For months, nine-year-old Aanya was treated for gastritis. Her stomach pain came and went, often brushed off with antacids and diet advice. But nothing helped.
It was an ultrasound that later revealed the real cause — multiple gallstones. Doctors were surprised, but not entirely. Ananya had a high BMI and consumed fried food almost daily — factors increasingly linked to gallstone formation in children.
She underwent laparoscopic gallbladder removal. Surgeons found the organ contracted and chronically inflamed, suggesting the problem had been progressing for a while. Her recovery was smooth, but the case has raised red flags.
With childhood obesity on the rise, doctors are seeing adult-like lifestyle diseases in younger patients. Once considered a condition confined to adults, gallstones are increasingly being detected in children — a shift that experts warn is closely tied to growing rates of childhood obesity and poor dietary habits.
A study published in the National Library of Medicine in June 2024, which examined 44 children aged 5-18, found a predominance of cases in adolescents, nearly 30% of whom were overweight or obese.
Shifting trends
Gallstone, or cholelithiasis, was rarely diagnosed in children until recently. Now, with rising obesity levels, doctors are seeing more paediatric cases.
“Obesity alters the composition of the bile, making it more cholesterol-rich and prone to forming stones. Adiposity also leads to reduced gallbladder motility, allowing bile to stagnate - another contributor to stone formation," said Dr Shreya Dubey, associate director of paediatrics & neonatology, CK Birla Hospital, Gurugram.
Dr Mriganka Sekhar Sharma, chief consultant, department of general minimal access and bariatric surgery at Manipal Hospital Gurugram, noted that excess fat impairs gallbladder motility and increases cholesterol secretion by the liver. “Obesity has been found to increase the risk of cholelithiasis development due to impaired gallbladder motility, excessive hepatic secretion, and bile saturation of cholesterol. Such children are far more likely to develop symptomatic gallstones than their healthier-weight peers,” he said.
Dr Ruchi Golas, a pediatrician at CMRI Kolkata, added that obesity often indicates gallbladder hypomotility, further encouraging stone formation.
Poor quality diet
Experts attribute the rising obesity levels — and by extension gallstones — to widespread dietary imbalances among children.
Dr Sharma pointed to the common urban diet: processed snacks, sugary beverages, and low fiber. “This proclivity creates the perfect storm, elevating triglycerides and bile cholesterol levels, directly increasing gallstone risk,” he said.
Modern diets rich in saturated fats and low in fiber are triggering metabolic conditions in children, including gallbladder disease, said Dr V S Chauhan, Director General (Surgery), Fortis Hospital, Noida. He pointed out that erratic eating patterns, such as skipping meals, impairs gallbladder emptying, and increases the risk of stones.
“Diets high in saturated fats and low in fiber increase cholesterol saturation in the bile. Moreover, erratic eating patterns and skipping meals can reduce gallbladder emptying, further promoting stone formation. These dietary habits, common among the urban youth, are likely contributing to the growing incidence of paediatric gallstones,” he explained.
Dr Dubey remarked that children today mirror adult dietary patterns that are already known to increase gallstone formation. Moreover, kids today consume far fewer fruits and vegetables, and far more high-fat, processed foods, Dr Golas noted.
“When high-fat diets are consumed, cholesterol saturation in the bile is induced, while low fiber intake slows digestion and alters gut motility — both of which contribute to gallstone formation,” said Dr Golas. She added that unregulated fad diets among children seeking quick weight loss are also raising risks.
A sedentary lifestyle, she said, is another significant yet overlooked factor. “Screen time has replaced playtime, further amplifying the metabolic burden in children.”
Missing early signs
Experts highlighted a worrying scenario in identifying young patients. Despite the rising numbers, routine screening for gallstones is not a standard practice in paediatric care — even in high-risk children, they said.
“Diagnosing paediatric gallstones requires a high index of suspicion. Since this has not been a disease traditionally found in children, we need to be more vigilant, especially in children who are obese, have a family history of gallbladder disease, or present with recurrent gastrointestinal complaints” said Dr Sharma.
Dr Chauhan said many cases are discovered incidentally or only after complications develop, including cholecystitis or pancreatitis. He called for wider use of ultrasonography, which is non-invasive and effective.
“Paediatricians and primary care providers must maintain a high index of suspicion, especially in overweight or obese children presenting with abdominal pain. Ultrasonography is a safe and effective diagnostic tool that should be more widely used for timely detection,” he suggested.
There is a growing shift in paediatric practice for screening as many cases go undetected until complications arrive, Dr Dubey added. “More and more paediatricians are now considering abdominal ultrasounds for obese children with chronic or unexplained abdominal discomfort,” she said.
There is also a need for change in perception as many clinicians still associate gallstones solely with adults. “This is an issue that must be brought to the forefront. Given the documented clear rise in paediatric obesity and its documented link to gallstones, clinicians should proactively screen overweight children with persistent abdominal complaints,” Dr Golas said.
Early detection, she emphasised, can prevent complications. “The standard method is an ultrasound scan of the abdomen, a simple and non-invasive procedure that can be carried out when symptoms warrant it. Early diagnosis can be essential in managing the condition before complications such as gallbladder inflammation or infection set in. We need to move from reactive care to early intervention.”
--- Symptoms ---
Sudden, sharp pain in the upper right abdomen
Nausea, vomiting, bloating after meals
Pain may radiate to the right shoulder or back
Vulnerable groups
Women are 2–3 times at risk than men due to hormonal factors
People age above 40
Obesity, type 2 diabetes, and rapid weight loss
Family history of liver illnesses
High intake of refined oils and saturated fats
Low-fiber diets, especially in urban middle class
Skipping meals or long fasting hours
Increased consumption of fried and processed foods
· (According to a study by AIIMS Delhi published in World Journal of Gastroenterology)