Childhood Obesity



Childhood Obesity

Globally, the prevalence of childhood obesity has risen in recent years.Overweight and obesity primarily happen either due to excess calorie intake or insufficient physical activity or both. Furthermore, various genetic, behavioural, and environmental factors play a role in its pathogenesis. Childhood obesity is a forerunner of metabolic syndrome, poor physical health, mental disorders, respiratory problems and glucose intolerance, all of which can track into adulthood . Developing countries like India have a unique problem of 'double burden' wherein at one end of the spectrum we have obesity in children and adolescents while at the other end we have malnutrition and underweight. The International Association for the Study of Obesity (IASO) and International Obesity Task Force (IOTF) estimate that 200 million school children are either overweight or obese For children and adolescents, overweight and obesity are usually defined using age and gender specific normograms of BM

A recent study based on 18,955 school children in Chennai , reported the prevalence of overweight to be 17 per cent while that of obesity was 4.4 per cent among private school children. Conversely, among the government school children the values were 3.1 and 0.5 per cent, respectively using the Cole cut-points.Subramanyam et al reported on obesity trends in adolescent girls in private schools in Chennai and showed that in 1981, overweight was present in 9.6 per cent and obesity in 5.9 per cent of the girls while in 1998, overweight was seen in 9.7 per cent and obesity in 6.2 per cent of the girls. A similar study from the same city in 2002 showed that among children attending private schools the prevalence of overweight/obesity had almost doubled - 17.8 per cent in boys and 15.8 per cent in girls. This increase was attributed to changes in lifestyle factors

India is a fast growing economy, currently undergoing major epidemiological, nutritional and demographic transitionssuggests that the prevalence of childhood obesity has probably been somewhat constant over the last couple of decades. However, the overweight and combined overweight/obesity prevalence showed an increasing trend. The prevalence of overweight increased from 9.7 per cent prior to 2001 to the value then increased to 17.4 per cent in the 2006-2010 period, finally reaching 19.3 per cent in studies reported after 2010. Hence, there was a trend of increase in overweight among children/adolescents in India. The WHO has been persuading paediatricians and governments all over the world to use the WHO growth charts for identifying underweight and overweight . de Onis and group thus came up with the WHO 2007 age and gender specific BMI cut-offs as a global standard. In children selected from across the globe it was seen that they grew at an astonishingly consistent pattern up to the age of five years, suggesting that there may not be ethnic differences in the growth pattern of babies and children . However, it is likely that the WHO cut-off will result in higher overweight and or obesity rates

What Causes childhood obesity( Metabolic Syndrome)?

Metabolic syndrome (also called dysmetabolic syndrome or syndrome X) is brought on by the same problems that cause heart disease and type 2 diabetes. So, having a diet that's high in calories and low in nutrients and consuming lots of fast food and sweetened beverages can put kids at risk.Sitting in front of a screen and not getting enough (or any) exercise also can increase a child's chance of developing factors like obesity, low HDL ("good") cholesterol, high blood pressure, and high blood sugar that define metabolic syndrome.

Risk appears to be highest around puberty. That may be because body fat, blood pressure, and lipids are all affected by the hormones that bring about the many changes of puberty.

Kids who have a family history of heart disease or diabetes are at greater risk for metabolic syndrome. But, as with many things in life, the lifestyle habits a child adopts can push things in one direction or another. So kids who are active, fit, and eat a lot of fruits and vegetables may drastically decrease their chances of developing metabolic syndrome — even if a close relative already has it.

What Problems Can Happen?

Metabolic syndrome itself often has no noticeable symptoms early on. But when its risk factors are left to snowball for too long, major changes may start to develop in the body. These include:

Arteriosclerosis. This happens when cholesterol hardens and begins to build up in the walls of arteries, causing blockages that can lead to high blood pressure, heart attack, and stroke.

Poor kidney function. The kidney become less able to filter toxins out of the blood, which can also increase the risk of high blood pressure, heart attack, or stroke.

Insulin resistance. This is when the body's cells don't respond to insulin (the hormone that helps to regulate sugar in the blood) normally, and that can lead to high blood sugar levels and diabetes.

Polycystic ovarian syndrome. Thought to be related to insulin resistance, this disorder involves the release of extra male hormones by the ovaries, which can lead to abnormal menstrual bleeding, excessive hair growth, acne, and fertility problems. It is also associated with an increased risk for obesity, hypertension, and — in the long-term — diabetes, heart disease, and cancer.

Acanthosis nigrans. A skin disorder that causes thick, dark, velvet-like patches of skin around the neck, armpits, groin, between the fingers and toes, or on the elbows and knees.

How Is Metabolic Syndrome Diagnosed?

For a diagnosis of metabolic syndrome, a child must have at least three of the four risk factors. The most common risk factors in teens are hypertension and abnormal cholesterol. Even when just one risk factor is present, a doctor will likely check for the others. This is especially true if a child is overweight, has a family member with type 2 diabetes, or has acanthosis nigricans.

These exams and tests can help doctors make a diagnosis of metabolic syndrome:

Body mass index (BMI) and waist measurement.

Blood pressure: Blood pressure is the force the blood exerts against the blood vessel walls as the heart pumps. When this force is at or above the 90th percentile for a child's age and sex, it is considered a risk factor.

Blood tests

Lipid profile- This test measures the levels of fats in the blood. Having low levels of good cholesterol (HDL) and high levels of bad cholesterol (LDL) or triglycerides would be considered a risk factor.

Fasting blood glucose -The fasting blood glucose test measures the amount of glucose in the blood after an 8-hour fast. After several hours without eating, a healthy person's blood glucose level should not be higher than a certain level. A glucose level higher than this could be a risk factor.

Insulin - A blood insulin test may also be performed in some cases as part of a check for insulin resistance.

Treating Risk Factors

Dropping excess weight. If your child is overweight, even a moderate amount of weight loss can bring big improvements in blood pressure, blood lipid levels, and the body's ability to use insulin.

Getting more exercise. By taking just one of those hours spent in front of a screen each day and spending it on something that gets the blood flowing, kids can greatly improve their blood pressure, cholesterol, and sensitivity to the effects of insulin.

Eating mindfully. A child who learns to see food as fuel and not emotional compensation can start to make better choices at mealtime — for example, selecting complex carbs instead of simple carbs (whole-grain instead of white bread, brown rice instead of white); getting more fiber with beans, fruits, and vegetables; choosing "healthy" fats like olive oil and nuts; and avoiding too many empty calories from soda and sweets.

Fiber supplements. If your child might not be getting enough fiber through food, a fiber supplement may provide an added boost to help improve the levels of cholesterol in the blood.

When lifestyle changes aren't enough, a child take prescription medicines to treat individual risk factors. So, kids with high blood pressure might be put on antihypertension drugs. Others with high LDL cholesterol might be prescribed statins or other lipid-lowering drugs. Children with high blood sugar, who are on the brink of developing diabetes, may get medicine to decrease insulin resistance.

Dr. M. P. Venkatesh

MBBS, MD (Pediatrics)

Consultant, Paediatrics

Paediatrics

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