【Concept】.
Obesity refers to the disease that the energy intake is greater than consumption, resulting in excessive accumulation of body fat. Clinically can be divided into simple obesity and secondary obesity two categories. Child simple obesity (obesity) refers to simply due to excessive diet and too little activity caused by, accounting for the vast majority of obesity in pediatric period. It is closely related to the lifestyle, characterized by excessive nutrition, insufficient exercise and behavioral deviation, and the chronic disease of general excessive growth and accumulation of fatty tissue in the whole body. Secondary obesity refers to those caused by brain diseases, endocrine disorders and some rare hereditary syndromes.
Whether it is simple obesity or secondary obesity, the physical development and sexual development of the affected children in adolescence can produce adverse effects. In addition, childhood obesity if not timely control, the future can develop into diabetes, coronary heart disease, hypertension and liver and gallbladder disease, etc., so should cause enough attention.
Etiology]
1, long-term caloric intake too much and too little activity Most of the children with hyperphagia and over-eating, but the activity is too little, the energy intake exceeds the consumption for a long time, and the excess is stored in the body in the form of triglycerides and leads to obesity. At present, it is thought that the child’s appetite is strong and the activity is too little may be caused by the abnormal function of the hypothalamus feeding and weight regulation center.
2, obesity gene, leptin and its related links abnormal obesity belongs to polygenic disease, its pathogenesis may involve a number of related genetic abnormalities and environmental factors (including diet structure, lifestyle habits, etc.) the combined effect.
Clinical manifestations
Simple obesity can be seen in children of any age, with peak incidence in infancy, preschool and adolescence. Affected children have excellent appetite, eat a large amount of food, like to eat sweet fat, lazy activity. They are not only heavier than children of the same age, but also their height and bone age are higher than those of children of the same age, and a few of them may exceed them. The subcutaneous fat is very thick and evenly distributed, with significant fat accumulation in the cheeks, shoulders, breast and abdominal wall, and the thighs and upper arms are thicker and thinner at the extremities. In boys, the penis is buried due to fat accumulation in the perineum and can be mistaken for external genital dysplasia. The intelligence of the affected children is good.
Severe obesity can cause hypoxemia, shortness of breath, cyanosis, even leading to erythrocytosis, heart enlargement and congestive heart failure, which is called obesity pulmonary heart syndrome (pickwickian syndrome) due to the restricted activity of the thorax and diaphragm.
Laboratory and other tests]
Ultrasound of abdomen (liver, gallbladder, spleen)
MRI and CT (cranial, adrenal) to exclude tumors;
Blood cortisol (8AM, 4PM) may have secretory rhythm disturbance;
blood thyroid function
blood lipids
Fasting glucose, insulin, may show hyperinsulinemia;
Other tests: the following tests are available as needed: blood parathyroid hormone, chromosome examination
Effect of simple obesity on physical development during puberty
Before puberty, the height of obese children is mostly higher than normal children, 78% of obese children are in the 50th to 97th percentile, and 15% are above the 97th percentile. The age of onset of growth spurt and the age of reaching peak height growth rate (PHV) are both earlier than normal children, the peak PHV is lower, and the duration of growth spurt is shorter, resulting in the final height of obese children not being significantly different from that of normal children, or even shorter.
[Effect of simple obesity on pubertal sexual development].
The age of puberty initiation is earlier than normal children, and the age of testicular P2 stage is 10.62±0.83 years for obese children, while it is 11.62±0.69 years for normal children, (P<0.01). However, sexual development was significantly delayed in middle and late adolescence, resulting in a significantly longer time from puberty initiation to maturity in obese children compared to normal children. Medium to heavy obese boys are often accompanied by testicular and penile dysplasia, and most also have gynecomastia, which is another type of delayed puberty that is more common today.
Diagnosis of simple obesity]
Where the weight of the child exceeds 2 standard deviations or 20% or more of the average value of height and weight of the same age and gender, can be diagnosed as obesity. More than 2~3 standard deviations or 20%~29% for mild obesity, more than 3~4 standard deviations or 30%~39% for moderate obesity, more than 4 standard deviations or more than 40% for severe obesity. In addition, in recent years, BMI is also often used as the judgment index, where BMI is greater than 25 can be diagnosed as obesity. 25~27 BMI is mild obesity, 27~30 is moderate obesity, more than 30 is severe obesity. Among them, those who are purely caused by over-eating and less movement or have a family history of obesity, physical examination shows uniform obesity and tallness, and laboratory examination has no other abnormalities except for high leptin, high insulin and hyperlipidemia, can be diagnosed as simple obesity.
【Treatment】
The treatment of simple obesity should follow the following principles.
(1) Appropriate restriction of caloric intake and increase of exercise consumption are the most basic treatment measures.
(2) The child is in the stage of growth and development, in restricting the diet must take care of the basic nutritional needs, especially to ensure adequate protein, vitamin and trace element intake.
(3) The structure of the diet should be high in protein, low in carbohydrates, low in fat and low in calories.
(4) It is necessary to appropriately treat with medications that adjust the abnormal function of the hypothalamic feeding and weight regulation centers. Drugs that promote the breakdown of fat and sugar and inhibit fat synthesis and accumulation are also helpful.
(5) The danger of obesity and the necessity of weight loss treatment should be explained to older children, so as to obtain their active cooperation and persistence in the treatment.
【Prevention】
Obesity that begins in childhood generally has both an increase in the number of fat cells and hypertrophy of fat cells. Weight loss treatment can only reduce the size of fat cells, but not the number, so it is difficult to control the disease and easy to recur, so the prevention of obesity should start at the peak of fat cell proliferation. Fetal period: adipocytes are formed in the last 3 months of pregnancy. The increase of energy intake can stimulate the proliferation of adipocytes, so the pregnant mother should avoid excessive nutrition in the second trimester to prevent the fetus from gaining weight too fast. The peak of adipocyte proliferation after birth is infancy and adolescence respectively. Parents must correct the misconception that obesity is healthy, especially in infancy and early childhood should be fed reasonably to avoid overnutrition.