According to epidemiological studies, the occurrence of simple obesity in preschool children is characterized by the fact that nearly half of them become obese as early as 3 months after birth, and a considerable part of them are continued by the occurrence of obesity at the age of 3~4 years after birth. Therefore, the first year after birth is the first important period to control obesity in preschool, and is also the first line of defense for early control in adolescence and even in adulthood; 5 years after birth is the second line of defense.
The risk factors affecting simple obesity in our childhood are: (1) the combined effect of environmental factors and genetic factors, but the role of environmental factors is greater than genetic factors. (2) parental motivation factors, especially spoiling to the formation and change of children’s lifestyle has a huge impact. (3) Overweight and obese children have significantly lower indoor activity. (4) The amount of staple food and meat is high, the amount of fruits and vegetables is low, and eating too fast is a feeding characteristic of obese children. (5) artificial feeding, early addition of solid food and early weaning is a feeding pattern that contributes to the occurrence of simple obesity. (6) The social custom of preference for male children and certain traditional cultural concepts should not be underestimated.
The connotation and prevention concept of simple obesity in children
(1) connotation connotation is a lifestyle disease, closely related to unhealthy lifestyle, over nutrition or little physical activity is only one of the synergistic factors, psycho-behavioral deviation plays an important role. Professor Ding Zongyi, a leading expert in the study of childhood obesity, has written that: current research has not proved that simple obesity in childhood is caused by endocrine disorders, nor has any treatment of endocrine means been found so far to intervene in obesity. Therefore, even for many endocrinologists who have the most contact with obese children in their clinical work, childhood simple obesity is a completely new field.
(2) Prevention and control concept Just because the root cause of the epidemic of obesity in the crowd is the unscientific and incorrect lifestyle, so this lifestyle has a great destructive effect on the traditional and correct lifestyle, so the control of obesity in the crowd is a major issue of socio-cultural protection. In our country, most of the urban preschool children live in collective child care institutions, so how to manage these children and develop a scientific and correct lifestyle is a major part of child health work, and the more serious of these obese children are also tried to give “treatment” in the management of child care institutions. Growth and development is a major life phenomenon in childhood, and no treatment should interfere with growth and development or leave risk factors that impair growth and development. Based on this principle, the concept of “weight loss” or “weight reduction” should not be used in childhood, and only “weight gain control” should be used as a guideline. The four taboos of childhood obesity treatment: ① prohibit the use of fasting, starvation/semi-starvation, disguised starvation therapy; ② prohibit short-term, rapid “weight loss” or “weight loss”; ③ prohibit the use of “weight loss drugs ③ prohibit the use of “diet drugs” or “diet food”; ④ prohibit the use of surgical treatment or so-called “physical therapy”, such as oscillation method.
Management and control of simple obesity in children
The management principle of simple obesity in preschool children should adopt a comprehensive program based on exercise prescription, behavior correction as the key technique, daily life as the basic occasion, family, teachers and obese children participate together, diet adjustment and health education are always implemented and persistent. From the concept of early prevention, other overweight and obese children should set up a favorable health goal, that is, the immediate goal to promote growth and development, enhance aerobic capacity, improve physical health and control body fat growth within the normal rate; the long-term goal is to develop scientific, correct and good living habits, maintain the healthy development of body and mind, and cultivate a cardiovascular disease risk factor-free A new generation. We need to develop programs that effectively prevent adult obesity, a program that emphasizes good nutrition and exercise habits for all children, whether obese or not.
Regarding obesity screening criteria
The detection rates of simple obesity in children reported in the literature may vary according to age, race, sex, age of the survey, measurement methods, indicators used, overweight/obesity cut-off points, and especially the reference population chosen for the screening criteria, making comparisons between regions difficult. But as long as the methodology is proper, some useful conclusions can still be drawn. According to the statistical statement requirements of our Ministry of Health, the screening standard we use at present is the diagnosis and classification of body fat content according to the WHO recommended height and weight method. Fat content exceeding 15% of the standard is considered obese. This value, if calculated by weight, is approximately the whole body fat content (i.e. 15% above normal fat content) when the weight for height exceeds 20% of the reference population. Therefore, the current set height and weight more than 20% of the reference population value as the diagnosis or screening obesity boundary value point. Overweight ≥ 10-19%; mild obesity ≥ 20-29%; moderate obesity ≥ 30-49%; severe obesity ≥ 50%. Currently, this method is mostly used in child health clinics for assessment.
BMI (weight/height2) has been widely used for screening and diagnosis of obesity in adults, but it is not routinely used in outpatient clinics because of the large number of variables in children and the need for further confirmation of reference population values and cut-off points. The emphasis on the term “screening” in routine surveillance is distinct from the clinical work on the “diagnosis” of simple obesity. Simple obesity, as a disease, must reach or conform to an abnormal state of fat accumulation as defined by “obesity”. However, children who have or reach this same value are not always simply obese. They may or may not develop simple obesity now or later. Therefore, the screening standard is mainly used for the initial screening of the population, which has the advantages of simplicity and practicality, and a rough comparison of the detection rate of overweight or obesity in different populations; it should be used with caution in outpatient clinics for individual guidance, because its disadvantage is that it cannot distinguish between bone, muscle and adipose tissue and cannot represent body fat content. It is less indicative of special populations such as children and athletes, and children with well-developed muscles can easily be mistaken for obese. Some hospitals already have the equipment to carry out body composition measurements, and the degree of obesity is more objectively estimated based on the proportion of body fat.
Keys and points for successful implementation of interventions
In the process of concrete implementation of the “weight control program”, the key to the long-term sustainability of the program is to make sure that the program does not become obese in normal-sized children, and that obese children control their weight and reduce rebound; the key to effectiveness is to make the program or various measures and methods take into account the actual situation of the region and the school, the family and individual Life habits and specific circumstances, combined with customs and cultural background to develop.
(1) Design of exercise prescriptions and scientific arrangement of exercise
The design of the prescription should pay attention to the following principles: first, safety, not to damage the growth and development process of children, to ensure the daily caloric intake required; children should not have negative weight growth, and serious obesity should not be rapid weight loss in a short period of time (one month), so as not to damage the cardiovascular function of children. Second is the acceptability, the exercise intensity is appropriate, the exercise should be suitable for different age children’s daily life style and fun, in order to make children happy to accept and can adhere to long-term. Third is the expected effect, cardiopulmonary function and physical health parameters have improved, obese children’s linear growth and normal non-obese children, at least not lower than the normal non-obese children’s growth value.
Exercise arrangements should be scientific, and training programs should be developed according to the individual. Training 1-2 hours a day, 5 days a week, a course of treatment for 12 weeks. The purpose of sports training is to make physical activity a habit of daily life, to master scientific training methods, knowledge of self-protection, etc.
Both group prevention in childcare institutions and family prevention should explore various forms of activities in response to the psychological characteristics of children, with fun and free activities as the main focus. Notes include: ① The choice of sports such as: walking, small steps, balls, rope skipping, shuttlecock, stair climbing, swimming, etc. Exercises should be diversified, including slow running, soft exercises, tai chi, music sports, etc. ② Gradually, gradually increase the intensity and extend the duration of exercise, no less than 3-4 times a week, at least 30 minutes each time, twice a day. The initial start of exercise should be low-intensity, short duration (such as 10 minutes), and gradually increase the amount of exercise. ③ Each exercise process includes three parts: pre-exercise preparation, exercise content, and finally relaxation activities. The intensity of regular exercise should be limited to moist and slightly sweaty skin, and the heart rate should not exceed 160/min. ④Generally, it takes at least 6 weeks of exercise to yield results, and the training effect can be maintained for 6-8 weeks. According to research, the same exercise program and intensity, afternoon or evening exercise than the morning 20% more energy consumption. ⑤ Assessing the effects of exercise should not impair the aerobic capacity and growth of children. If long-term overload exercise can fatigue the heart and affect cardiorespiratory function, so the target heart rate (the appropriate heart rate to be achieved during exercise. (That is, the heart rate that can obtain the best results and ensure the safety of exercise). Target heart rate = maximum heart rate (220 – age) x (65-85%). Some set it at 60-80%, and it can be lower (50%) for children and the elderly.
In collective child care institutions for obese children to arrange training must have a person in charge, the personnel must also undergo strict professional training, including to have clinical, exercise physiology, sports coaching, sports injuries, field protection and rescue. It cannot be assumed that general physicians, teachers or general sports personnel can be competent. This is because it is an integral part of performing disease treatment, unlike general physical activity. The process of arranging physical activities for all children in child care institutions to prevent overweight and obesity is also unlikely to achieve the desired results without highly trained professionals in charge.
(2) Behavior modification programs
In the 1960s Ferster et al. first proposed the use of behavior modification methods to treat obesity mainly by controlling diet, and then continued to improve the obesity control program based on primary care units, which has been initially applied in the population of obese children. Behavior modification program is a specialized technique, not the same as health education, not to mention the “lecture”, “reprimand”, “do not …… “The “ban” type of discipline. Behavior modification techniques include baseline behaviors, target behaviors and mediated behaviors. The baseline behaviors include eating, exercise, and daily living behaviors; on this basis, the target behaviors, or target behaviors, are developed. The mediating behaviors are then determined. A system of rewards and punishments should also be negotiated with the child. Necessary punishment can reinforce the correction of undesirable behaviors, but in weight control, punishment must not be physically damaging, not degrading, and beneficial to the child’s growth, development, and health. Behavior modification programs for children in group children’s institutions such as: ① Behavior analysis through individual interviews, parent visits/parent meetings. First, parents and children are made aware of the dangers of obesity and the need for diet control, so that diet control becomes a conscious behavior. Then develop a behavior modification program. Establish rules for encouragement/punishment, select relevant indicators. For example, regular weight monitoring, recording the name and quantity of the daily intake of mixed or non-fine processed foods, and recording the time spent in meditation or exercise (preschoolers need parental help). Special emphasis is placed on the involvement of (maternal) grandparents in terms of parental involvement. Teach parents and children how to choose the right foods, including the two types of foods that are encouraged and discouraged, such as the “light” food guide. To avoid gobbling, drink soup or fruit or eat root vegetables or food with bones and shells before the meal, and chew for 15 minutes before eating the main meal (chewing therapy). ③Children should change the habit of eating before bedtime, snacks, desserts and drinks at home on both days off. Small and frequent meals are allowed instead of eating a big meal when they are hungry. ④Parents should actively participate in changing the inherent concept of making daily menu and arranging reasonable number of meals according to the principle of diet management. Do not purchase too much food at home, do not store high-calorie snacks or drinks, do not persuade eating, and do not use food as a reward or punishment.
(3) Dietary adjustment
① Under the premise of ensuring children’s height development, gradually adjust the food structure and control the intake of high-fat and high-sugar foods, so that the intake of caloric energy is lower than the actual consumption. At the same time with behavior modification, so that families and children can selectively eat or avoid certain foods and establish correct eating habits. For those who are young or have just developed mild to moderate obesity, a less strict diet adjustment program can be used.
②For moderate to severe obese people whose interventions mentioned above are not effective, the types of food eaten should be further restricted (mainly referring to high-calorie foods or very finely processed carbohydrates such as refined white flour, potatoes, fats, fried foods, sugar, chocolate, cream products, etc.), reduce excessive staple foods, start with small amounts and replace them with bulky vegetables with low caloric energy and more dietary fiber, and limit any sweet drinks.
③Ensure the intake of sufficient amount of animal and plant protein, so that a certain proportion of leguminous protein foods.
④Calorie control should take into full consideration the needs of children’s growth and development. It is generally recommended that calorie intake should be 600-800 calories for obese children under 5 years old during the control period, and 800-1200 calories for those over 5 years old. Protein, vitamins, minerals and trace elements should be maintained at a daily intake higher than the low limit, and supplied according to the maintenance period calories (about 85% of the recommended amount) after satisfactory weight control. Increase the proportion of coarse grains, legumes and vegetables is encouraged.
Special attention: release the mental burden. Some parents worry too much about their obese children and seek medical advice everywhere, and some blame the children for their eating habits and interfere excessively, which may cause mental tension or confrontation in the children and should be avoided.
Regular monitoring and evaluation
Measure weight, height, abdominal circumference and hip circumference every 2-3 months, and review the control program after one month of the initial diagnosis of the severely obese children to understand whether the control program is feasible, so as to amend the program. If it is possible to control the weight not to increase again, the weight loss of 0.5~1 kg should be the target from the 2nd month.
Finally, it is emphasized that
l . What foods should obese children eat less or not eat? Lard, butter, fatty meat, soybean oil, peanut oil, sesame oil and other vegetable oils, sausage, red sausage, meat loaf, candy, honey, sweet snacks, jam, sweet drinks, brown and white sugar, etc.
l . What foods should be promoted to eat more? Vegetables and fruits with large volume, more fiber and less calories, such as: winter melon, cucumber, bitter melon, celery, leek, spinach, cabbage, mao bamboo shoots, radish, string beans, bean sprouts, etc.
l Pay attention to the combination of five colors of food and choose low glycemic index food
Different carbohydrates have different effects on blood sugar, and the process of digesting carbohydrates into blood sugar is regulated by insulin, so it is ideal to keep blood sugar stable and avoid fluctuations.
Attachment: five-color food (white, yellow, red, green, black)
White refers to rice, which is the staple food and also includes various kinds of mixed grains and fruits and vegetables such as white potatoes, yams, white lentils, white vegetables, white radishes, white melon seeds, white fungus, etc.
yellow refers to soybeans, including all kinds of soy products, as well as yellow fruits and eggs, such as soy bean sprouts, golden needles, pumpkins, persimmons, tangerines, ginger, etc.
red refers to meat (white meat refers to fish and chicken), red meat has a higher fat content than fish and chicken, so it is not advisable to eat more.
green refers to green leafy vegetables and fruits, a variety of leafy greens to the dark color is better, in addition to green beans, tea is also indispensable.
Black refers to plants and animals with health benefits, such as black bone chicken, turtle, black fish, black sesame, black beans, black glutinous rice, shiitake mushrooms, black fungus, etc.
What is the glycemic index (GI)?GI is a quantitative indicator of the effect of food on raising blood sugar after a meal. The GI of a food is measured by comparing it with the standard reference food glucose, reflecting the speed and ability to raise blood sugar. Generally GI >70 is a high GI food, GI 55-70 is a medium GI food, and GI <55 is a low GI food.
Glucose production index of some foods (glucose = 100)
Food GI
Food GI
Food GI
Food GI
Food GI
Bread 69
Rice72
Rice66
Corn Porridge80
Carrot 92
Potatoes (new) 70
Potatoes 80
Fructose 20
Maltose 108
Lactose 90
Honey 75
Sucrose 60
Apple 39
Banana 62
Milk 36
Soybeans 15
Lentils 29
Peas33
Glycemic load (GL) GL is the GI of this food multiplied by the actual amount of carbohydrates (CHO) consumed in that food. Determination of glycemic load: GL > 20 is high, GL 11 to 19 is medium, and GI < 10 is low.
For example, watermelon GI = 72%, eat 120 grams, check the table CHO content of 6.6 grams. Calculation of watermelon GL = 72% × 6.6 = 4.75, can be considered to have little effect on blood sugar. This indicates that although watermelon belongs to the high glycemic index, but because of its large size it does not contain many carbohydrates, the calculated glycemic load (GL) is not high, so you can eat a little bit appropriately.
Food glycemic index (GI) is a temporary new concept
Rational selection and matching of foods with different color foods (white, yellow, red, green, black, purple, blue)
Matching of high and low foods with different glycemic indexes
Preparation of low glycemic index (GI) foods in the right way
”Coarse” foods should not be made fine
Simple is good (e.g., large pieces of food, whole grains)
Eat more dietary fiber-rich foods (vegetables, bamboo shoots, mushrooms, fungus)
Increase protein in staple foods
Stir-fry with high heat and less water (long processing time makes it easy to paste)
Add some vinegar
High and low GI food pairing
Low glycemic index (GI) foods
Cereals Minimally processed coarse grains such as whole wheat, macaroni noodles, black rice, buckwheat, cornmeal porridge
Dried beans and products such as mung bean noodles, fava beans, peas, red beans, string beans, black bean soup
Dairy and products such as milk, yogurt (with sugar), yogurt
Potatoes Raw potatoes or cold-treated potato products such as potato vermicelli, lotus root flour, konjac, taro
Attachment: light food guide
Red light food (do not eat or eat less)
Yellow light food (eat in moderation)
Green light food (can eat more)
Lard, butter, cream, fatty meat
Lunch meat, lamb, soybean oil, sausage peanut oil, sesame oil, duck, red sausage
Fujian meat loaf, pork chops, ice cream
Cane sugar, honey, jam, sunflower seeds
Sweet drinks, sweet snacks, chocolate
Walnut meat, peanut rice, sesame seed paste, cashew nuts, almonds, doughnuts, oil tofu, oil gluten, fried
Beef, meat floss, pork liver, pork heart
Pork tenderloin, square leg, barbecue pork
Chicken leg, eel, egg, cake
Vegetarian chicken, bean curd, pak choi, potatoes
Rice, flour, instant noodles, baklava toast bread, cream cookies, banana grape, watermelon, milk
Winter melon, cucumber, celery, leek
Spinach, bok choy, lettuce, tomato
Cabbage, cabbage, bamboo shoots, radish, beans, bean sprouts, bean curd, grass carp, pomfret
Scallops, pig’s blood, shrimp skin, oatmeal kelp, fungus, mushrooms, shiitake mushrooms
Fresh fruit, skimmed milk, sea cucumber