Unlike being overweight, obesity is a disease. But what are we doing about it?

OBESITY is defined as an abnormal growth of the adipose (fat) tissue due to either an enlargement of the fat cell size (hypertrophic obesity), or an increase in fat cell number (hyperplasic obesity), or a combination of both. It should be cleared in mind that obesity and overweight are not synonyms. The term overweight means a weight in excess of the average for a given sex, height and age. Overweight is usually due to obesity but can result from abnormal muscle development or fluid (water retention).

CAUSES OF CHILDHOOD OBESITY: As with adult-onset obesity, childhood obesity has multiple causes centring around an imbalance between energy IN (calories obtained from food) and energy OUT (calories expended in the basal metabolic rate and physical activity). Childhood obesity most likely results from an interaction of nutritional, psychological, familial and physiological factors.

* THE FAMILY: The risk of becoming obese is greatest among children who have two obese parents. This may be due to parental modelling of both eating and exercise behaviours, indirectly affecting the child’s energy balance.

* LOW-ENERGY EXPENDITURE: Children and adolescents who watch TV most of the time are more obese than their peers who watch it less. There are several ways television contributes to childhood obesity: watching TV requires no energy above resting metabolic rates. TV reduces the time the child spends in energetic activities, such as running and playing. In other words, it’s not what the child is doing, rather it’s what he/she is not doing while watching TV.

The foods most heavily advertised on TV are high in calories. It is also suggested that the slim figures of TV stars indirectly indicates to children that high calorie food and drinks have little effect on weight.

* HEREDITY: Heredity has recently been shown to influence fatness. Infants born to overweight mothers have been found to be less active and to gain more weight as compared to infants of normal weight mothers, suggesting a possible inborn drive to conserve energy.

 

PROBLEMS DUE TO OBESITY:

• Commonest problem is the development of pain in the joints, especially in the legs. Here the most affected joints are the knee-joint and the ankle-joint (the weight-bearing joints).

• Sluggishness.

• Clumsy look.

• Depression, anxiety, frustration and loneliness, as an obese child cannot actively participate in sports. * Flat feet.

• Increased blood cholesterol level, which could result in hypertension.

• Coronary heart disease.

• Juvenile diabetes mellitus.

• Gall bladder disease.

• Varicose veins (visible and swollen veins) of the legs.

• Abdominal hernia.

• Lowered fertility in some cases.

ASSESSMENT OF OBESITY: Parents should measure the weight of their child periodically. The widely used parameter that the physicians use is the Body Mass Index (BMI)

BMI = Weight (kg)

Height2 (m)

A BMI of 30 or more in males and 28.6 or more in females indicates obesity or obesity is clinically diagnosed as: greater than 90th per centile weight for height; or greater than or equal to the 95th per centile BMI. The gold standard is becoming the BMI, since this is also used for adults. A trained technician may obtain skin fold measures relatively easily in either a school or clinical setting. When the triceps and calf skin folds are used, a sum of skin folds of 10-25mm is considered optimal for boys, and 16-30mm is optimal for girls.

AN INTRODUCTION TO WEIGHT MANAGEMENT FOR OVERWEIGHT CHILDREN: While most of the children can’t be put on restricted diet, management by a combined approach of a sensible diet and regular exercise will help to control their weight gain.

Children normally need a certain number of calories each day (energy allowance) that their bodies use as energy for normal daily activities (walking, breathing, etc.). This ranges for boys from 2000 calories for a 7-10 year old, 2500 calories for an 11-14 year old, and 3000 calories for a 15-18 year old. For girls the ranges are from 2000 calories or a 7-10 year old, to 2200 If a child consumes more food and calories than is required by their energy allowance, then those excess calories are converted to fat for storage. Conversely, if a child consumes less food and calories than is required by their energy allowance, than their body fat is converted to energy for the needed calories.

Energy Stored (Fat) = Energy In - Energy Used

The child can lose weight by either dieting (eating fewer calories each day) or by exercising, so that his body needs more energy and uses up more calories. Either way, body fat will be burned and converted to energy and the child will lose weight.

BEHAVIOUR MODIFICATION: It is easier for your child to lose weight if he is motivated to do so. You can help your child to lose weight by making healthy choices for his meals at home and encouraging regular exercise and physical activity. You can help him to become more motivated by getting the whole family actively involved in the process of eating healthier and exercising regularly.

It is also important to modify the behaviour of your child by:

* LIMITING TELEVISION: The television viewing of a child should be limited to about one or two hours each day (this includes playing video games or using the computer).

DRINKING: You should encourage your child to drink four to six glasses of water each day, especially before meals. Water has no calories and it will help you to feel full. Other drinks can include diet-sodas and low-fat milk. Avoid letting your child drink regular soft drinks or fruit juices, as they are high in calories (150-170 calories per serving).

DIET JOURNAL: Help your child to keep a weekly journal of food and beverage intake and also of the amount of time that he or she spends watching television, playing video games and exercising. You can also record your child’s weight each week (but do not weigh your child every day).

HEALTHY EATING HABITS: A child should be encouraged to have foods low in calories and low in fat. Also, begin checking the serving size of prepared meals and snacks. A bag of chips may only have 200 calories, but you may be surprised when the serving size is only 10 chips. Eating the whole bag can easily get the child over 1000 calories.

Some eating habits that will help your child lose weight include-

* HEALTHY MEALS: Your child should eat three well-balanced meals of average size each day. Serve fewer fatty foods. It is best to prepare foods that are baked, boiled or steamed, rather than fried. In addition to a small serving of lean meat, provide large servings of vegetables.

* SINGLE SERVINGS: Avoid serving second time the main food or desert. You can eat more salad or other vegetables if still hungry.

DESSERTS: Serve fresh fruit as a dessert and avoid frequent eating of ice-cream or cake or other high calorie foods.

AVOID FAST FOOD: You should limit your children to eat fast food, as it is usually high in fat and calories.

FITNESS: An essential part of any weight loss or weight management programme is regular fitness. Encourage your child to participate in a physical education class in school and extracurricular sports at school or in the community.

Some tips to increase your child’s and family’s physical activities include:

* Walk or ride your bike instead of driving for short distances.

* Use stairs instead of escalators or elevators. * Park your car at the end of the parking lot and walk to the entrance of the mall or grocery store.

* Encourage regular exercise for 20-30 minutes 4-5 times each week. This can include walking, jogging, swimming, bike riding, riding skateboard, etc. It can also include playing a new sport, such as basketball, volleyball, tennis, soccer, etc.

But, even after having practised this regimen, you child has is still not losing weight, or if it is affecting his self-esteem, the contact your paediatrician immediately.