What is childhood obesity
Childhood obesity is defined as obesity when a child’s body fat accumulates too much and his or her weight exceeds 20% of the average standard weight according to height, or exceeds the average standard weight according to age plus two or more standard deviations. A certain degree of obvious overweight and excessive fat layer is a state caused by excessive accumulation of body fat, especially triglycerides.
Childhood obesity profile
Recently two worrying trends appear, one is obesity gradually to the adolescent development, the second is from the first world to the third world spread in our country.
Obesity etiology
Excessive nutrition
Improper feeding of infants may lead to over-nutrition, for example, every time the infant cries, it immediately feeds milk, and over time it becomes a habit, and later, whenever there is frustration, it tries to find something to eat, which is easy to cause infant obesity. Too early to feed the infant high calorie solid food, make the weight increase too fast, form obesity; late pregnancy excessive nutrition, etc., all can become the cause of obesity after birth.
Psychological factors
Or to eat as self-indulgence, leading to obesity.
Lack of exercise
Genetic factors Both parents are fat, 70% to 80% of the offspring appear obese; One of the two parents is obese, 40% to 50% of the offspring are obese; Both parents are not obese, nearly 10-14% of the offspring appear obese. And the central regulation factor also has the relationship, the patient regulation function lost balance, and cause the body intake too much, more than the demand, cause obesity.
Obesity performance
The peak incidence is within 1 year old, 5-6 years old or adolescents. Affected children tend to.
1, heavy weight.
2, thick fat.
3, excellent appetite, preferring greasy and sweet food.
4.Low activity.
5. severely obese individuals may suffer from hypertrophy of the abdominal wall, too high diaphragm, difficulty in ventilation and hypoxia, leading to shortness of breath, cyanosis, secondary erythrocytopenia, cardiac enlargement and congestive heart failure, called obese pulmonary heart syndrome.
6. varying degrees of fatty liver visible on ultrasonography.
7, high blood lipids.
Diagnosis and differential diagnosis of obesity
The most simple and practical method is weight measurement, obese children’s weight reaches or exceeds 20% of the average standard weight calculated by length, there is over nutrition, less movement and obesity history, is uniformly obese and no other abnormal clinical manifestations, can be diagnosed as simple obesity. More than 10% of the weight of the same age is overweight, 20% is mild obesity, more than 30% is moderate, more than 50% is severe obesity, more than 100% is serious obesity.
Because of the different height of children, the influence of weight is great, so should use the body mass index (BMI, that is, kg/m2 (kg for weight, m for height) as the standard. 2000 February WHO Western Pacific region obesity working group put forward the standard of Asian adult body mass index: BMI 18.8 ~ 22.9 for normal, <18.5 for low weight, ≥23.0 for overweight, 25.0 ~ 29.9 for mild obesity, ≥ 30.0 for severe obesity, but children vary with age, BMI ≥ 85% for overweight, ≥ 95% diagnosed as obese.
Obesity is divided into two kinds, simple obesity, secondary obesity
The disease needs to be distinguished from secondary obesity, such as pituitary and hypothalamic lesions caused by obesity reproductive incompetence syndrome, also known as cerebral obesity, showing short stature, fat accumulation mainly waist and lower abdomen, delayed sexual development, can be accompanied by fundus abnormalities and uremia; adrenal cortical hyperplasia or tumor caused by Kushing syndrome (Kushing syndrome), showing short stature, cortical accumulation is centripetal, full-moon face, buffalo back, thin limbs, may be accompanied by precocious puberty, hirsutism, acne, hypertension, hypokalemia; and other secondary obesity, each has the clinical characteristics of the original disease, can be distinguished.
Treatment of obesity
The treatment of pediatric obesity, the main thing is diet control, followed by exercise, too fat need to be treated with drugs, the key lies in their own determination and the supervision and cooperation of parents. At present, the international weight loss follows three principles, namely, no anorexia, no fatigue, no diarrhea.
Dietary control: to reduce their weight to more than 10% of the average standard weight calculated for the length of the body can be, without strict control of diet, the general principles of calorie control are: 60kcal/(kg・d) for young children, 80kcal/(kg・d) for primary and secondary school children according to the degree of obesity, 50kcal/(kg・d) for those who are 100% overweight, can be selected 1 to 2 days a week to Vegetable soup, fruit or 1200ml milk instead of main food.
Eat more mixed grains, fish, vegetables and soy products, followed by poultry and lean meat. Potatoes, yams, sweet materials and sweets are not eaten as much as possible. And supply the general needs of vitamins and minerals. Eat small calories and large volume of food such as vegetables and fruits, etc. It is advisable to limit snacks and sweets and high-calorie food such as chocolate, etc. Increase exercise Obese children should increase exercise every day, to form a habit, should start with small amount of exercise activities, and then gradually increase the amount of exercise and activity time.
In the early stage, we should avoid strenuous activities to avoid increasing appetite, and the common exercises can be: jogging for 30min or climbing stairs, jumping rope, playing ball, running on treadmill and swimming for 1h after meal every day, which can be tolerated by the body. Behavior therapy Teach children and parents behavior management methods, older children should learn to self-monitor, record daily weight, activity, food intake and environmental influences, and regularly summarize, parents help children evaluate the implementation of treatment and establish good eating and behavior habits.
When diet control and exercise are not effective, medication can be added to the treatment. There are four main types of medication: appetite suppressants, metabolic and thermogenic drugs, drugs that affect digestion and absorption, and drugs that promote local lipolysis;
Currently, the following are commonly used.
(1) Fenfluramine: appetite suppressants.
(2) Orlistat or Xenical inhibit the activity of intestinal lipase to reduce fat absorption by 30%.
(3) trimethoprim (nomadine, sibutramine sibutramine): inhibit 5-hydroxytryptamine reabsorption, increase thermogenesis, can produce side effects of increased heart rate, increased blood pressure, adult daily dose of 10 mg. have not seen the application of children reported.
(4) Metformin: a drug affecting absorption, with hypoglycemic and hypolipidemic effects, suitable for people with hyperinsulinemia, dose 0.5-1.5g/d, divided into 3 oral doses, prohibited for patients with poor liver and kidney function and ketosis. Chinese medicine, auricular acupuncture and body acupuncture treatment, such as auricular acupuncture can suppress appetite, weight loss has a good effect, so does body acupuncture, good value for money, worthy of clinical promotion.
Obesity prevention
To prevent childhood obesity, we should start from the fetal period, strengthen nutrition education for pregnant women, cultivate good eating habits, avoid excessive intake of sweets, strengthen physical exercise, regularly monitor the growth and development of children, and give nutritional guidance to reduce the occurrence of pediatric obesity. Pediatric obesity can be complicated by three high, fatty liver, gallstones, joint lesions obese pulmonary heart syndrome, and even death.