Childhood Overweight And Obesity

When it comes to the low down on healthy eating and weight loss, most of what we read in the media, and what is portrayed on television, is directed at adults with little attention focused on children. But what about our children and where do they stand in the battle against the bulge?

Childhood obesity: The problem we are facing

South Africa has been experiencing an increase in obesity over the past 2 decades, especially among children and adolescents and is reaching epidemic proportions.

According to the International Obesity Taskforce one out of every 10 children is overweight.  13.5% of South African children (between ages 6-14 years) are overweight and/or obese. Scary about this statistic is that it is higher than the global prevalence of 10%. It is further estimated that 1 in 5 children is either overweight or obese. Research show that girls are more likely to be overweight or obese.

Ironically in developing countries like South Africa, where underweight and poor growth have been the main health concerns in children, overweight and obesity are now becoming significantly prevalent as a consequence of a poor diet and energy dense foods combined with increased sedentary activity.

Childhood obesity is a serious medical condition that affects children and adolescents. It occurs when a child is well above the normal weight for his/her age and height. Childhood obesity is particularly troubling because the extra kilo’s often start kids on the path to health problems that were once confined to adults, such as diabetes, high blood pressure and high cholesterol.

What causes childhood obesity

Although there are some genetic and hormonal causes of childhood obesity, most excess weight is caused by kids eating too much and exercising too little. Children, unlike adults, need extra nutrients and calories to fuel their growth and development. So if they consume the calories needed for daily activities, growth and metabolism, they add kilo’s in proportion to their growth. But children who eat more calories than needed, gain weight beyond what’s required to support their growing bodies.

However the picture is much more complex when one takes a look at all the risk factors involved in the development of childhood obesity. Many factors, usually working in combination, increase your child’s risk of becoming overweight.

These risk factors include:

• Genetic conditions: These rare genetic diseases and hormonal disorders predispose a child to obesity. They include conditions like Prader-Willi syndrome, Bardet-Biedl-syndrome, Cohen syndrome and affect a very small proportion of children.
• Diet: Regular consumption of high-calorie foods e.g. foods high in sugar and fat, together with low fruit and vegetable consumption.
• Inactivity: Sedentary kids are more likely to gain weight because they don’t burn calories through physical activity. Inactive leisure activities, such as watching television or playing video games, contribute to the problem.
• Family factors: It is well known that obesity ‘runs in families’. If a child comes from an overweight family he/she may be genetically predisposed to put on excess weight, especially in an environment where high-calorie food is always available and physical activity isn’t encouraged. For children under the age of 10, if one parent is obese, it doubles the chances of the child developing adult obesity. If both parents are obese, there is an 80% chance that the child will be obese.
• Psychological factors: Some children over eat to cope with problems or to deal with emotions.

How to tell if my child is overweight or obese?

Do you know when to be concerned about your child’s weight? Of course, all children gain weight as they grow older. But extra kilo’s – more than what’s needed to support their growth and development – can lead to childhood obesity. Not all children carrying extra weight are overweight or obese. Some children have larger than average body frames. Children normally carry different amounts of body fat at the various stages of development. So you might not know just by looking at your child if his/her weight is a health concern.

One of the tools that we use to determine if your child is obese/overweight is the Body Mass Index (BMI) chart.  By calculating your child’s BMI you will be able to determine where they fall on the BMI-for-age chart. Using the chart, your child’s BMI is compared to that of other children of the same sex and age. Cut-off points on these growth charts, help identify overweight and obese children.

You can calculate your child’s Body Mass Index (BMI) for their age and gender by the following equation: Current weight (kg) ÷ (Height x Height) = BMI. E.g. 30kg ÷ (1.35 × 1.35) = 16.5 kg/m. 

Then plot the number you have obtained against your child’s age on the chart below. This will serve as an indication of their nutritional status i.e. if they are overweight or obese and is it important that a paediatric dietitian evaluate your child. Your dietitian can give you advice on your child’s specific dietary needs and help you to make sure that they are receiving a nutritionally adequate diet and one that is right for them, while losing weight.

International cut-off points for body mass index for overweight and obesity by sex between 2 and 18 years (adapted from Cole et al., 2000)

Middle circumference is another important tool that is used to determine your childs’ risk of developing disease e.g. diabetes or heart disease.

If you are worried that your child is putting on too much weight, then it would be of benefit to see a paediatric dietitian for a complete weight assessment, taking in consideration your child’s individual history of growth and development, your family’s weight-for-height history, and where your child is situated on the growth charts. This evaluation can help determine if your child’s weight is at an unhealthy range.

What are the consequences of childhood obesity?

Childhood obesity, as in adulthood, comes with a host of health-related problems, not to mention that the obese child is probably going to hit puberty earlier than their normal-weight counterpart. This in itself is a complex issue, going hand-in-hand with many other psycho-social developmental factors.

Obesity can be classified as a chronic disease and children may develop serious health problems, such as diabetes and heart disease, often carrying these conditions into an obese adulthood.

Overweight and Obese children are at higher risk of developing:

• Insulin resistance
• Type 2 diabetes
• Metabolic syndrome
• High blood pressure
• High cholesterol
• Asthma and other respiratory problems
• Sleep disorders
• Liver disease
• Early puberty or menarche
• Eating disorders
• Skin infections
• Certain types of cancers e.g. colon, reproductive system.

The social and emotional fallout also can hurt your child. Being overweight can cause:

• Low self-esteem and bullying
• Behavioural and learning problems
• Depression

How can I help my child?

Treatment for childhood obesity is based on your child’s age and if he or she has other medical conditions. It usually includes changes in your child’s diet and level of physical activity. In certain circumstances, treatment may include medications.

The goal of treatment may be weight maintenance or weight loss depending on age and level of obesity. Maintenance allows the child to grow in height but not gain kilo’s, causing BMI-for-age to drop over time into a healthier range. Weight loss on the other hand should be slow and steady, depending on your child’s situation. It is therefore important to consult a paediatric dietitian that specialises in this field.

The methods for maintenance or losing weight are the same. Your child needs to eat a healthy diet and increase his/her physical activity. Success depends largely on the parent’s commitment to helping their child make these changes. Think of eating habits and exercise as two sides of the same coin: When you consider one, you also need to consider the other.

Healthy eating: 

Parents are the ones who buy the food, cook the food and decide where the food is eaten. A dietitian is able to make the necessary recommendations and provide a mealplan most suitable to your family. Even small changes can make a big difference in your child’s health.

Physical exercise: 

It’s no secret that physical activity is as important as diet in keeping weight off. Yes, it is a critical component of weight loss, especially for children. It not only burns calories but also build strong bones and muscles, helps children sleep well at night and stay alert during the day. Such habits established in childhood help adolescents maintain healthy weight despite the hormonal changes, rapid growth and social influnces that often lead to overeating. Active children are more likely to become fit adults.

• Reduce the intake of sugared beverages and food – easiest and most effective way to reduce energy intake.
• Follow a diet low in the glycaemic index.
• Limit total fat intake and rather choose plant based fats.
• Regular meals and especially breakfast, always have healthy snacks available.
• Families should sit down together for meals (and without the television on!)
• Parents should set a limit of 2 hours on ‘screen-time’ and encourage at least 60 minutes of activity a day. In fact, it was found that those children who watched three or more hours of television a day had significantly greater BMI’s.
• Children should not be told to finish all the food on their plates – this takes away from their ability to self-regulate their appetite.
• Limit fast food and take-aways to once a week.
• Never use food as a reward or punishment.
• Most importantly, parents should be excellent role models! Set an example – children copy their parents’ behaviour, if you don’t eat fruit, so won’t they.
• A Dietitian that specialices in childhood obesity would able to provide your child with a practical and individualised meal plan, including portion sizes to suit his/her lifestyle and give advice on suitable supplementation for age and weight.

One of the best strategies to combat excess weight in your child is to improve the diet and exercise levels of your entire familiy. This helps protect the health of your child now and in the future. Success depends largely on your commitment to helping your child make these changes.

There is a clear take-home message here: it is impossible to instil healthy eating habits and lifestyle choices if parents are not making these choices themselves. So next time you read an article or watch something on television encouraging you to be weight-conscience, take it to heart; you will be securing your child’s future health.

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