Childhood Obesity
Childhood obesity is a serious medical condition that affects children and adolescents. Children who are obese are above the normal weight for their age and height.
Childhood obesity is not just a cosmetic problem.
Childhood obesity is particularly troubling because the extra weight often starts children on the path to health problems that were once considered adult problems — diabetes, high blood pressure and high cholesterol but with proper diagnosis of obesity it is totally manageable. Many obese children become obese adults, especially if one or both parents are obese. Childhood obesity can also lead to poor self-esteem and depression.
- India beat USA to have 2nd highest no. of obese children.
- Urban population is more prone to childhood obesity as compared to rural region.
- Middle class more at risk of obesity.
- Even as India battles malnutrition, the country has developed another nutritional problem—obesity. In past 10 years, the number of obese people has doubled in the country, according to the National Family Health Survey.
- Childhood obesity affects more than is 15 percent of children, making it one of the common chronic disease of childhood.Obesity in children and adolescents has tripled over the past 30 years.
- Worldwide the number of obese girls in age group 5-19 has risen from 5 million to 50 million in 40 years, and boys from 6 million to 74 million.
Causes of Childhood Obesity
Although the causes of childhood obesity are widespread, certain factors are targeted as major contributors to this epidemic. Causes associated with childhood obesity include:
- Environment
- Lack of physical activity
- Heredity and family
- Dietary patterns
- Socioeconomic status
Environment
Today’s environment plays a major role in shaping the habits and perceptions of children and adolescents. The prevalence of television commercials promoting unhealthy foods and eating habits is a large contributor. In addition, children are surrounded by environmental influences that demote the importance of physical activity.
Today, it is estimated that more money is spent on food outside home, at restaurants, cafeterias, sporting events, etc. In addition, as portion sizes have increased, when people eat out they tend to eat a larger quantity of food (calories) than when they eat at home. Beverages such as carbonated soft drinks and juice boxes also greatly contribute to the childhood obesity epidemic. It is not uncommon for a bottle of soft drink to be marketed toward children, which contains approximately 400 calories.
The consumption of cola by children has increased throughout the last 20 years by 300 percent. Scientific studies have documented a 60 percent increase risk of obesity for every regular soft drink consumed per day. Box drinks, juice, fruit drinks and sports drinks present another significant problem. These beverages contain a significant amount of calories and it is estimated that 20 percent of children who are currently overweight are overweight due to excessive caloric intake from beverages.
Lack of Physical Activity
Children in today’s society show a decrease in overall physical activity. The growing use of computers, increased time watching television and decreased physical education in schools, all contribute to children and adolescents living a more sedentary lifestyle.
Another major factor contributing to the childhood obesity epidemic is the increased sedentary lifestyle of children. School-aged children spend most of their day in school where their only activity comes during breaks or physical education classes.
Only 50 percent of children, 12 to 21 years of age, regularly participate in rigorous physical activity, while 25 percent of children report no physical activity. The average child spends two hours a day watching television, but 26 percent of children watch at least four hours of television per day.
Heredity and Family
Science shows that genetics play a role in obesity. It has been proven that children with obese parents are more likely to be obese. Estimates say that heredity contributes between 5 to 25 percent of the risk for obesity. However, genes alone do not always dictate whether a child is overweight or obese. Learned behaviors from parents are a major contributor. Parents, especially of those whose children are at risk for obesity at a young age, should promote healthy food and lifestyle choices early in their development.
Dietary Patterns
Over the past few decades, dietary patterns have changed significantly. The average amount of calories consumed per day has dramatically increased. Furthermore, the increase in caloric intake has also decreased the nutrients needed for a healthy diet.
Food portions also play an important role in the unhealthy diet patterns that have evolved. The prevalence of “extra large” options and “all you can eat” buffets create a trend in overeating. Combined with a lack of physical activity, children are consuming more and expending less.
Socioeconomic Status
Educational levels contribute to the socioeconomic issue associated with obesity. Parents with little to no education have not been exposed to information about proper nutrition and healthy food choices. This makes it difficult to instill those important values in their children.
Measuring Obesity in Children
Weight categories for children and teens are defined so that they take into account normal differences in body fat between boys and girls and differences in body fat at various ages. Children’s weight categories are determined by measuring a child’s weight and then plotting them on a weight-to-age chart. There are separate weight-to-age curves for males and females, ages two to 20 years.
Treating Childhood Obesity
Treating obesity in children and adolescents differs from treatment in adults. Involving the family in a child’s weight management program is a key element to treatment.
Treatment of pediatric obesity is not accomplished by just dieting. You need to address multiple aspects of the child and the family’s lifestyle, nutrition and physical activity patterns. Prior to discussing any treatment plans, you first must determine the desired goals.
If your child is overweight, or at risk for becoming overweight, it is important to work and develop an individualized plan of care that includes realistic goals and action steps. As a support system, family is integral in ensuring weight management goals are met. You must first assess the readiness of the child and the family to make changes. If the child is very depressed, this needs to be addressed prior to working on the child’s weight problem. If a depressed child attempts weight-loss and is unsuccessful, this may worsen their depression or lower their self-esteem.
Similarly, if there is a lot of stress in the family at that time it is not ideal to try and tackle yet another major issue. In some situations where there is significant depression or stress, it may be most appropriate for the child and the family to seek counseling to address these issues. In addition, if parents express little concern regarding their child being overweight, they are not ready to make the necessary changes.
It is important to talk with your physician about options for treating childhood obesity. The various treatments of obesity in children and adolescents include:
- Dietary therapy
- Physical activity
- Behavior modification
Diet Therapy
When treating an obese child or adolescent, it is often recommended that they have a consultation with a dietitian who can address the child’s needs. Dietitians can help children understand healthy eating habits and how to implement them in their long-term diet.
Dietitians do not always recommend restricting caloric intake for children. Education on how to identify healthy food, cut back on portions, understand the food pyramid and eat smaller bites at a smaller pace is generally the information given to change a child’s eating habits.
Physical Activity
Another form of obesity treatment in children is increasing physical activity. Physical activity is an important long-term ingredient for children, as studies indicate that inactivity in childhood has been linked to a sedentary adult lifestyle.
Increasing physical activity can decrease, or at least slow the increase, in fatty tissues in obese children. It is recommended that children get at least 60 minutes of physical activity each day. Individualized programs are available and possible for those children or adolescents that are not able to meet minimum expectations.
Behavior Modification
Lifestyles and behaviors are established at a young age. It is important for parents and children to remain educated and focused on making long-term healthy lifestyle choices. There are several ways that children and adolescents can modify their behavior for healthier outcomes, such as:
- Changing eating habits
- Increasing physical activity
- Becoming educated about the body and how to nourish it appropriately
- Engaging in a support group activity and setting realistic weight management goals
Child weight-loss program
If your efforts at home don’t help your child reach a healthy weight, and your child’s healthcare provider determines that your child’s health is at risk unless he or she loses weight steadily, you may want to consider a formal treatment program.
Look for the following characteristics when choosing a weight-control program for your child. The program should:
- Be staffed with a variety of health professionals. The best programs may include Paediatricians, Bariatric Surgeon, Endocrinologist, Nutritionist, Fitness trainers and psychiatrists or psychologists.
- Perform a medical evaluation of the child. Before being enrolled in a program, your child’s weight, growth and health should be reviewed by a healthcare provider. During enrollment, your child’s weight, height, growth, and health should be monitored by a health professional at regular intervals.
- Focus on the whole family, not just the overweight child.
- Be adapted to the specific age and capabilities of the child. Programs for 4-year-olds are different from those for children 8 or 12 years old in terms of the responsibilities of the child and parents.
- Focus on behavioral changes.
- Teach the child how to select a variety of foods in appropriate portions.
- Encourage daily activity and limit sedentary activity, such as watching TV.
- Include a maintenance program and other support and referral resources to reinforce the new behaviours and to deal with underlying issues that contributed to the child becoming overweight.
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FREQUENTLY ASKED QUESTIONS
- Early initiation of breastfeeding within one hour of birth;
- Exclusive breastfeeding for the first 6 months of life; and
- The introduction of nutritionally-adequate and safe complementary (solid) foods at 6 months together with continued breastfeeding up to two years of age or beyond.
School-aged children and adolescents should:
- Limit energy intake from total fats and sugars;
- Increase consumption of fruit and vegetables, as well as legumes, whole grains and nuts;
- Engage in regular physical activity (60 minutes a day).
The food industry can play a significant role in reducing childhood obesity by:
- Reducing the fat, sugar and salt content of complementary foods and other processed foods;
- Ensuring that healthy and nutritious choices are available and affordable to all consumers;
- Practicing responsible marketing especially those aimed at children and teenagers.
Supportive policies, environments, schools and communities are fundamental in shaping parents’ and children’s choices, making the healthier choice of foods and regular physical activity the easiest choice (accessible, available and affordable), thereby preventing obesity.
Children at risk of becoming overweight or obese include children who:
- consume food and drinks that are high in sugar and fat on a regular basis such as fast food, candy, baked goods, and ESPECIALLY pop and other sugar-sweetened beverages
- are not physically active each day
- watch a lot of TV and play a lot of video games, activities that don’t burn calories (sedentary time)
- live in an environment where healthy eating and physical activity are not encouraged
- eat to help deal with stress or social problems
- come from a family of overweight people where genetics may be a factor, especially if healthy eating and physical activity are not a priority in the family
- come from a low-income family who do not have the resources or time to make healthy eating and active living a priority
- are exposed to the aggressive marketing of energy-dense foods and beverages to children and families
- have a lack of information about sound approaches to nutrition
- have a lack of access, availability and affordability to healthy foods
- have a genetic disease or hormone disorder such as Prader-Willi syndrome or Cushing’s syndrome
Obese infants and children are likely to continue being obese during adulthood and are more likely to develop a variety of health problems as adults. These include:
- Cardiovascular disease
- Insulin resistance (often an early sign of impending diabetes)
- Musculoskeletal disorders (especially osteoarthritis - a highly disabling degenerative disease of the joints)
- Some cancers (endometrial, breast and colon)
- Disability.
In adults overweight is defined as the individual’s body mass index (BMI). This is a simple index of weight-for-height, defined as a person's weight in kilograms divided by the square of his or her height in metres (kg/m2). In adults BMI greater than or equal to 25 is overweight; and BMI greater than or equal to 30 is obesity.
Obesity is defined as abnormal or excessive fat accumulation that may impair health. In infants and children under 5 years of age, obesity is assessed according to the WHO "Child growth standards" (weight-for-length, weight-for-height) and the WHO Reference for 5-19 years (body mass index-for-age).