Prevention of excess weight in children

Obesity is a disease that is manifested by increased deposition of fat in the subcutaneous tissue, which leads to an overweight child. Obesity is diagnosed only if the child’s body weight exceeds normal by 10 percent or more.

The problem of obesity in children is becoming threatening and is characterized by steady growth. According to WHO statistics, about 22 million children under the age of 6 are obese.

It should be noted that the reason for the development of obesity in adults often originates precisely in childhood. With age, this disease contributes to the development of more serious conditions: type 2 diabetes mellitus, high blood pressure, orthopedic problems, etc. Thus, the widespread prevalence of obesity in the population, a large number of complications of this disease determine the relevance of this problem in pediatrics.

Causes of obesity in children

• Excessive in quantity and improper quality nutrition of the child, which leads to a change in the work of the centers in the brain that are responsible for appetite.
• Hereditary factors.
•  Traumatic brain injury. Often, these injuries occur during childbirth.
•  Infections (neuroinfections).
• A tumor that attacks the hypothalamus. The hypothalamus is a structure in the brain that has various functions, including regulating a child’s appetite and satiety. 
• Chronic foci of infection in the nasopharynx and paranasal sinuses.
• Stress.
• Use of hormonal contraceptives in adolescent girls.
• Pregnancy and abortion in underage girls.

The above reasons play a role in the development of primary obesity (i.e. obesity as an independent disease). It should be noted that there are cases when obesity develops a second time, against the background of other diseases.

Classification of obesity in children

Types of obesity in children

1. Primary obesity. The most common form of obesity in children. It is represented by alimentary-constitutional obesity .
2. Secondary obesity. It develops against the background of other endocrine diseases.
3.  Diencephalic obesity. This group includes: hypothalamic, cerebral and mixed obesity. Complex terms, the essence of which boils down to the fact that the child has a disorder in the functioning of the central nervous system. This violation subsequently leads to excess weight in the child. Among this group, hypothalamic obesity should be noted . Hypothalamic syndrome of puberty (HSPP) is the most common form of adolescent obesity and the most common endocrine metabolic pathology in adolescents in general.
4.  Hereditary syndromes that are accompanied by excess weight. There are a huge number of them. We will not go into the essence of the problem of each of the syndromes, but only list the most common ones: Prader-Willi, Lawrence-Moon-Barde-Bill, Frohlich, etc.).
5.  Mixed.

Thus, the most common forms of obesity in children are alimentary-constitutional and hypothalamic obesity .

Types of obesity in children

There are two types of obesity in a child: hypertrophic and hyperplastic. Hypertrophic obesity is characterized by an increased accumulation of fat in fat cells and an increase in their size. Hyperplastic is characterized by an increased number of fat cells. From the point of view of prognosis, the most favorable is the hypertrophic type of obesity, since it responds well to dietary treatment and a decrease in the size of fat cells during treatment. Hyperplastic is difficult to treat. Resistance to treatment is associated with the irreversibility of the number of fat cells.

Excessive nutrition of a pregnant woman and overfeeding of a child in the first months of life stimulate the reproduction of fat cells and, therefore, contribute to the development of hyperplastic obesity.

Obesity in children

The degree of obesity depends on the percentage of excess body weight:

• 1 tbsp. – 10-29%
• 2 tbsp. – 30-49%
• 3 tbsp. – 50-99%
• 4 tbsp. – more than 100%

As a rule, 3 and 4 tbsp. obesity is almost never based on primary endocrine disorders and is observed in secondary obesity.

Complications of obesity in children

• Violation of the musculoskeletal system.
•  Pathology from the cardiovascular system, lungs, liver, kidneys, gonads.
• Metabolic disorders.

The most formidable complications are: type 2 diabetes mellitus, arterial hypertension, atherosclerosis.

Obesity symptoms in children

Primary obesity (alimentary-constitutional) is characterized by:

• Uniform fat deposition.
• Increased appetite. An almost constant feeling of hunger is characteristic, which does not go away even after an abundant meal.
• Normal or tall.
• Delicate, elastic skin. Sometimes there are pink striae (skin lesions in the form of stripes), follicular keratosis (small, raised skin rashes).
• Earlier or delayed sexual development.
• In girls, an early formation of menstruation occurs.
•  Flat feet and X-shaped deformity of the knees.
• Increased blood pressure.
• Shortness of breath is common. It occurs even with mild physical exertion.
• Headaches in the morning, associated with a decrease in oxygen at night.
• Decreased self-esteem of the child, the development of depression, which negatively affects the child’s learning.

In more severe cases, the development of Pickwick’s syndrome is possible . This syndrome is characterized by a rapid increase in body weight, narrowing of the upper respiratory tract, cardiorespiratory disorders (rapid breathing, rapid pulse, poor circulation), drowsiness or falling asleep while standing.

Hypothalamic syndrome of puberty is characterized by:

• The emergence of obesity in early childhood. Children aged 11-13 are especially fattening, so they look older than their peers.
•  Formation of uniform female obesity (fat deposition on the thighs and lower abdomen).
• Tall.
• Enlargement of the mammary glands.
• The appearance of pink stripes on the skin of the abdomen, shoulders and thighs – stretch marks.
• Increased blood pressure.
•  Constant hunger. Especially the feeling of hunger occurs in the second half of the day, towards night.
•  Thirst.
•  Frequent and profuse urination.
•  Accelerated sexual development. Young men often have pseudo-eunuchoid constitutional features, enlargement of the mammary glands, hypersexuality, they are prone to early sexual activity. Girls may have increased male-pattern hair growth, menstrual irregularities.

Diagnosis of obesity in children

The main condition for the diagnosis is overweight.

To assess body weight, special tables are used that allow you to determine the ideal body weight depending on the gender, age, height of the child. 

 In everyday practice, pediatricians use BMI, which you can calculate at home. It is determined by dividing the body weight in kilograms by the height in meters squared (kg / m 2 ). BMI more than 30 indicates the development of obesity in a child.

In addition, to make a diagnosis, the doctor may prescribe:

• General blood analysis.
•  Biochemical blood test (lipidogram).
•  X-ray of the hand. Allows you to determine the bone age, which may differ from the passport age.
• X-ray of the skull in two projections. Allows you to judge the pathology of the pituitary gland, as it shows the state of the anatomical structure – “Turkish saddle”.
•  Neurologist’s consultation.
•  Ophthalmologist consultation.
•  Determination of blood sugar levels, as well as carrying out a load of sugar to detect disorders in carbohydrate metabolism.
• Hormonal examination.
•  Calculation of the index of insulin resistance, or as it is also called the HOMA index. In healthy children and adolescents, the HOMA index is <3.5.
•  Determination of the level of leptin in the blood.
•  Ultrasound of the thyroid gland.
•  Geneticist consultation – according to indications.

Treatment and prevention of obesity in children and adolescents

The most frequently asked question by parents: “How can a child lose weight?” The main methods of treatment and prevention of obesity in children are the normalization of eating behavior, strict adherence to diet and exercise regimen for many years.

Typical eating disorders:

• Eating in the evening.
• Multiple snacks while watching TV, playing on the computer, doing lessons.

To eliminate these factors, careful monitoring by the parents is required.

The most important thing in a diet is to reduce the calorie content of food by reducing the amount of carbohydrates and, to a lesser extent, fat. Easily digestible carbohydrates (white bread, potatoes, pasta and confectionery) should be excluded from the diet. Meat, fish and dairy products should be low in fat. It is also important to limit the intake of table salt (up to 3 g / day) and water (up to 1.5 l / day). The amount of protein remains within the normal range. It is very difficult for obese children to reduce portions of food at the beginning of treatment. To this end, parents can use fiber, which will create serving size and a sense of fullness, while not being high in calories (vegetables, legumes, unsweetened fruits). Diet meals for obese children should be given at least 4 times a day, with 20% or more of the daily calorie intake from breakfast.

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In addition to diet, exercise and water procedures play a huge role. They accelerate oxidative processes and promote the release of metabolic products. Therapeutic swimming in the pool and water aerobics are shown.

This treatment program is effective in only 50% of children. Therefore, medications can be used in the treatment of obese children:

• Vitamins, antioxidants (vit. E).
• Fiber preparations.
• In the presence of pathology on the part of the cerebral vessels, cinnarizine, vinpocetine, cerebrolysin, and actovegin can be used. The course of treatment is 1 month.
• With HSPP, and insulin resistance, the appointment of metformin (Siofor, Glucophage, metfogamma, etc.) is recommended. The course of treatment is from 3 to 12 months.
• In case of disorders of fat metabolism, the appointment of alpha-lipoic acid (berlin) is recommended. The course of treatment is 2 months.
• With high blood pressure, soothing herbal preparations are prescribed, such as person, glycine, valerian, phenibut, Novo passit, etc. With a persistent increase in pressure, noblest, and enalapril are recommended.
• Diphenin is well-proven and can help eliminate pink streaks (stretch marks).
• In girls with increased hairiness and acne, bromocriptine may be prescribed, which has a positive effect on these processes.

Obesity prevention in most cases does not represent a large material cost on the part of the parents. All that is required is careful monitoring of the child’s nutrition, weight gain, and general condition of the child.