Prevention of childhood obesity
The treatment of childhood obesity is still a worldwide problem. At present, it is internationally recognized that the prevention of obesity is more important and effective than the treatment. Obesity mainly depends on the number and volume of fat cells in the body. And the number of fat cells mainly depends on the accumulation of the mother’s late pregnancy three months, the first year after birth and 11 ~ 13 years old pre-puberty three stages. If in these three stages of over-eating so that the number of fat cells overgrow, after even efforts to lose weight can only make the fat volume slightly reduced, and the number of fat cells will not have any change.
1. The mother should not overeat during the second trimester of pregnancy. Children in these two periods should not eat more and move less, or easily obese and difficult to lose weight. As overweight is the potential danger and warning line of obesity. Therefore, in terms of height and standard weight, the best period to prevent and control obesity is the overweight and mildly obese stage. Early prevention and treatment of overweight and mildly obese children can prevent obesity before it happens, reduce the number of moderate to severe obesity, and reduce the physical and mental damage of obesity to children. Parents’ awareness is crucial to prevent and treat childhood obesity. Sometimes parents think their children are normal when they are overweight or even mildly obese, and continue to endorse their children’s unhealthy lifestyle and encourage them to continue to overeat and let them burn out without exercising, causing them to develop into obese or moderately obese. In fact, parents’ misconceptions cause many children to miss the best time to prevent and control obesity. Because obesity in the age of small or light when not control, to adolescence or moderate and heavy obesity when trying to lose weight again is very difficult, often half the effort. Intrauterine factors pediatric birth weight and maternal nutrition related. Such as pregnant women eat too much, especially in the second three months of pregnancy, prone to fetal overweight and lead to pediatric obesity.
2, first of all, pregnancy precautions: two aspects: birth weight is too small less than 2KG, and weight greater than 4kg of obese children is more than 4 times the normal birth weight. Birth weight less than 2.5kg obese children is normal children more than 3 times. The increase in the number of fat cells in the second trimester of pregnancy. Therefore, the mother pays attention to the weight gain in the second trimester of pregnancy. After seven months of pregnancy, is the mother and child weight rise relatively fast stage, the body adapted, appetite up, plus many parents think to supplement nutrition, so more not control; in fact, seven months later the child organs and other development has been more mature, if excess nutrition is mainly long weight, it is easy to raise a huge child, and huge children in adulthood the chances of obesity is very large. ” Chen Qing said. Not only is it bad for the baby to be fat, but it is also not easy for the mother to recover naturally from too much fat. She recommends that the mother should not weigh more than 12 kg before delivery than before pregnancy, and the child is best at a weight of 2.75 to 3.25 kg. Diet, the food mix in the second trimester should have enough vitamins, proteins, minerals and fiber, more fruits and vegetables, one or two staples per meal is fine, eat less and more meals, but foods with large sugar and fat content should be eaten as little as possible.
3, but pregnant mothers also pay attention to less than gestational age children clinical studies have found: low birth weight, weight fluctuates more in early life, or after birth weight catch up faster children with a stronger correlation with IR, the risk of developing type 2 diabetes is relatively high; huge children also have a higher risk of developing IR. The association of low birth weight with insulin resistance syndrome in adults has been confirmed in almost all cross-sectional and longitudinal studies (including different countries and regions, and different ethnic populations) in the last decade. To explain the correlation between IR and birth weight, the “fetal programming theory” has been proposed, suggesting that the normal programmed development of multicellular organisms depends on a series of synchronous drivers of genetic signals acquired during pregnancy, i.e., the nutritional status during critical or sensitive periods of development will have long-term or lifelong effects on the organism or function. Early nutritional environmental stimuli leading to adaptive selection of the organism or proliferation of differentiated mother cells may result in permanent acquisition of altered tissue cell numbers or proportions, the metabolic and hormonal response of the fetus to intrauterine growth restriction and rapid postnatal growth may be key to early pathophysiological changes in adult disease, and adult-onset IR may be the price paid by the developing fetus for successful short-term adaptation to intrauterine nutritional deficiencies. To explain the correlation between obesity and IR and type 2 diabetes, the “thrifty genotype theory” has been proposed from a biological evolutionary perspective, which suggests that genes originating from a state of “deprivation” may lead to adaptations that have unfavorable consequences in times of “abundance. The “thrifty genotype theory” was proposed from a biological evolutionary perspective. The “fetal programming theory” explains the mechanism of fetal origin of adult diseases from the perspective of short-term nutrition of individual development, while the “thrifty genotype theory” explains the mechanism of insulin resistance syndrome from the perspective of population evolution and long-term nutritional adaptation.
Prevention within one year of age.
1. Ensure breastfeeding. Perinatal care should include guidance on infant feeding, emphasizing the benefits of breastfeeding, giving specific instructions on breastfeeding, and promoting the dangers of overfeeding. In infancy, encourage exclusive breastfeeding for 4-6 months Breastfeeding can make infants handle cholesterol enzyme system function better than non-breastfeders, and when they grow into adulthood as well. Thus, children who are breastfed are more effective in lowering serum cholesterol. In addition, the composition of breast milk changes frequently, as the taste of milk changes if the infant sucks too much, which keeps the infant from sucking too much milk and therefore prevents obesity. And milk powder taste is always the same, which makes feeding the baby often have milk to eat, easy to cause obesity.
2. No solid food is added for the first 6 months after birth. Monthly measurement and record weight, if found that the baby weight growth is too fast, to give timely guidance to the mother, less to give, late solid food, especially cereals, replaced by fruits and vegetables 3-6 years old to adolescent children to prevent baby, and then eat a bite, and then eat a bowl “, parents do not want to let the child hungry, always worried that the child does not grow strong enough, so they want them to eat more, to encourage child to eat a little more.
1.Overfeeding
Parents overfeeding so that obese children eat more than their physiological needs, eating fast. Common improper feeding behavior are.
Much like to eat fried food or sweets and other high-energy food. Eating one ice cream a day can add 500 calories and increase weight by 0.45 kg a week.
Eating irregularly or even overeating.
Skipping breakfast, overeating in Chinese food and dinner.
More fatty foods and meat products in food, less fruits and vegetables.
2.Insufficient exercise
In order to prevent accidental injury, parents overprotect their children by not doing enough outdoor activities or exercise, often watching TV or playing video games indoors (the risk of weight gain increases 2 times when watching TV for 3 hours a day). The excess caloric energy is not consumed and is turned into fat in the body, resulting in obesity over time. Obese children gradually enter the vicious circle because of fat fat two idle movement, not moving is more food, more food is more fat.
3.Heredity factor
Parents obese, the possibility of their offspring obesity is 80%. One of the parents is obese, the possibility of obesity of its offspring is 40%, parents are not obese, the possibility of obesity of its offspring is 7%. This is in addition to genetic genes, but also the role of family environmental factors. Sometimes, the bad living environment is even more terrible than the genes. In poor areas, even if children with obesity genes, because of a light diet and high activity, but does not necessarily appear obese. Familial obesity often exists in the form of common lifestyle and dietary habits that lead to obesity. According to statistics, approximately 10,000 junk food advertisements continue to tempt children each year in media such as television, magazines and radio. It can be said that genes approve of your obesity, while environment and individuals contribute to or even determine your obesity.
Principles of dietary control.
Because of the characteristics of children’s continuous growth and development, overweight and mildly obese children can control diet (less or no high-calorie, high-fat food replaced by food rich in protein, vitamins, minerals, dietary fiber and non-fine processed food, slow down the speed of eating), increase exercise and correct bad habits, maintain the principle of slow weight gain or no change, so that with the continuous increase in height can be maintained in overweight and restore the purpose of normal. For children with moderate to severe obesity, appropriate restriction of food intake and prohibition of foods that promote obesity. For moderately obese children, it is recommended to lose 0.5~1kg per month (to reduce the harm of obesity to children’s body and mind); for children with severe obesity combined with hypertension and existing weight exceeding 20% of the standard weight of adult height, it is appropriate to lose 2~3kg per month. The caloric intake should be gradually controlled to the physiological requirement without the feeling of hunger.
In short, obese children should not be given “ambitious” goals that are unattainable, in order to improve the feasibility, effectiveness and sustainability of the program. To guide obese children to target and correct their bad habits more successfully. Obesity prevention is also important for normal weight children. Dietary intervention includes changing bad eating habits, choosing foods reasonably and reducing food intake. Three meals a day should be reasonably distributed, breakfast eat 35% of the whole day’s food, Chinese food eat 45% of the whole day’s food, dinner eat 20% of the whole day’s food. The cooking method is mainly steamed and cold, and dinner is especially suitable for light. Change the order of meals and eat in small bowls. Eat low-calorie foods first and then high-calorie foods. Have soup before meals, eat vegetarian dishes first, then meat dishes, and then eat the main meal. Slow down the speed of eating. To eat while watching TV. Brush your teeth as early as possible after a meal and stop eating before bedtime. For children with severe obesity who eat too much staple food, limit the amount of staple food. Do not eat or eat less snacks during the day. This dietary modification program will not affect the growth and development of children, and certainly will not result in significant weight loss in the short term.
Food selection.
For the sake of convenience some scholars have divided food into three main categories: red light food, yellow light food and green light food. Obese children should try not to eat red light food, eat less yellow light food and replaced by green light food.
Red light food: fatty meat, butter, fried food, Western fast food, etc. (fat in the body burning slow easy to accumulate in the body), candy, chocolate, cold drinks, sweet drinks, sweet snacks, nuts, potatoes, white potatoes, puffed food, etc.
Yellow light food: pork, rice, pasta, stuffed food, bananas, grapes, etc.
Green light foods: beef, fish, eggs, milk, shrimp, animal liver, soy milk, vegetables, apples, pears, watermelon, oranges, etc.
Exercise intervention.
Obesity is caused by the imbalance between income and expenditure of energy. Along with dietary modification, moderate exercise ( moderate intensity, long duration endurance exercise) is essential. The two complement each other, because only control diet without exercise to lose weight slowly; only exercise without control diet may become more obese. Because exercise not only increases energy consumption, but also can reduce appetite. Some obese children are lazy all day long. Some although love to exercise but the amount of exercise is not enough not only can not play a role in weight loss but also increase the appetite. Obese children are required to exercise intensity should reach the exercise pulse rate of about 150 times per minute. This moderate intensity of aerobic exercise to consume fat for the purpose, will not cause obese children too fatigue and play a role in suppressing appetite. (Exercise intensity is too large and not easy to adhere to the health; exercise intensity is too small, less energy consumption will increase appetite, can not achieve the purpose of reducing body weight). In this intensity need to exercise 40 ~ 60 minutes / day, to ensure that the exercise days per week. The best way to exercise is to choose exercises that involve the whole body muscles and require body movement: such as long-distance running (is a better way to burn calories), climbing stairs, pedaling, walking. Jumping rope, playing shuttlecock, cycling can also be. Exercise can be scheduled in the afternoon, because the same exercise consumes more calories in the afternoon than in the morning. This kind of exercise way in the short term also may not have the obvious effect, generally need to adhere to 2~3 months, obesity degree only has decreased, estimate the total course of treatment need more than one year.
This kind of case treatment through health education, diet control, change of life habits has shown that 80% of the weight reduction, in about 4 weeks, the average weight loss of obese children about 3.5 kg, and obesity has also been reduced. As the prevalence of childhood obesity increases, individual treatment is no longer sufficient to control the rapid increase, so group intervention is necessary. Some of the techniques of case management are also applicable to group interventions, but the difference is that the interventions cover different targets and settings. Group interventions are targeted at children and students in kindergartens and schools, with a focus on overweight and obese children; the sites are kindergartens and schools. Systematic and comprehensive interventions are carried out for dietary, exercise, physiological and biochemical indicators of overweight and obese children. Establish a human and physical environment to prevent and control obesity factors in order to stifle and reduce the incidence of childhood obesity. Some studies have shown that group interventions can reduce the prevalence of obesity from 16.9% to 12.1% and reduce the risk of non-obese children developing into obese children.
Interventions.
1. Health education, physical examinations and health indicators are conducted in schools by professional staff. Weight was measured every 2 months and biochemical indicators were measured every 6 months. Technical guidance is provided by professionals and health and physical education teachers.
2. The principles of dietary intervention are to ensure adequate intake of protein, vitamins, minerals and dietary fiber, and to control the intake of fat and carbohydrates for children with moderate to severe obesity in order to achieve a balanced diet with low calories. Obese children can reduce the intake of excess calories from the following four aspects (no fried food, basically no pure calorie food, limit the intake of fruits and fruit products with high sugar content, the main food is mainly rice). In order to achieve no more calorie accumulation by diet, consolidate the balance of daily calorie intake and consumption, increase the amount of exercise to gradually consume the accumulated fat in the past, continue to consolidate the balance of daily calorie intake and consumption, continue to increase the amount of exercise to basically consume the accumulated fat in the past, so that the weight maintains the status quo or decreases to the normal level. Children with mild obesity can consume 125-200 kilocalories less per day; children with moderate to severe obesity can consume 250-500 kilocalories less per day (for example, walking for 0.5 hours can consume the calories of a bag of milk, cycling for 20 minutes can consume the calories of two slices of ham sausage, swimming for 20 minutes can consume the calories of half a chicken breast, and running for 6 minutes can consume the calories of a fried egg). Heavy obese children lose about 3 kg of weight per month.
3. Obese children keep diary of diet and exercise behavior.
4. Supervision by class teachers and health and physical education teachers. Through the above measures to achieve the basic balance of individual calorie income and expenditure, individual weight monitoring curve flattened or decreased; lung capacity increased; blood biochemical indicators controlled in the normal range, the purpose of establishing a healthy life pattern.
5.The role of family
Whether to increase exercise or reduce non-physiological eating, obese children are unwilling or difficult to do. Therefore, whether it is case treatment or group intervention such as no parental support, participation and exemplary role, it is difficult to succeed. Moreover, families with obese children have common lifestyle habits that lead to obesity. In addition, children’s basal metabolic rate decreases after weight loss, and further calorie consumption is needed to cross the weight loss plateau period. In addition, weight reduction is the most important issue for children and parents, and it is also the key for children and parents to lose confidence and discontinue the treatment, so we should inform them that the change of bad behavior and the mastering of treatment methods are more important than weight reduction, and help children to pass this extraordinary period while establishing a healthy life pattern for families.
In short, obesity is formed over time, and weight loss cannot be achieved overnight. Weight loss is certainly not an easy and pleasant thing for obese children to start, but as long as they are persistent, they will certainly reap the rewards.