Obesity means having too much body fat. A child is obese if their weight is more than 20% higher than the ideal weight for a boy or girl of their age and height.
In many obese people, the roots of their disorder can be traced back to childhood. Obesity tends to persist through life. While most obese infants will not remain so, they are at increased risk of becoming obese children. These children are in turn more likely to become obese adolescents, who are then very likely to remain obese as adults. Evaluation and treatment of obesity in childhood offers the best hope for preventing disease progression with its associated morbidities into adulthood. The persistence of obesity into adulthood depends on several factors, including the age at which the child becomes obese, the severity of the disease and the presence of obesity in at least one parent. Overweight in a child under three years of age does not predict future obesity, unless at least one parent is also obese. After age three, however, the likelihood that obesity will persist into adulthood increases with the advancing age of the child and is higher in children with severe obesity in all age groups. After an obese child reaches six years of age, the probability that obesity persists exceeds 50 percent, and 70 to 80 percent of obese adolescents will remain so as adults. The presence of obesity in at least one parent increases the risk of persistence in children at every age.
Only a small percentage of childhood obesity is associated with a hormonal or genetic defect, with the remainder being idiopathic in nature. Obese children should be evaluated for associated morbidity. This includes an assessment of cardiac risk factors, weight-related orthopedic problems, skin disorders and potential psychiatric sequels.
Obese children also have increased average blood pressure, heart rate and cardiac output when compared to non-obese peers. Tobacco use should be ascertained in all young people, as this represents an independent risk for cardiovascular disease. Finally, the presence of diabetes should be considered in all morbidly obese children. While overt type 2 diabetes mellitus is rare in childhood, hyper-insulinemia and glucose intolerance are nearly universal in morbidly obese children.
The child’s level of physical activity should be assessed, not only for cardiac risk evaluation, but also to help guide future treatment. Television viewing patterns should be reviewed, since television viewing has been shown to be associated with obesity in childhood.
In summary being obese increases a child’s risk for some serious childhood medical problems:

• Pre-diabetes and diabetes
• Heart disease, high blood pressure (hypertension)
• Hyperlipidemia (too much fat in the blood, which can clog the arteries), high cholesterol
• Sleep apnea and breathing problems
• Bone conditions, such as hip problems
• Gastro-intestinal diseases
• Early puberty
• Psychological problems, like poor self-esteem and depression

How do kids become obese or overweight?

Many studies have shown that there is not a big difference in the amount of food eaten and physical activity between obese and non-obese kids. Probably small differences in eating and activity over time really add up and lead to weight gain. Obese children do tend to eat larger portions or higher calorie foods, like high-fat foods.
Physical activity and inactivity are very important factors. Many studies have shown that kids who spend more time watching television and playing video games are at higher risk of becoming overweight. One in three high school youth do not engage in vigorous physical activity. Less than 30% attend daily gym class. Sprawling development that discourages physical activity and makes walking and biking difficult or dangerous is also a factor.
Children need lots of energy because they are growing. A varied and nutritious diet is essential for their development. However, like adults, if they take in more energy – in the form of food – than they use up, the extra energy is stored in their bodies as fat.

Why are more children overweight?

Very few children become overweight because of an underlying medical problem. Research indicates that children are more likely to be obese if their parents are obese. It isn’t known whether this is because of genetic factors which the child inherits, if its because families tend to share eating and activity habits, or a combination of them both.
However, it’s thought that most children put on excess weight because their lifestyles include an unhealthy diet and a lack of physical activity.
It is certainly easier than ever before for children to become overweight. High-calorie foods, such as fast food and confectionery, are abundant, relatively cheap and heavily promoted, specifically at children.
Kids in families with obese parents tend to be obese themselves. If one parent is obese or overweight, their teen has an 80% chance of being overweight. This is probably because of a combination of genetics and family behavior and habits. Exercise is no longer a regular part of everyone’s day – some children never walk or cycle to school, or play any kind of sport. It is not unusual for children to spend hours in front of a television or computer.

THE IMPORTANCE OF A BALANCED DIET:

If you are concerned about your child’s weight, encourage a variety of fresh, nutritious foods in his or her diet.

  • Starchy foods which are rich in complex carbohydrates are bulky, relative to the amount of calories they contain. This makes them both filling and nutritious. Sources such as bread, potatoes, pasta, rice and chapatti should provide half the energy in a child’s diet.
  • Instead of high-fat foods like chocolate, biscuits, cakes and crisps, try healthier alternatives such as fresh fruit, crusty bread or crackers.
  • Try to grill or bake foods instead of frying. Burgers, fish fingers and sausages are just as tasty when grilled, but have a lower fat content. Oven chips are lower in fat than fried chips.
  • Avoid fizzy drinks that are high in sugar. Substitute them with fresh juices diluted with water or sugar-free alternatives.
  • A healthy breakfast of a low-sugar cereal (eg wholemeal wheat biscuits) with milk, plus a piece of fruit is a good start to the day.
  • Instead of sweets, offer dried fruit or tinned fruit in natural juice. Frozen yogurt is an alternative to ice cream. Bagels are an alternative to donuts.

CHANGE HABITS:

To achieve lasting effects, the whole family attitudes and habits towards food and exercise need to change.

  • Try to set a good example with your own eating habits.
  • Provide meals and snacks at regular times to prevent “grazing” throughout the day.
  • Don’t allow your children to eat while watching TV or doing homework.
  • Make mealtimes an occasion by eating as a family group as often as possible.
  • Encourage children to ‘listen to their tummies’ and eat when they are hungry rather than out of habit.
  • Teach children to chew food more slowly and savor the food, as they will feel fuller more quickly and be less likely to overeat at mealtimes.
  • Don’t keep lots of high-fat, high-sugar snack foods in the house.
  • Don’t make outings for fast foods part of the weekly routine.
  • Try to get your children involved in preparing food as this will make them more aware of what they are eating.

Obesity Treatment

For some children, especially if they are still growing taller, it’s more important to stabilize weight and allow them to grow into their weight. Overweight children who are still growing do not necessarily need to lose weight but simply maintain so that they can grow into their weight. The earlier a child is identified as being overweight or at risk the easier it is to treat. Because it’s hard to permanently change dietary and exercise habits, it’s essential to do something sooner rather than later.
Obese children need a thorough medical evaluation by a pediatrician or family doctor to assess their family history as well as their diet and exercise routines. First, the doctor will check for genetic and biochemical disorders related to obesity, such as Prader-Willi Syndrome and other genetic disorders, and hypothyroidism, and other hormonal disorders.

Eat a healthy diet

Parents are the ones who buy the food, cook the food and decide where the food is eaten. Even small changes can make a big difference in your child’s health.

Increase physical activity

A critical component of weight loss, especially for children, is physical activity. It not only burns calories, but also builds strong bones and muscles and helps children sleep well at night and stay alert during the day. Such habits established in childhood help adolescents maintain healthy weight despite the hormonal changes, rapid growth and social influences that often lead to overeating. And active children are more likely to become fit adults.
To increase your child’s activity level:

• Limit recreational screen time to fewer than two hours a day.
• Emphasize activity not exercise
• Find activities your child likes to do
• If you want an active child, be active yourself
• Make chores a family affair
• Vary the activities

Make a family commitment

Children can’t change their exercise and eating habits by themselves. They need the support and encouragement of their family and other caregivers. To increase the odds that your child finds success:

  • Commit to new healthy habits and behaviors as a family, with all members sticking to the plan. If not, your child may feel singled-out, deprived or resentful.
  • Be ready to make changes. Small, gradual changes are easiest to follow and incorporate into your daily lives.
  • Focus on long-term diet and exercise changes, not quick fixes or fad diets aimed at rapid weight loss. The goal is healthier eating and lifestyle changes not pounds lost.
  • Set achievable goals for your child and family. For example, your child’s goal might be to reduce the number of sugar-sweetened beverages he or she drinks. The family’s goal might be to eat meals at the table every night instead of in front of the television.

Sources: HCD2 BUPA, Med Umich, Child obesity

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