Obesity in children – a condition in which the body weight of the child above the age norm by more than 15%, and this figure as a body mass index equal to or more than 30%. Obesity affects 8.5% of children who live in the cities, and among children living in rural areas, this percentage is about 5.5.
Today in the world the number of children with obesity increases, so pediatricians should pay serious attention to this issue, as, indeed, children’s endocrinologists. More than half of adults with a diagnosis of “obesity” these processes began in childhood or adolescence. Progresses the more obese the child, the higher his risk of having the endocrine, cardiovascular, reproductive and metabolic disorders. Also obesity increases the risk of disorders and diseases of the gastrointestinal tract and the musculoskeletal system.
Obesity in children – a condition that can be prevented, because it is important to pay attention to preventive measures, which will be detailed below.
Classification of obesity in children
There are 2 forms of obesity in children:
Primary can be nutritional (which relates to improper diet), or exogenous-constitutional (passed by descent from parents). When the child inherits not fat mass and clinical features of the metabolic processes in the body.
Alimentary obesity most likely to occur at this age:
- 3 years
- 5-7 years
- 12-16 years
Secondary obesity in children may be endocrine in diseases of the ovaries in the female children, and diseases of the adrenal glands and/or thyroid. Criteria for determining obesity in children today are still under discussion by specialists. The researcher Gaivoronsky A. A. offers to divide obesity into four degrees:
- grade I – exceeds normal weight by 15-24%
- grade II – exceeds normal weight by 25-49%
- third degree – exceeds normal weight by up to 50–99%
- fourth degree is exceeding the normal weight by 100% and more
According to statistics, primary obesity in 80% of children refers to the I–II degree.
Causes of obesity
Obesity in children can be triggered by several reasons. In its development participate among factors and genetics. In 100% of cases, the essence of obesity is energy imbalance, which is caused by reduced archidom and higher energy consumption.
If the obesity of both parents, the chance 80% of what the same violation would have their son or daughter. If obese suffers only the mother, the probability of a child having a similar condition – 50%, and if only the father, then 38%.
At risk are children who were born weighing more than 4 kg, as well as having a monthly gain above normal, being on artificial feeding. Obesity in infants can be caused by feeding him high-calorie mixes in excess or violations of the rules of nutrition of infants.
Most of the little children and school-age children obesity occurs if broken the diet, and the child gets little physical activity. Obesity appears if the diet is dominated by “fast” carbohydrates (digestible), solid fats (derived from the products of “fast food”), sparkling water, juices and teas with sugar. Usually in children with obesity is not enough protein, fiber and water in diet.
Important factor sedentary lifestyle. Obesity threatens those who do not practice any sport, playing active games, is not going to physical education classes or idle. Also risk factors: intense mental pressure, leading to physical inactivity, a frequent pastime at the computer or on the couch watching TV.
The cause of obesity (overweight) in children can be a serious pathological state:
- Down syndrome
- Cohen syndrome
- Syndrome of Laurence-moon-Biddle
- Syndrome Itsenko-Kushinga
- Congenital hypothyroidism
- Adiposo-genital dystrophy
- Meningitis, encephalitis
- Brain injury
- Brain tumors
Sometimes obesity can trigger such emotional causes:
- Admission to first grade
- Death of a family
- The child has witnessed homicide or other crimes
Pathogenesis of obesity in children
Pathogenesis of obesity has no dependence on its causes. Plenty of food, especially with high content of carbohydrates, causing hyperinsulinism. A consequence of hypoglycemia that causes hunger in the child. Lipogenesis insulin is the main hormone that has anabolic effects and affects the synthesis of triglycerides in adipose tissue.
Accumulation of fat is higher than normal accompanied by a secondary change in the function of the hypothalamus. It enhances the production of adrenocorticotropic hormone, hypercortisolism appears, disturbed sensitivity ventro … the ventromedial and-lateral nuclei to signals of hunger and satiety, etc.
Obesity in children researchers believe chronic inflammatory processes. In the pathogenesis are important cytokines of adipose tissue and altered lipid composition of blood serum and activation of lipid peroxidation processes.
Adipocytes adipose tissue synthesize enzymes that regulate lipoproteinemia metabolism, leptin and free fatty acids. If the “food center” is not responding to leptin, after a meal the child is not saturated. The amount of leptin is associated with insulin amount in the body. Also the centers of hunger regulate cholecystokinin, serotonin, norepinephrine.
The mechanism of dietary thermogenesis implement, including thyroid hormones, enteral hormones of the duodenum. If in the body low concentration, after ingestion the child still wants to eat. Appetite also increases due to abnormally high concentrations of endogenous opiates or neuropeptide.
Symptoms of Obesity in children
Main symptom of obesity children – layer of subcutaneous fat becomes more. Also to the signs of obesity include delayed development of motor skills, inactivity, tendency to allergic reactions, constipation, the incidence of various infections.
Alimentary obesity in children doctors see fat deposits in the abdominal area, hips, pelvis, back, chest, hands, face. At the age of 7 to 16 years in such cases symptoms: reduced tolerance to exercise, shortness of breath, increased AD. To sixteen years, ¼ of children is fixed with metabolic syndrome, which is manifested not only obesity, but insulin resistance, hypertension and dyslipidemia. Obesity in a child can also be dysmetabolic nephropathy and the metabolism of uric acid.
Secondary obesity in children occurs due to the main disease manifestations correlate with her symptoms. For example, when the diagnosis of “congenital hypothyroidism” later, the child begins to hold his head, sit and walk, teeth erupt later than in healthy children. Fix acquired hypothyroidism in children in the pubertal period, if the deficiency of iodine in the body. Except obesity in such cases, patients record symptoms such as weakness, fatigue, impaired school performance, tendency to sleep at the wrong time, the skin becomes dry, and the girls disturbed menstrual cycle.
When cushingoid obesity in children (syndrome of Cushing) leads to fatty deposits in the neck, face, abdomen, and arms and legs remain slender. In puberty in girls may be hirsutism and amenorrhea.
If obesity in children is combined with prolactin, increase Breasts, that scientific language is called gynecomastia. This also applies to boys. Typical symptoms:
Obesity plus polycystic ovaries give these symptoms (combined with the formation of excess mass): acne, oily skin, irregular menstrual cycle, excessive hair growth. When adiposogenital dystrophy in patients male is cryptorchidism, obesity, hypoplastic penis, gynecomastia, underdeveloped secondary sex characteristics, in female patients amenorrhea.
Complications of obesity in children
In obesity there is a risk of these diseases:
- diabetes type 2
- chronic cholecystitis and cholelithiasis
- steatosis (which later may evolve into cirrhosis of the liver)
If overweight and obesity in children often have such eating disorders as anorexia and bulimia and sleep disorders, e.g. sleep apnea and snoring. From what the child increases stress on the bones and muscles appears scoliosis, incorrect posture, hallux valgus, osteoarthritis, flat feet. If a person is obese since childhood, he increased the risk to never conceive a child.
Among the psychological consequences of obesity is to provide a state of melancholy and depression, social isolation, ridicule from classmates and friends, deviant behaviour, etc.
Diagnosis of obesity in children
The doctor collects the medical history, including figuring out how the child was fed at the age from birth to 1 year, especially the diet of the baby today, says the level of physical activity. The physical examination includes the examination, anthropometry by such indicators:
- waist circumference
- body weight
- body mass index
There are specific centile tables for which data are mapped. On their basis it is possible to determine whether the child is overweight or obese. In mass examinations can apply the measurement of the thickness of the skin fold, and bioelectrical resistance method (to determine the relative mass of adipose tissue in the body).
To determine the etiology of obesity, the necessary consultations of such specialists as a pediatric neurologist, an endocrinologist, a geneticist and a gastroenterologist. Doctors may prescribe biochemical analysis of blood:
- glucose tolerance test
- uric acid
- liver function tests
Also needed are study the hormonal profile:
- St. T4
- cortisol blood and urine
Advanced research methods (needed only in some cases):
- Ultrasound of the thyroid
- Pituitary MRI
Obesity Treatment in children
The first step to getting rid of obesity – a review of dietary habits and the diet of not only the child but also his family. Without abandoning fast carbohydrates (sweets) to lose weight or you cannot, but only slightly. It is difficult for children to opt out of this eating habits because dieting may be the stress. You need to instill in your child and those with whom he lives, habits of a healthy lifestyle – healthy lifestyle.
Diet for obese child
- First of all, you need to reduce the serving size of food they consume at 1 time.
- Replace sugary store-bought beverages, water (mineral without gas or tap water that has been filtered).
- In the diet to include fruits and berries: bananas, apples, strawberries, oranges, blackberries, melons, watermelons, raspberries, etc.
- Foods with high protein content should be low-fat. To exclude pork, to give preference to the chicken. Also welcome lean fish.
- To Include in the diet as many fresh fruits and vegetables that reduce hunger and help avoid constipation.
- You Should avoid trendy diets, especially those that are based on the use of only one product (mono-diet: watermelon, buckwheat, etc.).
- You Need to introduce the concept of “violation of the regime” – when the child ate something unplanned, harmful. For such violations don’t need to abuse the baby. You must install a useful punishment: 20 time to sit down or to download the press 30 times. Also suitable exercise Bicycle, push-UPS, jog, twist wrap, etc.
Make a child’s life more active. It is possible to write in the sports section, just give the baby right to self-selection. For this purpose it is possible to drive in sports circles, to show what the sports are, so he can choose. Fun (and helpful) will, for example, swimming. Activity physical activity should be regular.
In some cases, obesity can occur due to hypothalamic-pituitary disease, when the child has a disturbed hormonal system, has bulimia, etc. Then the child experiences the feeling of hunger during the night, increased appetite during the day, pink striae on the thighs, upper arms, abdomen, hyperpigmentation of the elbows, neck, etc. the Treatment in such cases is as follows:
- low calorie diet
- meals 6 times a day (fractional)
- organization fasting days (vegetable, protein)
- systematic therapeutic exercises
- active movement
Treatment of obesity in children can be motels, but only if such was recommended by the attending physician. Healthy recreation in health resorts by the sea, because the metabolic processes in the body faster than normal under the influence of the fresh sea air.
If child’s appetite is above normal, the doctor may prescribe laxatives, stimulants and thyroid medications.
Homeopathic remedies for the treatment of excess weight in children:
- Antimonium Krudum
- Grafites of Cosmoplex
- Testis compositum
- Thyreoidea compositum
- Ovarium compositum (for girls)
The medication must be accompanied by the supervision of the attending endocrinologist. Sometimes it is necessary to resort to operative methods of treatment – for example, if obesity and its complications threaten death in the near future. Section surgery involved in the treatment of obesity, is called bariatrics.
Why can’t the child to starve for obesity?
With weight loss, according to experts, the body weight should be reduced at 500-800 g per week. But these figures may vary depending on the child’s age, weight and health outcomes. Sometimes, the doctor may be developed for children with overweight a diet that will allow for 1 week to lose 1.5 kg of excess weight. But such diets should be conducted under strict medical control.
Diets that offer to lose more than what was stated above, in a short period of time, can harm your health, and seriously. In addition, following such diets the weight can quickly return as it starts in the body modes of self-preservation (the body thinks that the famine came, and then trying to gain weight in reserve).
During the period of fasting, the energy deficit in the body is compensated by glucose. When blood glucose is gone, begins the breakdown of the reserves of glucose as glycogen. In the body of glycogen lasts for only 24 hours of fasting. Then they start to disintegrate proteins, and, as you know, our body consists mainly of proteins including heart muscle. And the breakdown of fats begins only as a last resort.
When fasting of the child or the improper diet, the body lacks the required minerals and vitamins. This leads to the fact that your metabolism slows down, because the weight of “is” and not reduced. If the weight decreases dramatically, adaptation of the organism does not have time to engage. Because there is a weakness in the muscles, sagging skin, disturbed gastrointestinal tract.
A food Diary and energy expenditure for children with obesity
To understand the cause weight child can, if within 1 weeks keep a special food diary. In it write down everything that was eaten throughout the day during the main meals and snacks. It is helpful to count the calories eaten and you do the calculation on proteins, fats, carbohydrates. In this diary you can count calories. If the consumption is, according to you, exceeds the consumption, the cause of excess weight in children is clear – overeating.
Medications that reduce the absorption of fats and carbohydrates
Such drugs used by a doctor in some cases of obesity in children, to reduce the absorption of fats and carbohydrates. Thus it is possible to reduce the energy value of feed consumed, with a positive impact on the process of losing weight.
A few years ago was such a popular drug as xenical (orlistat). It blocks the lipase (a digestive enzyme), which promotes the assimilation of fats in the digestive tract. Because about 30% of fats that were eaten, the “exit” from the body, not putting off anywhere. Xenical stalowym step in the treatment of obesity. But experience has shown that taking fat blockers will not help those who eat too many fatty foods. Undigested fat passing through the intestines, leading to indigestion, causing bloating, diarrhea, etc.
Because the patient has to choose between the intake of fatty food and the above mentioned medications. When withdrawal of medication and transition to a normal, healthy diet, normal weight and condition of the intestine. That is, xenical is more psychotherapeutic than the physical effect.
Famous like a drug – chitosan. It binds the fat contained in food, undigested compounds, in the form which leaves the body. Independent studies saying that the chitosan only helps if a person eats low-calorie. Both drugs do not affect the absorption of carbohydrates, which constitute the main problem in the diet of children with obesity.
Among carbohydrate blocker called glucobay, lipobay does and polyphepanum. They cause adverse reactions, about which you should remember, using these funds to treat children:
- arachnia in the abdomen
- digestive problems
Thus, the child with obesity, even when taking special medications from obesity will have to part with harmful food and to form habits of good nutrition.
Obesity Prevention in children
In the implementation of preventive measures against childhood obesity must involve parents, physicians and teachers/educators. The first step parents must understand the importance of proper nutrition and a healthy lifestyle. Need to educate the child with adequate food habits, and mode for the necessary level of physical activity.
The second step is to develop a child’s interest in physical culture and sports. It must engage not only teachers and parents. Parents should be an example of a healthy lifestyle, and not the dictators who say one thing and do the opposite. There is a need to develop screening programs to identify obesity and its complications among children and adolescents.