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Wednesday, June 20, 2018

Childhood obesity

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Siyam, 13 years boy, has been brought the endocrinologist by his mother with the complaints of steady weight gaining and blackening of skin around neck and axilla. The physician diagnosed him as primary childhood obesity. The diagnosis is simple but the outcome and consequences are not such. Let's focus on it in depth.

Childhood obesity is one of the most serious public health challenges of the 21st century. The problem is global and is steadily affecting many low- and middle-income countries, particularly in urban settings. The prevalence has increased at an alarming rate. Globally, in 2016 the number of overweight children under the age of five, is estimated to be over 41 million. Almost half of all overweight children under 5 lived in Asia and one quarter lived in Africa. In Bangladesh, the at least 13% of the children are obese. Overweight and obesity are defined as 'abnormal or excessive fat accumulation that presents a risk to health'.

Measuring overweight and obesity: It is difficult to develop one simple index for the measurement of overweight and obesity in children and adolescents because their bodies undergo a number of physiological changes as they grow. Depending on the age, different methods to measure a body's healthy weight are available -

For children aged 0-5 years
The WHO Child Growth Standards, launched in April 2006, include measures for overweight and obesity for infants and young children up to age 5.

For individuals aged 5-19 years

WHO developed the Growth Reference Data for 5-19 years. It is a reconstruction of the 1977 National Center for Health Statistics (NCHS)/WHO reference and uses the original NCHS data set supplemented with data from the WHO child growth standards sample for young children up to age 5.

Impacts of childhood obesity:
Childhood obesity has immediate and long-term impacts on physical, social, and emotional health. For example:

*   Obese children are at higher risk for having other chronic health conditions and diseases that impact physical health, such as asthma, sleep apnea, bone and joint problems, type 2 diabetes, and risk factors for heart disease.

*    Children with obesity are bullied and teased more than their normal weight peers, and are more likely to suffer from social isolation, depression, and lower self-esteem.

*    Childhood obesity also is associated with having obesity as an adult, which is linked to serious conditions and diseases such as heart disease, type 2 diabetes, metabolic syndrome, and several types of cancer.

Why are children getting obese?
Children become overweight and obese for a variety of reasons. The most common causes are genetic factors, lack of physical activity, unhealthy eating patterns, or a combination of these factors. Only in rare cases is being overweight caused by a medical condition such as a hormonal problem. A physical exam and some blood tests can rule out the possibility of a medical condition as the cause for obesity.

Although weight problems run in families, not all children with a family history of obesity will be overweight. Children whose parents or brothers or sisters are overweight may be at an increased risk of becoming overweight themselves, but this can be linked to shared family behaviors such as eating and activity habits.

A child's total diet and activity level play an important role in determining a child's weight. Today, many children spend a lot of time being inactive. For example, the average child spends approximately four hours each day watching television. As computers and video games become increasingly popular, the number of hours of inactivity may increase.

Management of childhood obesity: Obesity in children is treated with dietary changes and physical activity. Dieting and missing meals should; however, be discourage. The benefit of tracking BMI and providing counseling around weight is minimal.

Lifestyle: Exclusive breast-feeding is recommended in all newborn infants for its nutritional and other beneficial effects. Parents changing the diet and lifestyle of their offspring by offering appropriate food portions, increasing physical activity, and keeping sedentary behaviors at a minimum may also decrease the obesity levels in children. If children were more mobile and less sedentary, the rate of obesity would decrease. Parents should recognize the signs and encourage their children to be more physically active.

By walking or riding a bike, instead of using motorized transport or watching television, will reduce sedentary activity

Medications: There are no medications currently approved for the treatment of obesity in children. The American Academy of Pediatrics recommends medications for obesity is discouraged. Orlistat and sibutramine may be helpful in managing moderate obesity in adolescence. Metformin is minimally useful. A Cochrane review in 2016 concluded that medications might reduce BMI and bodyweight to a small extent in obese children and adolescents. This conclusion was based only on low quality evidence.

Surgery: As of 2015 there is not good evidence comparing surgery to lifestyle change for obesity in children. There are a number of high quality ongoing studies looking at this issue.

What can be done?

It is crucial to realize the present situation of obesity in children and predictable morbidities and mortalities of childhood obesity. This is to be perceived by the parents, health care providers and respective authorities and steps are to be taken in concert by all the concerns. Schools play a large role in preventing childhood obesity by providing a safe and supporting environment with policies and practices that support healthy behaviors. At home, parents can help prevent their children from becoming overweight by changing the way the family eats and exercises together. The best way children learn is by example, so parents should lead by example by living a healthy lifestyle. Screening for obesity is recommended in those over the age of six.

Dietary: The effects of eating habits on childhood obesity are difficult to determine. Calorie-rich drinks and foods are readily available to children. Consumption of sugar-laden soft drinks may contribute to childhood obesity. Calorie-dense, prepared snacks are available in many locations frequented by children.

As childhood obesity has become more prevalent, snack vending machines in school settings have been reduced by law in a small number of localities. Some research suggests that the increase in availability of junk foods in schools can account for about one-fifth of the increase in average BMI among adolescents over the last decade. Eating at fast food restaurants is very common among young people with 75% of 7th to 12th 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. However the trend of substituting sweetened drinks for milk has been found to lead to excess weight gain.

Physical activity: 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. Researchers studied the physical activity of 133 children over a three-week period using an accelerometer to measure each child's level of physical activity. They discovered the obese children were 35% less active on school days and 65% less active on weekends compared to non-obese children.

Childhood inactivity is linked to obesity in the United States with more children being overweight at younger ages. In a 2009 preschool study 89% of a preschoolers' day was found to be sedentary while the same study also found that even when outside, 56 percent of activities were still sedentary. One factor believed to contribute to the lack of activity found was little teacher motivation, but when toys, such as balls were made available, the children were more likely to play.

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