NUTRITION III OBESITY IN CHILDREN

PROFESSOR SHAHENAZ M. HUSSIEN

OBJECTIVES By the end this lecture you will be able to know the followings:
-Definition; BMI; Causes of overweight in children and the role of genetics. -Health side-effects that include serious diseases and psychological effect. -Lines of management and prevention.

Childhood Obesity

Childhood obesity is a condition where excess body fat negatively affects a child's health or wellbeing. The diagnosis of obesity is based on BMI. The term overweight rather than obese is often used in children as it is less stigmatizing. DIAGNOSIS: Body mass index (BMI) is acceptable for determining obesity for children two years of age and older. The normal range for BMI in children vary with age and sex. BMI = Weight in kilogrammes (Height in metres)2 -Obese children defined to have a BMI 95percentile. -Overweight children defined to have a BMI 85-<95 percentile

Causes
1- Dietary
Soft drink consumption may contribute to childhood obesity. Eating in fast food restaurants has become prevalent among young people with 75% of 7 to 12 grade students consuming fast food in a given week. Whole milk consumption verses 2% milk consumption in children of one to two years of age had no effect on weight, height, or body fat percentage. Therefore whole milk continues to be recommended for this age group.

Sedentary lifestyle Physical inactivity of children has also shown to be a serious cause, and children who fail to engage in regular physical activity are at greater risk of obesity. Many children fail to exercise because they are spending time doing stationary activities such as playing video games or watching TV. Technological activities are not the only household influences of childhood obesity. Low-income households can affect a child's tendency to gain weight.

Genetics
Childhood obesity is often the result of an interplay between many genetic and environmental factors. Polymorphisms in various genes controlling appetite and metabolism predispose individuals to obesity when sufficient calories are present. -Prader-Willi syndrome is characterized by hyperphagia which leads to rapid weight gain in those affected. -Bardet-Biedl syndrome -Leptin receptor mutations -Congenital leptin deficiency -Melanocortin receptor mutations The percentage of obesity that can be attributed to genetics varies from 6% to 85% depending on the population examined.

Home environment
Children's food choices are also influenced by family meals. Studies revealed that four out of five parents let their children make their own food decisions.

Developmental factors
Various developmental factors may affects rates of obesity. Breast-feeding for example may protect against obesity in later life with the duration of breast-feeding inversely associated with the risk of being overweight later on. A child's weight may be influenced when he/she is only an infant.

Effects on health
The first problems to occur in obese children are usually emotional or psychological. Childhood obesity however can also lead to life-threatening conditions including diabetes, high blood pressure, heart disease, sleep problems, cancer, and other disorders. Some of the other disorders would include liver disease, early puberty or menarche, eating disorders such as anorexia, skin infections, and asthma and other respiratory problems. Obese children often suffer from teasing by their peers.Some are discriminated against by their own family. This may lead to low self esteem and depression. A recent study revealed that children who are obese have carotid arteries which have prematurely aged by thirty years as well as abnormal levels of cholesterol.

Medical illness
Cushing's syndrome (condition in which body contains excess amounts of cortisol) may influence childhood obesity as well. Hypothyroidism is a hormonal cause of obesity. Psychological factors Researchers discovered a positive correlation between obesity and low self esteem in the four year follow up. They also discovered that decreased self esteem led to feeling sad, feeling bored, and feeling nervous. Stress can influence a child's eating habits.

MESSEGE TO PARENTS AND PATIENTS:

- Obesity is due to an imbalance between energy consumption and energy expenditure. - Obese children have high energy needs to support their high body weight. - An obese child tends to become an obese adult. - There is no evidence that any drug is effective in treating childhood obesity. - Obesity in children may be prevented and treated by: Increasing physical activity/Decreasing physical inactivity such as watching TV, and encouraging a well balanced healthy diet. - A medical cause of obesity is more likely in the child who is obese and short. - Most children are not obese because of medical cause, but as a result of their lifestyle.

Management
Lifestyle Exclusive breast-feeding is recommended in all newborn infants for its nutritional and other beneficial effects. Medications There are no medications currently approved for the treatment of obesity in children. Orlistat and sibutramine may however be helpful in managing moderate obesity in adolescence. Sibutramine is approved for adolescents older than 16. It works by altering the brain's chemistry and decreasing appetite. Orlistat is approved for adolescents older than 12. It works by preventing the absorption of fat in the intestines. Epidemiology Prevalence of overweight among children 6 to 19 years of age in the USA. 10% of children worldwide are either overweight or obese.