How to manage childhood obesity
A chubby child may look attractive to many but can become a cause for concern if he or she gains excessive weight. Obesity is described as one of the most common nutritional disorders in developed countries, whereas protein calorie malnutrition is the leading cause of malnutrition in developing countries. A spokesman for the American Heart […]
A chubby child may look attractive to many but can become a cause for concern if he or she gains excessive weight.
Obesity is described as one of the most common nutritional disorders in developed countries, whereas protein calorie malnutrition is the leading cause of malnutrition in developing countries.
A spokesman for the American Heart Association, Dr Rani Whitfield, said childhood obesity was not a cosmetic issue or something the child would just out grow. Obese children tend to become obese adults, and there are many medical issues associated with obesity.
“Children are now taking the same type of medications as their parents to manage blood pressure, diabetes and cholesterol. This is frightening but true. Over the past 30 years, the rate of childhood obesity has more than doubled in children and quadrupled in adolescents.”
He said, the prevalence of obesity in children aged 6-11 years increased from 7% in 1980 to 18% in 2012, while the percentage of obese adolescents aged 12-19 years soared from 5% to 21% in the same period.
“The effects of childhood obesity can persist well into adulthood, and there is global concern that if rates of childhood obesity continue to rise, so will the prevalence of related medical conditions. This will not only put the health of future generations at risk, but it will also put an enormous strain on the economy.”
A Consultant Pediatrician and Pediatric Cardiologist, Dr Nubwa Yusufu Papka, said overweight and obesity are defined as abnormal or excessive fat accumulation that presents a risk to health.
She said childhood obesity is one of the most serious global public health challenges of the 21st century, affecting every country in the world, adding that body mass index (BMI) is a measure used to determine childhood overweight and obesity.
Dr Papka said overweight is defined as a BMI at or above the 85th percentile and below the 95th percentile for children and teens of the same age and sex.
She said the difference between an adult and a child is that a child’s weight status is determined using age- and sex-specific percentile for BMI rather than the BMI categories used for adults.
“This is because children’s body composition varies as they age and varies between boys and girls. Therefore, BMI levels among children and teens need to be expressed relative to other children of the same age and sex, that’s why their BMI is expressed as percentiles for age and sex.
“It should be noted however that overweight and obese children are more likely to stay obese into adulthood and to develop non-communicable diseases (NCDs) like diabetes and cardiovascular diseases at a younger age.”
Risk factors and causes
The risk factors and cause of pediatric or childhood obesity are divided into; genetic, behavioral and environmental factors.
Genetic factors – this is when it comes from gene and passed down by parents. Children with both parents obese are at greater risk (nearly 10-fold) risk of obesity in later life compared to children with one obese parent.
Behavioural: this has to do with diet – consumption of high-calorie sugar-sweetened beverages that are of low nutritional value, fast food, junk food, have all been implicated as risk factors for obesity.
Exclusive breast feeding and duration of feeding is inversely related to the weight gain rate and risk of obesity in children. Risk of obesity is 22% lower in breastfed children; this may be attributable to self-regulated feeding in breastfed children, increased level of energy and protein in supplementary feeds compared to breast milk and parents’ socio-economic factors.
Environmental factors – Children aged 8 to 18 years have been seen to spend more time (up to 7.5 h per day on technological gadgets like cell phone, television, video games, others and less time on physical activity or active play. Each additional hour of television per day increases the prevalence of obesity by 2%. Many schools lack adequate play space for children to play.
Family habit may also contribute; type of food preference in the family, the meal time, whether active or sedentary family.
Other causes include medications: steroids, some antidepressants and others, medical conditions: genetic syndromes like Prader-Willi, and hormonal conditions like hypothyroidism are among the medical disorders that can cause obesity.
Management and prevention
The prevention and treatment of pediatric obesity can be achieved by less food consumption and increased physical activity.
Childhood and adolescent obesity treatment programs can lead to sustained weight loss and decreases in BMI when treatment focuses on behavioral changes and is family-centered. Concurrent changes in dietary and physical activity patterns are most likely to provide success.
Treatments are in stages depending on the degree of obesity and the most aggressive therapy is considered only for those who have not responded to other interventions.
Problem areas identified by dietary and physical activity history should be provided and emphasis should be placed on healthy eating and physical activity patterns. This is especially useful for preventing further weight gain and for overweight and mildly obese children.
Dr Papka however warned that childhood obesity can profoundly affect children’s physical health, social, and emotional well being, and self-esteem and it can also lead to poor academic performance and a lower quality of life experienced by the child.
“It has been linked to numerous medical conditions. Such as, sleep apnea, Type 2 diabetes, asthma, hepatic steatosis (fatty liver disease), cardiovascular disease, high cholesterol, cholelithiasis (gallstones), glucose intolerance and insulin resistance, skin conditions, menstrual abnormalities, impaired balance, and orthopedic problems.”
She also said obese children usually face social and emotional challenges and the condition has been rated as one of the most stigmatising and least socially acceptable conditions in childhood.
“Overweight and obese children are often teased and/or bullied for their weight which often result to low self-esteem and it may be counter-productive as these children tend to retreat to safe environment like home, and tend to eat more as a source of comfort, thereby worsening the situation.”
On the management of childhood obesity she said, structured weight management which includes planned diet, structured daily meals, and planned snacks; additional reduction in screen (computer/video game/television/tablet) time; planned, supervised activity; self-monitoring of behaviors, including logs; and planned reinforcement for achievement of targeted behavior change should be adopted for such child adding that this may require the service of a dietician or clinician with specialised training to handle.
According to the consultant pediatrician, there is a comprehensive multidisciplinary intervention level where treatment increases the intensity of behavior change, frequency of visits, and the specialists involved.
Typical components of a program include structured behavior modification, food monitoring, diet and physical activity goal setting, and contingency management. A multidisciplinary team with expertise in childhood obesity are involved, these includes a behavior counselor, registered dietitian, exercise specialist, and primary care provider to monitor ongoing medical issues.
Tertiary care intervention: This more intensive approach should be considered for severely obese children. Approaches include medications, very low calorie diets, and weight control surgery, in addition to the attainment of behavior changes to improve diet and activity patterns.