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Childhood obesity is a chronic condition characterized by children having a body mass index (BMI) at or above the 95th percentile for their age, height, and sex assigned at birth. It’s a serious concern as it predisposes children to health issues traditionally seen in adults, such as diabetes, high blood pressure, and high cholesterol. Additionally, it can lead to psychological problems like poor self-esteem and depression. For accurate assessment, healthcare providers use age- and sex-specific BMI growth charts due to the natural changes in body composition as children grow.
One effective approach to combating childhood -obesity is by fostering better eating and exercise habits within the family setting. This not only helps in treating the current condition but also in preventing future incidences of obesity. By prioritizing a healthy lifestyle, families can safeguard their children’s health both now and in the future, steering them away from the onset of obesity-related complications.
Symptoms
Not all children who appear heavier are necessarily overweight. Some have larger body frames naturally, and children go through stages where they carry varying amounts of body fat. Simply looking at a child might not accurately indicate whether their weight is a concern for their health.
The Body Mass Index (BMI) is the standard measurement used to assess overweight and obesity by comparing weight to height. Pediatricians use BMI along with growth charts and, if needed, additional tests to determine if a child’s weight might lead to health issues.
If you are concerned about your child’s weight gain, it is advisable to consult with their doctor. The doctor will review your child’s growth and developmental history, your family’s weight and height patterns, and analyze their position on the growth charts to assess if your child’s weight is within an unhealthy range.
Causes
Childhood obesity is influenced by a myriad of factors that impact a child’s health and weight.
Caloric Balance
Proper balance between calorie intake and energy usage is crucial. Excess calories are stored as body fat.
Genetics and Epigenetics
- Genetics: A family history of obesity increases the risk, though not all children with obese relatives will become obese.
- Epigenetics: External factors like adversity can alter gene expression affecting metabolism and increasing obesity risk.
Influential factors include:
- Diet and eating habits.
- High consumption of sugar-sweetened and processed foods.
- Increased screen time and sedentary lifestyle.
- Inadequate sleep and exposure to secondhand smoke.
Social determinants of health (SDoHs): Environmental and social conditions affect obesity risks, such as:
- Access to healthy foods and recreational facilities.
- Proximity to fast food outlets.
- Economic and social support systems.
Cultural factors: Advertising influences eating behaviors, with children exposed to marketing for unhealthy foods often consuming more of those foods.
Underlying health conditions: Some medical issues can contribute to obesity, including:
- Hormonal imbalances (e.g., hypothyroidism, Cushing syndrome).
- Genetic conditions (e.g., Prader-Willi syndrome).
- Certain medications (e.g., antipsychotics, corticosteroids).
Understanding these factors can aid in managing and preventing childhood obesity through targeted interventions.
Risk factors
Childhood obesity can impact any child, though it tends to be more prevalent in specific groups. Recent data indicates that the rates of childhood obesity have decreased with higher levels of education among the heads of households.
Risk factors that may contribute to childhood obesity include:
- Family factors: Family behaviors, such as shared eating habits and a lack of physical activity, can play a role in the development of childhood obesity. Children may be more prone to gain weight if they are raised in an overweight family.
- Diet: Busy families are increasingly consuming foods and drinks that are high in fat, sugar, and calories, often lacking essential vitamins and minerals. Regular consumption of high-calorie items and sugar-filled beverages like baked goods, fast food, candies, fruit juices, and sports drinks may contribute to weight gain.
- Insufficient physical activity: Many children are reducing outdoor activities and becoming more sedentary indoors. The rising popularity of video games, tablets, and smartphones may contribute to an even greater number of inactive hours. Children with low levels of physical activity are at a higher risk of weight gain because they do not expend as many calories.
- Psychological factors: Some kids overindulge in food as a coping mechanism for issues or as a way to express emotions like stress or boredom. Stress in the home, on parents, and in the family can raise a child’s risk of obesity.
- Socioeconomic factors: The risk of childhood obesity can be influenced by the child’s residential environment, with factors such as the availability and affordability of healthy food options, the social support system, and the accessibility of recreational facilities or safe spaces for physical activity playing significant roles.
- Certain medications: Prednisone, lithium, amitriptyline, paroxetine, gabapentin, and propranolol are among the prescription medications that may elevate the likelihood of developing obesity.
Diagnosis
BMI-for-age growth charts is often utilized to assess the size and growth trends in children. A heightened BMI could indicate an increased level of body fat, although BMI itself does not directly measure body fat. However, it serves as a signal to healthcare providers that additional tests may be necessary to determine if excessive fat poses a concern for the child.
As BMI does not account for factors like muscle mass or having a larger-than-average body frame and considering the significant variability in growth patterns among children, healthcare providers also consider the child’s individual growth and development.
BMI percentile cutoffs establish a threshold beyond which a child might be at a higher risk of developing health issues related to weight:
- Overweight, if BMI is between the 85th and 94th percentiles
- Obesity, if BMI is 95th percentile or higher
- Severe obesity, a BMI of 99th percentile or above
So, if the child is in the 80th percentile, it signifies that 80% of children of the same sex and age have a lower BMI. The growth chart assesses the child’s percentile, indicating their comparison with peers of the same sex and age.
Apart from assessing BMI and tracking weight on growth charts, various factors are also considered, including the family’s history of obesity and weight-related issues, the child’s eating habits, activity level, other health conditions, and psychosocial history. This includes incidents of depression, sleep disturbances, feelings of sadness, and whether the child experiences isolation, loneliness, or bullying.
Blood tests
For certain blood tests, it is necessary for the child to abstain from food and liquids before to the exam. Blood tests that may be required include blood sugar test, cholesterol test, and tests to look for illnesses linked to obesity or hormone imbalances.
Treatment
The primary focus in addressing childhood obesity should be on enhancing overall well-being rather than solely concentrating on weight. It is vital to offer supportive measures to children as they work towards better health. Treatment typically involves adjustments to diet and exercise, and in certain instances, may include medications or bariatric surgery. The specific approach to addressing childhood obesity is determined by factors such as the child’s age and any accompanying medical conditions.
- Treatment for children whose weight falls into the overweight category: A weight-maintenance program that aims to decelerate the pace of weight gain, enabling the child to gain height without adding pounds, is suggested for children aged 2 and older who are classified as overweight.
- Treatment for children whose weight falls into the obesity category: Regardless of whether the goal is weight maintenance or weight loss, the strategy remains unchanged: advocating for a nutritious diet in terms of food choices and portion sizes, combined with elevated physical activity levels. In the case of older children and adolescents dealing with obesity or severe obesity, the objective might involve aiming for a more significant weight reduction of up to 2 pounds per week through dietary adjustments. For children aged 6 to 11 categorized as obese, it is recommended to pursue gradual weight loss of about 1 pound per month by promoting alterations in eating habits.
- Healthy eating: Modest adjustments in choosing what food to prepare for children can benefit the child’s health. It is also beneficial to ensure that one’s home has a diverse range of nutritious foods accessible.
- Prioritize fruits and vegetables: A way to initiate the teaching of healthy eating habits is by offering a diverse range of fruits and vegetables to the family, creating a colorful array in every meal, including snacks.
- Limit drinks with added sugar: It is advisable to steer clear of sugary beverages such as soda, sweet tea, lemonade, and sports drinks, as these can contribute to an excess of more than 120 calories per day in a child’s diet.
- Avoid fast food: The food options on their menu are generally heavy in calories and fat.
- Eat meals together as a family: Strive to create enjoyable mealtimes centered around conversation and sharing rather than criticism or conflict. Unpleasant mealtimes may prompt the child to eat quickly to leave the table swiftly, potentially associating eating with stress.
Discourage eating in front of screens like TV, computers, or video games, as this can lead to rapid consumption and reduced awareness of the quantity consumed.
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- Provide sensible serving sizes: Encourage the child to eat until they feel satisfied, even if it means leaving food on the plate. Begin with a modest portion, and if the child is still hungry, they can request more. Kids usually require less food compared to adults.
- Physical activity: Active kids are more likely to grow up to be fit adults, and effective weight management in young people is facilitated by good habits formed in childhood. Physical activity is essential to reaching and maintaining a healthy weight. In addition to helping kids sleep better at night and remain awake throughout the day, it burns calories and improves bones and muscles.
To improve physical activity:
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- Set time limits for TV: There should be absolutely no screen time for kids under the age of two. For kids older than two, recreational screen time should be restricted to no more than two hours per day.
- Emphasize activity, not exercise: Organize activities that ensure everyone in the family gets exercise, such as engaging in walks, bike rides, or swimming. Playing games like jump rope, tag, or hide-and-seek can be excellent for increasing physical fitness and burning calories. Kids should be active for at least an hour a day, ranging from mild to strenuous.
- Determine what is enjoyable to the child: Assist children in discovering physical activities they find enjoyable and not overly challenging. If the kids enjoy climbing, take them to the closest climbing wall or jungle gym in the area.
- Medications: As part of a comprehensive weight-loss plan, some children and adolescents may be prescribed medication.
- Weight-loss surgery: Weight loss surgery is not a cure-all solution. It cannot replace the necessity for a balanced diet and regular physical activity. However, in cases where the health risks associated with a child’s weight outweigh the potential dangers of surgery, healthcare providers may recommend this intervention. If lifestyle changes prove ineffective in assisting teenagers with severe obesity in losing weight, weight-loss surgery may be considered. Nevertheless, it does not guarantee that adolescents will shed additional pounds or sustain weight loss over the long term. It’s essential to also consider the risk of potential complications associated with such procedures.
