Treatment

Overweight children and their parents may be referred to a registered dietician or nutritionist who can help them develop a plan for eliminating empty calories and increasing the amount of nutrient-rich, low-calorie foods in their diets.

Nutrition education usually involves the entire family.

Children may be asked to keep a food diary to record everything that they eat in order to determine what changes in behaviour and diet need to be made.

Typically, children are encouraged to increase their level of exercise rather than to drastically reduce calories.

Drug therapy and weight-loss surgery are very rarely used in children, except in the most extreme cases of health-threatening obesity when other methods of weight control have failed. Some teenagers benefit from joining a structured weight-loss program such as Weight Watchers or Jenny Craig. They should check with their physician before joining.

Definition

Childhood obesity is the condition of being overweight or severely overweight which causes risks to health between the ages of 2 and 19.

Risks associated with childhood obesity

• CARDIOVASCULAR DISEASE.
• DEGENERATIVE JOINT DISORDER
• DEPRESSION
• EARLY PUBERTY AND EARLY START OF MENSTRUATION IN GIRLS
• EATING DISORDERS
• EXPOSURE TO SOCILA PREJUDICEAND DISCRIMINATION
• FAT ACCLUMATION IN THE LIVER (FATTY LIVER/LIVER DISEASE)
• GALL BLADDER DISEASE
• HIGH CHOLESTEROL
• HYPERTENSION
• INCREASED ANXIETY AND STRESS
• JOINT PAIN
• SLEEP APNEA
• TYPE-2 DIABETES MELLITUS

Description

Childhood obesity is of increasing concern as a public health problem in the United States. Overweight and obesity are defined by most healthcare professionals using the Body Mass Index (BMI). BMI is a calculation that compares a person’s weight and height to arrive at a specific number. For details of how to calculate BMI see the body mass index entry.

Children between the ages of 2 and 19 are assigned a percentile based on their BMI number. The percentile tells them how their weight compares to that of other children who are their same age and gender. For example, if a boy is in the 65th percentile for his age group, 65 of every 100 children who are his age weigh less than he does and 35 of every 100 weigh more than he does. Adult BMI is interpreted differently.

The BMI weight categories for children are:

• Below the 5th percentile: Underweight
• 5th percentile to less than the 85th percentile: Healthy weight
• 85th percentile to less than the 95th percentile: At risk of overweight
• 95th percentile and above: Overweight

There is some debate about what to call children who are in the at risk for overweight and overweight categories. Some healthcare organizations such as the American Obesity Association use the term overweight for those at or above the 85th percentile and obese for those at or above the 95th percentile. The National Institutes of Health prefers to avoid applying the term obese to children, in part because of the social stigma the word carries. Whatever term is used to describe children in the top 15th percentile, these.

Demographics

Other surveys have found the total obesity rate among children and adolescents to be between 21% and 24%. Significant differences exist in the number of children who are overweight in different races and ethnic groups, and these mirror the differences in the adult population. Significantly more Mexican American boys are overweight than non-Hispanic black or white boys. Significantly more Mexican American girls and non-Hispanic black girls are overweight than white girls. Native Americans and Hawaiians also have higher rates of overweight than whites.

Causes and symptoms

At its simplest, overweight is caused by taking in more calories than the body uses. This difference is called the “energy gap

Causes

There are many reasons why the energy gap exists; these reasons are related to both increased food intake and decreased energy use. Food intake reasons include:

• Increased consumption of sugary beverages, and along with this, a decreased consumption of milk
• Tendency to super-size portions. In some fast food restaurants portions have almost tripled since the 1970s.
• More meals eaten away from home
• More use of prepared foods in the home
• Increased snacking between meals along with fewer meals eaten together as a family
• Heavy advertising of high-sugar, high-fat foods to children
• Decrease in children carrying their lunch to school from home
• Poor eating habits such as skipping breakfast and later snacking on high fat, sugary foods

Inadequate energy use reasons include:

• More time spent watching television or using the computer.
• Fewer physical education requirements at school. According to the centres for disease control, in 2000, only 8% of elementary schools, 6.4% of middle schools, and 5.8% of high school required daily physical education classes.
• Fewer children walking to school. In 1969 half of all school children walked or biked to school. The rate was 87% for children living within 1 mile of their school. In 2003, only 15% of children walked or biked to school
• Decreased recess in grades 1-5. More than 28% of schools do not provide a regularly scheduled recess in these grades.
• Fear of crime, which limits outdoor activities of children
• More affluence. Teen access to cars has increased over the past 30 years.

Other factors that affect childhood obesity include an inherited tendency toward weight gain, mental illness, binge eating disorder, and eating in response to stress, boredom, and loneliness, poor sleeping habits, and having at least one obese parent.

In rare cases, medical or genetic disorders can cause obesity.

• For example, Prader-Willi syndrome is a genetic disorder that causes an uncontrollable urge to eat. The only way to prevent a person with Prader-Willi disorder from constant eating is to keep them in an environment where they have no free access to food.
• Other genetic and hormonal disorders (e.g. hypothyroidism) can cause obesity.
• Certain medications also can cause weight gain (e.g. cortisone, tri-cyclic antidepressants), but these situations are the exception. Most children are too heavy because they eat too much and/or exercise too little.

Symptoms

The most obvious symptom of obesity is an accumulation of body fat. Other symptoms involve changes in body chemistry. Some of these changes cause disease in children, while others put the child at risk for developing health problems later in life. Children who are overweight are at increased risk of:

• Type 2 diabetes. This disease is appearing in children and young adults at an alarmingly high rate. In the past, it was usually seen in older adults.
• High blood pressure (hypertension)
• Fat accumulation in the liver (fatty liver/liver disease)
• Sleep apnoea
• Early puberty; early start of menstruation in girls
• Eating disorders
• Joint pain
• Depression
• Increased anxiety and stress
• Low self-worth
• Exposure to social prejudice and discrimination

Treatment

Overweight children and their parents may be referred to a registered dietician or nutritionist who can help them develop a plan for eliminating empty calories and increasing the amount of nutrient-rich, low-calorie foods in their diets.

Nutrition education usually involves the entire family.

Children may be asked to keep a food diary to record everything that they eat in order to determine what changes in behaviour and diet need to be made.

Typically, children are encouraged to increase their level of exercise rather than to drastically reduce calories.

Drug therapy and weight-loss surgery are very rarely used in children, except in the most extreme cases of health-threatening obesity when other methods of weight control have failed. Some teenagers benefit from joining a structured weight-loss program such as Weight Watchers or Jenny Craig. They should check with their physician before joining.

Prevention

Parents must take the lead in preventing obesity in children. Some of the ways they can do this are:

• Serve a healthy variety of foods; keep healthy snacks on hand.
• Choose low-fat cooking methods such as broiling or baking.
• Eliminate junk snack food and sugary beverages from the house. This removes temptation and eliminates the need to nag.
• Eat meals together as a family rather than grabbing something quick on the run.
• Limit visits to fast-food restaurants.
• Limit television and computer time.
• Plan family activities that involve physical activity, such as hiking, biking, or swimming.
• Encourage children to become more active in small ways such as walking to school, biking to friends” houses or doing chores such as waking the dog or mowing the lawn.
• Avoid using food as a reward.
• Pack healthy homemade lunches on school days.
• Encourage school officials to eliminate soda machines on campus, bake sales, and fundraising with candy and cookies
• Set realistic goals for weight control and reward children’s efforts.

Model the eating behaviours and active lifestyle you would like your child adopt.