50 and 79 years now exceed the waist circumference threshold for central obesity.

 

Central obesity is positively associated with coronary heart disease risk in women and men. It has been hypothesized that the sex differences in fat distribution may explain the sex difference in coronary heart disease risk. Even with the differences, at any given level of central obesity measured as waist circumference or waist to hip ratio, coronary artery disease rates are identical in men and women.

 

Management

         

A permanent routine of exercise, eating healthily, and, during periods of being overweight, consuming the same number or fewer calories than used will prevent and help fight obesity. A single pound of fat yields approximately 3500 calories of energy (32 000 kJ energy per kilogram of fat), and weight loss is achieved by reducing energy intake, or increasing energy expenditure, thus achieving a negative balance. Adjunctive therapies which may be prescribed by a physician are orlistat or sibutramine, although the latter has been associated with increased cardiovascular events and strokes and has been withdrawn from the market in the US, the UK, the EU, Australia,[105] Canada, Hong Kong] and Thailand.[

 

A 2006 study published in the International Journal of Sport Nutrition and Exercise Metabolism, suggests that combining cardiovascular (aerobic) exercise with resistance training is more effective than cardiovascular training alone in getting rid of abdominal fat. An additional benefit to exercising is that it reduces stress and insulin levels, which reduce the presence of cortisol, a hormone that leads to more belly fat deposits and leptin resistance.

 

Self-motivation by understanding the risks associated with abdominal obesity is widely regarded as being far more important than worries about cosmetics. In addition, understanding the health issues linked with abdominal obesity can help in the self-motivation process of losing the abdominal fat. As mentioned above, abdominal fat is linked with cardiovascular disease, diabetes, and cancer. Specifically it's the deepest layer of belly fat (the fat that cannot be seen or grabbed) that poses health risks, as these "visceral" fat cells produce hormones that can affect health (e.g. increased insulin resistance and/or breast cancer risk). The risk increases considering the fact that they are located in the proximity or in between organs in the abdominal cavity. For example, fat next to the liver drains into it, causing a fatty liver, which is a risk factor for insulin resistance, setting the stage for type 2 diabetes. However, visceral fat is more responsive to the circulation of catecholamines.

 

In the presence of type 2 diabetes, the physician might instead prescribe metformin and thiazolidinediones (rosiglitazone or pioglitazone) as antidiabetic drugs rather than sulfonylurea derivatives. Thiazolidinediones may cause slight weight gain but decrease "pathologic" abdominal fat (visceral fat), and therefore may be prescribed for diabetics with central obesity. Thiazolidinedione has been associated with heart failure and increased cardiovascular risk; so it has been withdrawn from the market in Europe by EMA in 2010.

 

Low-fat diets may not be an effective long-term intervention for obesity: as Bacon and Aphramor wrote, "The majority of individuals regain virtually all of the weight that was lost during treatment."[113] The Women's Health Initiative ("the largest and longest randomized, controlled dietary intervention clinical trial" found that long-term dietary intervention increased the waist circumference of both the intervention group and the control group, though the increase was smaller for the intervention group. The conclusion was that mean weight decreased significantly in the intervention group from baseline to year 1 by 2.2 kg (P<.001) and was 2.2 kg less than the control group change from baseline at year 1. This difference from baseline between control and intervention groups diminished over time, but a significant difference in weight was maintained through year 9, the end of the study.

Society and culture

Myths

There is a common misconception that spot exercise (that is, exercising a specific muscle or location of the body) most effectively burns fat at the desired location, but this is not the case. Spot exercise is beneficial for building specific muscles, but it has little effect, if any, on fat in that area of the body, or on the body's distribution of body fat. The same logic applies to sit-ups and belly fat. Sit-ups, crunches and other abdominal exercises are useful in building the abdominal muscles, but they have little effect, if any, on the adipose tissue located there.

 

Colloquialisms

A large central adiposity deposit has been assigned many common use names, including "spare tire", "paunch", and "potbelly". Several colloquial terms used to refer to central obesity, and to people who have it, refer to beer drinking. However, there is little scientific evidence that beer drinkers are more prone to central obesity, despite its being known colloquially as "beer belly", "beer gut", or "beer pot". One of the few studies conducted on the subject did not find that beer drinkers are more prone to central obesity than nondrinkers or drinkers of wine or spirits.   Chronic alcoholism can lead to cirrhosis, symptoms of which include gynecomastia (enlarged breasts) and ascites (abdominal fluid). These symptoms can suggest the appearance of central obesity.

 

Deposits of excess fat at the sides of one's waistline or obliques are commonly referred to as "love handles".

 

Economics

Researchers in Copenhagen examined the relationship between waist circumferences and costs among 31,840 subjects aged 50–64 years of age with different waist circumferences. Their study showed that an increase in just an additional centimetre above normal waistline caused a 1.25% and 2.08% rise in health care costs in women and men respectively. To put this in perspective, a woman with a waistline of 95 cm (approx 37.4 in) and without underlying health problems or co-morbidities can incur economic costs that are 22%, or US$397, higher per year than a woman with a normal waist circumference.

Jan Ricks Jennings, MHA, LFACHE

Senior Consultant

Senior Management Resources, LLC

Jan.Jennings@EagleTalons.net

JanJenningsBlog.Blogspot.com

 

412.913.0636 Cell

724.733.0509 Office

 

September 24. 2022  

                                                                                   

Laser Resurfacing

Overview

 

Laser resurfacing is a facial rejuvenation procedure that uses a laser to improve the skin's appearance or treat minor facial flaws. It can be done with:

 

Ablative laser. This type of laser removes the thin outer layer of skin (epidermis) and heats the underlying skin (dermis), which stimulates the growth of collagen — a protein that improves skin firmness and texture. As the epidermis heals and regrows, the treated area appears smoother and tighter. Types of ablative therapy include a carbon dioxide (CO2) laser, an erbium laser and combination systems.

Nonablative laser or light source. This approach also stimulates collagen growth. It's a less aggressive approach than an ablative laser and has a shorter recovery time. But the results are less noticeable. Types include pulsed-dye laser, erbium (Er:YAG) and intense pulsed light (IPL) therapy.

Both methods can be delivered with a fractional laser, which leaves microscopic columns of untreated tissue throughout the treatment area. Fractional lasers were developed to shorten recovery time and reduce the risk of side effects.

 

Laser resurfacing can lessen the appearance of fine lines in the face. It can also treat loss of skin tone and improve your complexion. Laser resurfacing can't eliminate excessive or sagging skin.

 

Why it's done

Laser resurfacing can be used to treat:

 

Fine wrinkles

Age spots

Uneven skin tone or texture

Sun-damaged skin

Mild to moderate acne scars

Risks

Laser resurfacing can cause side effects. Side effects are milder and less likely with nonablative approaches than with ablative laser resurfacing.

 

Redness, swelling, itching and pain. Treated skin may swell, itch or have a burning sensation. Redness may be intense and might last for several months.

Acne. Applying thick creams and bandages to your face after treatment can worsen acne or cause you to temporarily develop tiny white bumps (milia) on treated skin.

Infection. Laser resurfacing can lead to a bacterial, viral or fungal infection. The most common infection is a flare-up of the herpes virus — the virus that causes cold sores. In most cases, the herpes virus is already present but dormant in the skin.

Changes in skin color. Laser resurfacing can cause treated skin to become darker than it was before treatment (hyperpigmentation) or lighter (hypopigmentation). Permanent changes in skin color are more common in people with dark brown or Black skin. Talk with your doctor about which laser resurfacing technique reduces this risk.

Scarring. Ablative laser resurfacing poses a slight risk of scarring.

Laser resurfacing isn't for everyone. Your doctor might caution against laser resurfacing if you:

 

Have taken the acne medication isotretinoin (Amnesteem) during the past year

Have a connective tissue or autoimmune disease or a weak immune system

Have a history of keloid scars

Have had radiation therapy to the face

Have a history of previous laser resurfacing

Are prone to cold sores or have had a recent outbreak of cold sores or herpes virus

Have darker brown or Black skin or are very tanned

Are pregnant or breastfeeding

Have a history of an outward-turning eyelid (ectropion)

How you prepare

                                                                                       

Before you have laser resurfacing, your doctor will likely:

 

Ask about your medical history. Be prepared to answer questions about current and past medical conditions and any medications you are taking or have taken recently. Your doctor might also ask about previous cosmetic procedures you've had and how you react to sun exposure — for example, do you burn easily? rarely?

Do a physical exam. Your doctor will inspect your skin and the area that will be treated. This helps determine what changes can be made and how your physical features — for example, the tone and thickness of your skin — might affect your results.

Discuss your expectations. Talk with your doctor about your motivations, expectations and the potential risks. Together, you can decide whether laser resurfacing is right for you and, if so, which approach to use. Make sure you understand how long it'll take to heal and what your results might be.

Before laser resurfacing, you might also need to:

                                                                     

 

Take medication to prevent complications. If you're having ablative laser resurfacing — or nonablative laser resurfacing and you have a history of herpes infections around your mouth — your doctor will prescribe an antiviral medication before and after treatment to prevent a viral infection. Depending on your medical history, your doctor might recommend other medications before your procedure.

Avoid unprotected sun exposure. Too much sun up to two months before the procedure can cause permanent irregular pigmentation in treated areas. Discuss sun protection and acceptable sun exposure with your doctor.

Stop smoking. If you smoke, try to stop at least two weeks before and after your treatment. This improves your chance of avoiding complications and helps your body heal.

Arrange for a ride home. If you're going to be sedated during laser can expect resurfacing, you'll need help getting home after the procedure.

What you can expect.

During the procedure

How laser resurfacing is done

 

Your doctor may do laser resurfacing as an outpatient procedure. Your care team will numb skin with medication. For extensive resurfacing, such as treatment to your whole face, you might be sedated.

 

During ablative laser resurfacing, an intense beam of light energy (laser) is directed at your skin. The laser beam destroys the outer layer of skin (epidermis). At the same time, the laser heats the underlying skin (dermis), which stimulates collagen production over time, resulting in better skin tone and texture. Ablative laser resurfacing typically takes between 30 minutes and two hours, depending on the technique used and the size of the area treated. This approach usually needs only one treatment.

 

If you're undergoing nonablative laser treatment or fractional Er:YAG laser resurfacing, you'll likely need 1 to 3 treatments scheduled over weeks or months to get the results you're looking for.

 

After the procedure

After ablative laser resurfacing, the treated skin will be raw, swollen and itchy. Your doctor will apply a thick ointment to the treated skin and might cover the area with an airtight and watertight dressing. You may take a pain reliever and use ice packs. New skin usually covers the area in one or two weeks and full recovery takes at least a month. During this time do not use products that may irritate your face, such as cosmetics. And avoid situations that increase your risk of infection, such as public whirlpools. Always use sun protection following laser resurfacing.

 

After nonablative laser resurfacing, recovery time is minimal. Your skin might be swollen or inflamed for a few hours. Use ice packs as needed. Typically, you can resume your usual activities and skin routine immediately.

 

Results

After ablative laser resurfacing, your skin might stay inflamed for up to several months. But once the treatment area begins to heal, you'll notice a difference in your skin quality and appearance. The effects can last for years.

 

Results after nonablative laser resurfacing tend to be gradual and progressive. You're more likely to notice improvements in skin texture and pigment than in wrinkles.

 

After laser resurfacing, always use sun protection. As you age, you'll continue to get lines by squinting and smiling. New sun damage also can reverse your results. Every day, use a moisturizer and a sunscreen with an SPF of at least 30.

                                                                             

 

Jan Ricks Jennings, MHA, LCACHE

Senior Consultant

Senior Management Resources, LLC

 

Jan.Jennings@EagleTalons.net

JanJenningsBlog.Blogspot.com

412.913.0636 Cell

724.733.0509  Office

 

September 21, 2022

 

                                                                     Child abuse

Symptoms & causes

 

Any intentional harm or mistreatment of a child under 18 years old is considered child abuse. Child abuse takes many forms, which often occur at the same time.

 

Physical abuse. Physical child abuse occurs when a child is purposely physically injured or put at risk of harm by another person.

Sexual abuse. Child sexual abuse is any sexual activity with a child. This can involve sexual contact, such as intentional sexual touching, oral-genital contact or intercourse. This can also involve noncontact sexual abuse of a child, such as exposing a child to sexual activity or pornography; observing or filming a child in a sexual manner; sexual harassment of a child; or prostitution of a child, including sex trafficking.

Emotional abuse. Emotional child abuse means injuring a child's self-esteem or emotional well-being. It includes verbal and emotional assault — such as continually belittling or berating a child — as well as isolating, ignoring or rejecting a child.

Medical abuse. Medical child abuse occurs when someone gives false information about illness in a child that requires medical attention, putting the child at risk of injury and unnecessary medical care.

Neglect. Child neglect is failure to provide adequate food, clothing, shelter, clean living conditions, affection, supervision, education, or dental or medical care.

In many cases, child abuse is perpetrated by someone the child knows and trusts — often a parent or other relative. If you suspect child abuse, report the abuse to the proper authorities.

 

 

Symptoms

A child who's being abused may feel guilty, ashamed or confused. The child may be afraid to tell anyone about the abuse, especially if the abuser is a parent, other relative or family friend. That's why it's vital to watch for red flags, such as:

 

Withdrawal from friends or usual activities

Changes in behavior — such as aggression, anger, hostility or hyperactivity — or changes in school performance

Depression, anxiety or unusual fears, or a sudden loss of self-confidence

Sleep problems and nightmares

An apparent lack of supervision

Frequent absences from school

Rebellious or defiant behavior

Self-harm or attempts at suicide

Specific signs and symptoms depend on the type of abuse and can vary. Keep in mind that warning signs are just that — warning signs. The presence of warning signs doesn't necessarily mean that a child is being abused.

 

Physical abuse signs and symptoms

Unexplained injuries, such as bruises, broken bones (fractures) or burns

Injuries that don't match the given explanation

Injuries that aren't compatible with the child's developmental ability

 

Sexual abuse signs and symptoms

Sexual behavior or knowledge that's inappropriate for the child's age

Pregnancy or a sexually transmitted infection

Genital or anal pain, bleeding, or injury

Statements by the child that he or she was sexually abused

Inappropriate sexual behavior with other children

 

Emotional abuse signs and symptoms

Delayed or inappropriate emotional development

Loss of self-confidence or self-esteem

Social withdrawal or a loss of interest or enthusiasm

Depression

Avoidance of certain situations, such as refusing to go to school or ride the bus

Appears to desperately seek affection

A decrease in school performance or loss of interest in school

Loss of previously acquired developmental skills

Neglect signs and symptoms

Poor growth

Excessive weight with medical complications that are not being adequately addressed

Poor personal cleanliness

Lack of clothing or supplies to meet physical needs

Hoarding or stealing food

Poor record of school attendance

Lack of appropriate attention for medical, dental or psychological problems or lack of necessary follow-up care

 

Parental behavior

Sometimes a parent's demeanor or behavior sends red flags about child abuse. Warning signs include a parent who:

 

Shows little concern for the child

Appears unable to recognize physical or emotional distress in the child

Blames the child for the problems

Consistently belittles or berates the child, and describes the child with negative terms, such as "worthless" or "evil"

Expects the child to provide attention and care to the parent and seems jealous of other family members getting attention from the child

Uses harsh physical discipline

Demands an inappropriate level of physical or academic performance

Severely limits the child's contact with others

Offers conflicting or unconvincing explanations for a child's injuries or no explanation at all

Repeatedly brings the child for medical evaluations or requests medical tests, such as X-rays and lab tests, for concerns not seen during the health care provider's examination

 

Physical punishment

Child health experts condemn the use of violence in any form, but some people still use physical punishment, such as spanking, to discipline their children. While parents and caregivers often use physical punishment with the intention of helping their children or making their behavior better, research shows that spanking is linked with worse, not better, behavior. It's also linked to mental health problems, difficult relationships with parents, lower self-esteem and lower academic performance.

 

Any physical punishment may leave emotional scars. Parental behaviors that cause pain, physical injury or emotional trauma — even when done in the name of discipline — could be child abuse.

 

When to see a doctor

If you're concerned that your child or another child has been abused, seek help immediately. Depending on the situation, contact the child's health care provider, a local child welfare agency, the police department or a 24-hour hotline for advice. In the United States, you can get information and assistance by calling or texting the Child help National Child Abuse Hotline at 1-800-422-4453.

 

If the child needs immediate medical attention, call 911 or your local emergency number.

 

In the United States, keep in mind that health care professionals and many other people, such as teachers and social workers, are legally required to report all suspected cases of child abuse to the appropriate local child welfare agency.

Risk factors

Factors that may increase a person's risk of becoming abusive include:

 

A history of being abused or neglected as a child

Physical or mental illness, such as depression or post-traumatic stress disorder (PTSD)

Family crisis or stress, including domestic violence and other marital conflicts, or single parenting

A child in the family who is developmentally or physically disabled

Financial stress, unemployment or poverty

Social or extended family isolation

Poor understanding of child development and parenting skills

Alcohol, drugs or other substance abuse

 

Complications

Some children overcome the physical and psychological effects of child abuse, particularly those with strong social support and resiliency skills who can adapt and cope with bad experiences. For many others, however, child abuse may result in physical, behavioral, emotional or mental health issues — even years later.

 

Here are some examples:

 

Physical issues

Premature death

Physical disabilities

Learning disabilities

Substance abuse

Health problems, such as heart disease, diabetes, chronic lung disease and cancer

Behavioral issues

Illegal or violent behavior

Abuse of others

Withdrawal

Suicide attempts or self-injury

High-risk sexual behaviors or teen pregnancy

Problems in school or not finishing high school

Limited social and relationship skills

Problems with work or staying employed

Emotional issues

Low self-esteem

Difficulty establishing or maintaining relationships

Challenges with intimacy and trust

An unhealthy view of parenthood

Inability to cope with stress and frustrations

An acceptance that violence is a normal part of relationships

Mental health disorders

Eating disorders

Personality disorders

Behavior disorders

Depression

Anxiety disorders

Post-traumatic stress disorder (PTSD)

Trouble sleeping (insomnia) and nightmares

Attachment disorders

Prevention

You can take important steps to protect your child from exploitation and child abuse, as well as prevent child abuse in your neighborhood or community. The goal is to provide safe, stable, nurturing relationships for children.

                                                                    

Here's how you can help keep children safe:

 

Offer your child love and attention. Nurture and listen to your child and be involved in your child's life to develop trust and good communication. Encourage your child to tell you if there's a problem. A supportive family environment and social networks can help improve your child's feelings of self-esteem and self-worth.

Don't respond in anger. If you feel overwhelmed or out of control, take a break. Don't take out your anger on your child. Talk with your health care provider or a therapist about ways you can learn to cope with stress and better interact with your child.

Ensure Adequate supervision. Don't leave a young child home alone. In public, keep a close eye on your child. Volunteer at school and for activities to get to know the adults who spend time with your child. When old enough to go out without supervision, encourage your child to stay away from strangers and to hang out with friends rather than be alone. Make it a rule that your child tells you where he or she is at all times. Find out who's supervising your child — for example, at a sleepover.

Know your child's caregivers. Check references for babysitters and other caregivers. Make irregular, but frequent, unannounced visits to observe what's happening. Don't allow substitutes for your usual child care provider if you don't know the substitute.

Emphasize when to say no. Make sure your child understands that he or she doesn't have to do anything that seems scary or uncomfortable. Encourage your child to leave a threatening or frightening situation immediately and seek help from a trusted adult. If something happens, encourage your child to talk to you or another trusted adult about what happened. Assure your child that it's OK to talk and that he or she won't get in trouble.

Teach your child how to stay safe online. Put the computer in a common area of your home, not the child's bedroom. Use the parental controls to restrict the types of websites your child can visit. Check your child's privacy settings on social networking sites. Consider it a red flag if your child is secretive about online activities.

 

Cover online ground rules, such as not sharing personal information; not responding to inappropriate, hurtful or frightening messages; and not arranging to meet an online contact in person without your permission. Tell your child to let you know if an unknown person makes contact through a social networking site. Report online harassment or inappropriate senders to your service provider and local authorities, if necessary.

 

Reach out. Meet the families in your neighborhood, including parents and children. Develop a network of supportive family and friends. If a friend or neighbor seems to be struggling, offer to babysit or help in another way. Consider joining a parent support group so that you have an appropriate place to vent your frustrations.

 

If you worry that you might abuse your child

If you're concerned that you might abuse your child, seek help immediately. In the United States, you can get information and assistance by calling or texting the Child help National Child Abuse Hotline: 1-800-4-A-CHILD (1-800-422-4453).

 

Or you can start by talking with your family health care provider. Your provider may offer a referral to a parent education class, counseling or a support group for parents to help you learn appropriate ways to deal with your anger. If you're misusing alcohol or drugs, ask your health care provider about treatment options.

 

If you were abused as a child, get counseling to ensure you don't continue the abuse cycle or teach those destructive behaviors to your child.

 

Remember, child abuse is preventable — and often a symptom of a problem that may be treatable. Ask for help today.

Jan Ricks Jennings, MHA, LFACHE

Senior Consultant

Senior Management Resources, LLC

 

Jan.Jennings@EagleTalons.net

JanJenningsBlog.Blogspot.com

 

412.913.0636 Cell

724.733.0509 Office

September 21, 2022