Dr Tariq Jagnarine
Fam Medicine, Endocrinology/Diabetes
Childhood obesity is a complex health issue. It occurs when a child is well above the normal or healthy weight for his or her age and height. The causes of excess weight gain in young people are similar to those in adults, including behaviour and genetics. Obesity is also influenced by a person’s community as it can affect the ability to make healthy choices.
Like adults, children become obese when they eat more calories than they use. Obesity in children is determined by using a body mass index (BMI) percentile. BMI is a measure of weight in relation to height.
Obesity can increase a child’s risk for serious and chronic medical problems, such as type 2 diabetes, high blood pressure (hypertension), high cholesterol, orthopaedic problems, and liver disease.
Researchers continue to search for ways to treat obesity, but taking preventive measures has proven to be the best method so far. This means eating a healthy diet based on vegetables, fruits, legumes, whole grains, and lean protein. It is also important to maintain an active lifestyle by getting at least an hour of physical activity a day.
WORLDWIDE
The Centres for Disease Control and Prevention estimate that 17 percent of 2- to 19-year-old American children are obese, as measured by their body mass index (BMI) percentile. The rate of childhood obesity has more than tripled in the past 30 years.
• Worldwide obesity has nearly tripled since 1975.
• In 2016, more than 1.9 billion adults, 18 years and older, were overweight. Of these over 650 million were obese.
• 39% of adults aged 18 years and over were overweight in 2016, and 13% were obese.
• Most of the world’s population live in countries where overweight and obesity kills more people than underweight.
• 38 million children under the age of 5 were overweight or obese in 2019.
• Over 340 million children and adolescents aged 5-19 were overweight or obese in 2016.
• Obesity is preventable.
CHILDREN’S RISK OF OBESITY
There are several tools that are used to determine if a child is at risk for obesity, including:
• Plotting a child’s BMI percentile yearly to see if there’s a sudden increase
• Identifying babies who gain weight too rapidly in infancy; studies show that these babies are at risk for becoming overweight as they get older
• Birth weight and gestational diabetes: these factors may increase a child’s risk for obesity and type 2 diabetes later in life
• Family history of obesity, type 2 diabetes, hyperlipidemia, hypertension, sleep apnea, and early heart attack: these factors can also put a child at increased risk for obesity and associated medical complications
CAUSES OF CHILDHOOD OBESITY
There are many reasons why a child may be obese, including medical or genetic ones. In most cases, though, children are overweight because they eat unhealthful foods and lead a sedentary lifestyle. Reasons why more and more children are becoming obese include:
• Behavioural factors: eating bigger portions, eating foods that are calorie-rich but nutrient poor (junk foods), spending lots of time in front of the television or computer, and spending too little time doing physical activities.
• Environmental factors: easy access to high-calorie junk foods, few opportunities for physical activity, lack of parks and playgrounds in some communities.
• Genetic factors: A child is at increased risk for obesity when at least one parent is obese. However, genes do not necessarily mean a child is destined to be overweight — there are several steps a child can take to lower their risk.
• Medications: steroids, some antidepressants, and ARVS
• Medical conditions: Genetic syndromes like Prader-Willi, and hormonal conditions like hypothyroidism are among the medical disorders that can cause obesity.
The “body weight set point theory” suggests that weight is determined by complex interactions of genetic, hormonal, and metabolic factors
SYMPTOMS OF CHILDHOOD OBESITY
Each child may experience different symptoms but some of the most common include:
• Appearance: stretch marks on hips and abdomen; dark, velvety skin (known as acanthosis nigricans) around the neck and in other areas; fatty tissue deposition in breast area (an especially troublesome issue for boys)
• Psychological : teasing and abuse; poor self-esteem; eating disorders, depression , anxiety
• Lung Issues: shortness of breath when physically active; sleep apnea
• Gastroenterological : constipation, gastroesophageal reflux
• Reproductive: early puberty and irregular menstrual cycles in girls; delayed puberty in boys; genitals may appear disproportionately small in males
• Orthopaedic: flat feet; knock knees; dislocated hip
CONSEQUENCES OF CHILDHOOD OBESITY
More Immediate Health Risks
Obesity during childhood can harm the body in a variety of ways. Children who have obesity are more likely to have:
• High blood pressure and high cholesterol, which are risk factors for cardiovascular disease.
• Increased risk of impaired glucose tolerance, insulin resistance, and type 2 diabetes.
• Breathing problems, such as asthma and sleep apnea.
• Joint problems and musculoskeletal discomfort.
• Fatty liver disease, gallstones, and gastro-esophageal reflux (i.e., heartburn).
Childhood obesity is also related to:
• Psychological problems such as anxiety and depression.
• Low self-esteem and lower self-reported quality of life.
• Social problems such as bullying and stigma.
Future Health Risks
• Children who have obesity are more likely to become adults with obesity. Adult obesity is associated with increased risk of several serious health conditions including heart disease, type 2 diabetes, and cancer.
• If children have obesity, their obesity and disease risk factors in adulthood are likely to be more severe.
TREATMENT
Treatment for children who are overweight or obese seems easy, that is, just counsel children and their families to eat less and to exercise more. In practice, however, treatment of childhood obesity is time-consuming, frustrating, difficult, and expensive. In fact, choosing the most effective methods for treating overweight and obesity in children is complex at best.
• Nutrition counseling and modification of diet quality and caloric content
• Increased physical activity
• Behavior modification to address self-esteem and attitudes about food
• Individual or group therapy focused on changing behaviors and confronting feelings related to weight and normal developmental issues
• Family counseling to help support changes in the home
The large-scale quarantine and home confinement have imposed new stressors on children. The closure of schools has led to increased out-of-school time, while lockdown measures have resulted in decreased organised physical activity and increased food insecurity, a more sedentary lifestyle, and too much screen time for many children. All this, further fuelled by the stress-induced indulgence of unhealthy, calorie-dense and sugary foods has created a new unpredictable layer of difficulty in this modern battle. This untrustworthy cocktail has made the fight against childhood obesity much more difficult. To this end, it is vital that we start with public health, planning and social service responses to support healthy eating for, and the active living of, school-age children.
