Recommendations for the prevention of obesity in children from ESPGHAN

Specialist: Nutritionist

TO GET A CONSULTATION

Causes of obesity Degrees of obesity in children The dangers of overweight in a child Diagnosis of obesity in children and adolescents Treatment of obesity in children and adolescents Prevention of childhood obesity The problem of obesity is becoming more pressing every year. Excess body weight and associated complications occur not only in adults, but also in children, and the number of cases is growing every year. According to the latest data, in Russia every tenth child is overweight, and in the USA - every fifth. How to identify the problem in time, cope with it, and is it possible to prevent childhood obesity?

Causes of obesity

Doctors say the main cause of childhood obesity is excess intake of calories from food.
Most are sure that chubby cheeks and constrictions on a child’s arms and legs are indicators of good health, and the extra pounds will grow over time. They are constantly trying to feed the baby: cookies, sweets, bread - all this complements the main meals. Less common factors that increase the risk of obesity are:

• lack of physical activity;
• heredity;
• metabolic disorders;
• endocrine pathology (hypothyroidism, excess adrenal hormones);
• improper daily routine, lack of sleep;
• taking certain medications for a long time (hormonal drugs, antidepressants);
• genetic abnormalities, etc.

Causes of obesity

Obesity is a multifactorial disease that occurs as a result of an unhealthy lifestyle, genetic predisposition, or is a manifestation of severe congenital pathology. All causes of obesity can be divided into several groups:

1. Behavioral factors:

• overeating (overfeeding);
• predominance of fast carbohydrates (flour and confectionery products) in the diet;
• lack or insufficiency of physical activity;
• suffered psycho-emotional shock.

2. Related factors (if parents have problems with excess weight, then there is a high probability of a similar condition in the child).

3. Obesity as a secondary manifestation of another disease:

• endocrinological pathology (hypothyroidism, adipose-genital dystrophy, Itsenko-Cushing disease, etc.);
• brain tumors (in particular pituitary tumors);
• lesions of the central nervous system (encephalitis, traumatic brain injury).

The structural unit of adipose tissue is the adipocyte. In childhood, fat cells actively multiply (due to hyperplasia), and after reaching puberty, they increase (hypertrophy). Adipocytes contain large amounts of triglycerides, which are a source of energy for the body. In addition, adipose tissue protects internal organs from mechanical damage, takes part in thermoregulation, and accumulates vitamins A, E, K and D. Enzymatic reactions of the formation and breakdown of lipids, metabolism of fatty acids and triglycerides continuously occur in adipocytes. In a healthy body, a balance is maintained between the synthesis and breakdown of lipids. With excessive accumulation of subcutaneous and visceral fat, the level of adipokines increases, which rearranges the child’s metabolism and leads to multiple organ dysfunction.

Obesity levels

The very fact that a child is obese or overweight is determined by body mass index.
This indicator is calculated very easily: you need to divide your weight by your height raised to the second power. The resulting number is estimated in accordance with the tables. For boys

For girls

For children under one year old, average height and weight indicators are used.

The amount of BMI deviation from the norm determines the degree of obesity in a child:

Statistics show that most often children experience grade 1 and 2 obesity.

Degrees of childhood obesity

Childhood obesity is divided into 4 stages:

1. Obesity of the first degree – in which the child’s body weight exceeds the norm by 15-24%
2. Obesity II degree – the child’s body weight exceeds the norm by 25–49%
3. Obesity III degree - the child’s body weight is beyond the normal range by 50–99%.
4. Obesity IV degree is an extreme degree of obesity, in which the child’s body weight exceeds the permissible norm by more than 100%.

Children and adolescents of the following age groups are at risk

• Young children - from birth to three years;
• Preschoolers - from three to seven years old;
• Adolescents - These include children between the ages of twelve and seventeen.

What are the dangers of being overweight in a child?

The more extra pounds a child carries, the more difficult it is for the body.
The load on the cardiovascular and respiratory systems increases, and the musculoskeletal system suffers. Regular overeating contributes to the development of digestive problems, pancreatitis and cholecystitis. Grade 1 obesity often seems insignificant because the child does not look fat. However, even this can lead to:

• curvature of the spine;
• high blood pressure;
• headaches;
• gastritis.

2nd degree causes more significant violations:

• increased sweating;
• hormonal imbalances;
• blackheads and acne (in adolescence).

With the development of stage 3 obesity, children develop:

• joint diseases;
• disorders of puberty and reproductive function;
• femoral and inguinal hernia;
• increased risk of diabetes mellitus and arterial hypertension.

Stage 4 is an extremely dangerous condition.
Even a child can develop such serious diseases as diabetes, atherosclerosis, hemorrhoids, angina pectoris, liver failure, etc. The risk of breathing disorders during sleep (night apnea) increases. In advanced cases, the ability to move independently is lost because the spine and joints cannot support the weight of one’s own body. We must not forget about the psychological complexes that are caused by excess weight in a child. Children can be bullied at school, and the inability to fully play with peers only makes the situation worse. In adolescence, this can result in complexes.

In recent years, there has been a sharp increase in the number of children suffering from obesity. This is facilitated by dietary disturbances (both in the quantity and quality of products used), and a sharp decrease in the physical activity of children and adolescents.

In Russia as a whole, more than half of Russians (63%) over 30 years of age suffer from overweight and obesity. Since 2012, there has been an increase in the incidence of obesity (2.3 times) among adults aged 18 years and older diagnosed for the first time in their lives.

According to the annual monitoring of the morbidity rate of the population of the Altai Republic for 2021, the overall incidence of obesity among adolescents was 3891.4 cases per 100 thousand population, primary – 700.7; among children under 14 years of age, the overall incidence was 783.7 cases per 100 thousand population, the primary incidence was 143.7. Among adults, these figures are lower: the total incidence was 2238.8 per 100 thousand population, the primary incidence was 478.2.

There are critical periods during a child's physical development when susceptibility to obesity may increase. Primary (constitutional-exogenous) obesity in children most often develops in early (2-3 years) and preschool (5-6 years) age and during puberty in the presence of a hereditary predisposition. Unfortunately, the majority of children (up to 30-60%) who are overweight will suffer from obesity in adulthood, with a more severe course, a pronounced increase in body weight and a high frequency of concomitant diseases, in contrast to obesity, which debuted in mature age.

With obesity in children and adolescents, as well as in adults, numerous complications can develop, affecting almost all organs and systems of the body. Concomitant diseases that were previously observed only in adults are already diagnosed in early childhood: metabolic syndrome, arterial hypertension, atherosclerosis, non-alcoholic fatty liver disease, type 2 diabetes mellitus, cholelithiasis, diseases of the musculoskeletal and reproductive systems.

All methods of reducing body weight in children are based on reducing energy intake from food and increasing energy expenditure during physical activity. A negative energy balance is achieved by reducing the calorie content of food and increasing the amount of physical activity. The same recommendations are relevant for the prevention of obesity, and not only in children, but also in adults.

Naturally, if the cause of obesity is a medical disorder, then you should definitely seek advice and treatment from a doctor. However, for most, obesity is the result of poor lifestyle and family eating habits.

It is the last reason - eating disorders - that is the most common and is laid down by parents in childhood: eating a significant amount of food in the evening, overeating, a large number of snacks during the day and while watching TV shows, computer games, doing homework or, conversely, eating only in the evening, and during the day - kirieshki and chips with juices and water; eating outside the home, preference for fast food, eating “for”, “delicious” after minor stressful situations (going to the doctor, conflict, etc.).

The second, no less important reason for obesity is physical inactivity. Comfort of movement, the presence of “smart” household appliances, automation and computerization of many work and household processes lead to the fact that physical activity is becoming less and less, and the desire to receive it even in the presence of all the conditions (gyms, stadiums, sports grounds, sports equipment, sports sections and circles) decreases and, in the end, disappears completely.

Psychological factors also play an important role: dependence on the opinion of fashion imposed by advertising and television on certain “beauty standards”; addiction to TV, computer, social networks, Internet; inability and unwillingness to deal with stress, etc.

What to do? Change your lifestyle - increase physical activity, learn to deal with stress, and develop proper eating behavior in the child and all family members.

It is necessary to start changing the lifestyle of an obese child and the whole family gradually, by setting simple goals. It is very important for parents themselves to be persistent and consistent in their demands and set a positive example. If parents do not have the motivation to change their lifestyle, the likelihood of effective treatment and prevention of obesity is very low or reduced to zero.

Strict control over the eating habits of all family members is necessary: ​​the range of products purchased (do not buy non-recommended products at all), the frequency of visits to fast food cafes, the time, place and frequency of meals. Particular attention should be paid to grandparents, from whom children most often receive dietary allowances. Strict control over the child’s meals outside the home, the child’s spending of money, etc. is also necessary.

To increase physical activity, it is necessary to conduct joint physical education classes, walking, cycling, etc. According to WHO recommendations, adequate physical activity for children and adolescents aged 5-17 years includes daily aerobic activities (walking, swimming, gymnastics, games, competitions, sports, trips, recreational activities, physical education or planned exercises within the family) for a duration of at least 60 minutes a day.

With any lifestyle changes, self-control of behavior is very important, since in its absence it is difficult to assess effectiveness, make adjustments to the treatment plan and encourage success. It is necessary to learn to quantify the goals achieved. For example, you can count the amount of juice you drink, soda, candy, cookies, chips, etc. You can allow the child to independently choose the type of physical activity (dancing, sports section), calculate the time allocated for inactive activities (computer games, watching TV shows, etc.); determine the distance that the child has walked or cycled (by the number of steps or in kilometers based on data from pedometers or programs installed in mobile devices). Children and adolescents can use activity diaries (nutrition and physical activity) installed in mobile devices as self-monitoring. Diaries can be kept by the parents themselves (if they are preschoolers or early school children) or by the teenagers themselves.

Dear parents and adults! Remember that not only your health, but also the health of the younger generation is in your hands. Follow simple rules for eating, move more and be slim and healthy!

The information was prepared based on materials from the journal “Practical Dietetics” No. 3, 2021 (E.N. Lobykina “Obesity in Children”) and open sources

Diagnosis of obesity

To identify obesity and assess its degree, it is enough to measure the child’s height and weight, and then calculate the body mass index. Additional examinations make it possible to identify possible causes of the condition and determine treatment tactics. Doctors interview parents about the baby’s weight at birth, the dynamics of his growth, previous and existing diseases, and heredity. The list of basic examinations also includes:

• determining waist circumference;
• blood pressure measurement;
• bioimpedansometry (determining the amount of adipose tissue in the body);
• blood chemistry;
• determination of the level of insulin and thyroid hormones in the blood;
• Ultrasound of the abdominal cavity and thyroid gland;
• ECG;
• examination by an endocrinologist, gastroenterologist, geneticist, neurologist.

In each specific case, the list of examinations and consultations can be expanded.

Obesity symptoms

The main symptom of obesity is a significant increase in body weight due to adipose tissue. Obesity in most cases is a symptom of another disease. Therefore, clinical manifestations are very variable and depend on the type of pathology.

With 1-2 degrees of obesity, children can feel satisfactory.

Primary obesity is characterized by the following symptoms:

• excessive sweating;
• shortness of breath on exertion;
• increased blood pressure;
• headache;
• increased appetite.

Symptoms of secondary obesity vary from person to person. In addition to the usual symptoms of obesity, there are specific signs:

• with hypothalamic obesity - neurological symptoms (enuresis, convulsions, hearing impairment, mental retardation), impaired thermoregulation, constipation or diarrhea, arterial hypertension, drowsiness, etc.;
• with endocrinological obesity - impaired puberty in boys and girls, the appearance of stretch marks, stretch marks on the skin, late psychophysical development of the child, etc.

Obesity in children is associated with decreased insulin resistance, arterial hypertension and hypercholesterolemia. All these pathological components aggravate each other and lead to severe clinical obesity.

Obesity treatment

Treatment of childhood obesity, regardless of its cause, is a complex and lengthy process that requires the participation of not only doctors, but also the child’s parents.
It is important that each family member understands the importance of all prescribed activities and follows the instructions of the nutritionist and other specialists. It is important for parents and all family members to set the right example and switch to a healthy lifestyle. Modern clinical recommendations for the treatment of grade 1 and 2 obesity in children include, first of all, diet and physical activity. A child’s metabolism is much more intense than that of an adult, so following basic nutritional rules is the key to success.

A diet for an overweight child is based on the following rules:

• a minimum of sweet and fatty foods, salt;
• regular consumption of clean water in sufficient quantities;
• fractional meals in small portions;
• last meal 3 hours before bedtime;
• exclusion of fast food, soda, chips, etc.

The child's menu for obesity includes dairy products without sugar of medium fat content, baked, boiled or steamed dishes from lean meat, poultry or fish, cereals and sweet fruits in moderation, vegetables without restrictions.
Physical activity will not only speed up weight loss, but also tighten your skin and strengthen your muscles. The set of exercises is built with the participation of a physical therapy doctor and takes into account the child’s initial body weight, his age and wishes. Team sports, competitions, daily gymnastics or strength exercises - movement should be fun.

Treatment of severe obesity, in addition to sports and diet, includes medications, correction of hormonal and other disorders. Surgeries to reduce the volume of the stomach and other bariatric surgery techniques are permitted only from 18 years of age.

A nutritionist treats obesity

Preventing childhood obesity

To reduce the risk of obesity in infants and young children, it is necessary to follow such preventive measures as mandatory breastfeeding in the first six months of life, as well as alternating mother's milk with solid foods during the introduction of complementary foods. It is important that the baby’s diet contains a variety of foods, and the content of salt, sugar and fat in these foods should be minimal.

For older children and adolescents, the following preventive measures are recommended:

1. setting restrictions on the consumption of fatty foods, fast food, flour, sweet and salty foods;
2. teaching the child to consume vegetables, fruits, nuts and whole grains;
3. regular physical activity: walking, outdoor games, exercise, dancing, sports classes, physical therapy, including swimming.

Do you have any questions or suspect your child has health problems? A pediatric endocrinologist will help you figure it out and give the necessary recommendations for treatment or prevention.

See also : Appointment with a pediatrician.

Obesity prevention

The chance of developing obesity is reduced if the mother of the child leads a healthy lifestyle during pregnancy and does not eat for two.
Breastfeeding also promotes proper metabolism later on. The best prevention of obesity in children and adolescents is maintaining a healthy lifestyle with the whole family. If there are no prohibited foods in the refrigerator, and the best treat is fresh fruit, if everyone goes for a walk every evening and does exercises in the morning, excess weight has no chance. What to do when your child is overweight or obese? If this issue is really relevant, you need to seek help from professionals. Don't try to use radical diets or force your child to exercise to their limits. Such techniques can cause even more harm.

Timely comprehensive assistance from specialists, based on data from laboratory and instrumental examinations, will make it possible to return to normal weight. Sign up for a consultation at the SM-Doctor children's clinic.

Prevention of obesity in children and adolescents

As noted by the World Health Organization , the problem of excess weight in children is becoming increasingly widespread. Obesity is associated with a number of complications and diseases, such as diabetes and heart disease. A child may be considered obese if their weight is 10 percent or more above normal for their height and body type. According to domestic endocrinologists , in Russia the proportion of children and adolescents 6-18 years old who are overweight reaches 11.8%, and obesity is observed in 8.5% of representatives of this age group. Along with the prevalence of overweight in children and adolescents, the incidence of dental caries in them also increases, which suggests a connection between weight and dental health, which is confirmed by the latest research.

Today, doctors are increasingly linking diabetes and heart disease to periodontal disease, which affects the soft tissue of the gums and the bone structure of the jaw. Blood pressure-lowering medications, which are often taken by overweight people, also have an adverse effect on oral health. The most common side effects of these medications are dry mouth and overgrowth of soft gum tissue, which creates conditions for plaque to accumulate. Both of these side effects can lead to periodonitis and tooth decay. It is also worth noting the connection between dental health and the consumption of large amounts of carbohydrates with a lack of essential nutrients in the diet. Foods containing excess sugar and acids increase the risk of developing caries and enamel erosion.

The first step in the fight against excess weight in a child should be to visit a doctor who can confirm the presence of the problem and rule out diseases that predispose to obesity. Parents should not limit the caloric intake of their child, focusing only on his appearance: too strict a diet can negatively affect the growth and development of children. Below we provide expert for treating obesity in children and adolescents.

Change your child's eating habits and monitor his regularity

Having dinner at the same time is a wonderful tradition: this gives the family the opportunity to get together and exchange news. Breakfast should also be a family affair: it has long been noted that children who regularly eat breakfast cope better with their school curriculum. If your child spends most of the day outside the home, give him a container with his own prepared lunch: this way you can better control what and how much your baby eats.

Reduce portion sizes and caloric content of meals

Children begin to demonstrate food preferences very early. Figure out how to make their favorite food healthier . Make sure your child gets enough vegetables, fruits, and whole grains at each meal. Water not only contains fewer calories than soda, but it is also much better for your teeth. Trips to eateries and pizzerias should be an exception, possible only on holidays. The dishes offered by such catering establishments contain much more fat, carbohydrates and salt than not only children, but also adults need, and the portions are simply huge!

Reduce the volume and number of snacks

A small snack won't hurt, but you should limit your stock of junk food at home. Do not deprive your child of all treats at once: this will only lead to the fact that, out of your sight, the child will attack them with redoubled force. Having a variety of healthy foods in the house, such as cheese, unsweetened whole grain cookies, fruits and vegetables, will help your child give up chips and candy more quickly. Replace fried potatoes with baked potatoes and regular ice cream with frozen yogurt or natural popsicles. Wholewheat crackers, figs and vanilla wafers are a great alternative to sweets like donuts and chocolate chip cookies.

Increase your child's physical activity

Explain to your child how proper nutrition and a healthy lifestyle can benefit him. Play sports with him. Energetic walks, active games in the yard, football, dancing, swimming and even such fun as tug of war can awaken a child’s craving for sports. It is important that children spend as little time as possible sitting in front of the TV or playing computer games. There are many home activities that will allow your child to be active even on days when the weather is not favorable for spending time outdoors.

A well-balanced, nutritious diet will help your children be more energetic, more focused and happier. By following the tips above, parents can create healthy habits in their children that they will keep for life.

Consequences of obesity

Complications of obesity in children:

• diabetes mellitus type 2;
• arterial hypertension;
• atherosclerosis;
• chronic constipation;
• fatty liver (fatty hepatosis);
• pancreatitis;
• cholelithiasis;
• haemorrhoids;
• cardiac ischemia;
• apnea syndrome, snoring;
• skeletal deformation (as a result of excessive load on the musculoskeletal system);
• osteochondrosis;
• psychological disorders;
• in the future – reproductive dysfunction, infertility;
• increased risk of cancer.