Simple obesity is closely related to lifestyle, characterized by excessive nutrition, insufficient exercise, behavioral deviations, generalized overgrowth of adipose tissue throughout the body, the accumulation of chronic disease.
A, obesity etiology
Simple obesity is produced by a combination of genetic and environmental factors. Genetic factors (obesity caused by genetic mutation) play a very small role, environmental factors play an important role. Environmental factors in the lifestyle and personal behavior pattern is the main risk factors.
Second, obesity diagnosis
In the field and clinical diagnosis of simple obesity, first of all, except for certain endocrine, metabolic, genetic, central nervous system diseases caused by secondary obesity or induced by the use of drugs. As a chronic disease, the diagnosis of simple obesity still requires a comprehensive diagnosis in terms of history, symptoms, signs and laboratory tests. However, simple obesity has its unique aspect, which is highlighted by the excessive growth and accumulation of adipose tissue throughout the body. Therefore, the measurement of adipose tissue becomes an important basis for the diagnosis of simple obesity. There are many methods for diagnosing body fat content, and the recommended method is the height-weight method for diagnosing and grading body fat content. The use of BMI (similar to the Kaup index in pediatrics) to screen for obesity in pediatrics is currently being discussed in academic circles. This index can be used in the field screening together with the visual method.
Third, obesity standard
In terms of quantity, the fat content exceeds 15% of the standard that is obese. This value if calculated by weight is about more than standard weight 20% of the whole body fat content that is more than the normal fat content of 15%. Therefore, at present, it is set to exceed 20% of the weight of the reference population is obese. Here the reference population weight is recommended by the World Health Organization, the U.S. Center for Health Statistics (NCHS)/U.S. Centers for Disease Control (CDC) to develop a height-specific weight (weightforheight), also known as height standard weight. If the use of Kaup / BMI index, the boundary point still need to study.
Fourth, obesity classification
Obesity grading has the following levels.
1, overweight: greater than the reference population weight 10% ~ 19%.
2, mild obesity: greater than the reference population weight 20% ~ 39%.
3, moderate obesity: greater than the reference population weight 40% to 49%.
4, severe obesity: greater than the reference population weight 50%.
Five, simple obesity prevention and control measures
1, treatment program: exercise prescription as the basis, behavior correction as the key technology, diet adjustment and health education to carry out; family as a unit, daily life as a control site; obese children, parents, teachers, medical staff to participate in a comprehensive treatment program. The treatment course under the supervision of medical personnel is at least one year.
2.The concept of “weight loss” or “weight reduction” is not used in childhood, and only “weight gain control” is used as the guiding idea.
3, taboo: childhood obesity control prohibit the use of the following means.
(1) starvation / semi-starvation or disguised starvation therapy.
(2) short-term (shorter than 3 months) rapid weight loss. Repeated rebound cycles of weight loss/weight gain.
(3) Taking “diet foods”, “diet drugs” or “diet crystals”.
(4) Surgery, physical therapy and other means to remove fat.
4, weight control goals: there are near-term goals and long-term goals, near-term goals.
(1) to promote growth and development (especially linear development), the rate of weight gain within the normal physiological range.
(2) To improve aerobic capacity and enhance physical fitness.
(3) Passing physical education scores.
(4) Knowledge of proper nutrition, correct food choices, and knowledge of which foods and lifestyles are not conducive to weight control. Long-term goal: to cultivate a new generation with science, correct and reasonable lifestyle, healthy physical and mental development, and no risk factors for cardiovascular diseases.
5.Risk factors of simple obesity in Chinese children are tired.
(1) parental motivation factors: apparent wealth, wrong love, overprotection, overfeeding.
(2) Western dietary pattern: high-fat fast food, soft drinks, sweets/cold drinks, chocolate, etc.
(3) bad habits in traditional eating habits: overeating, gorging, forced persuasive drinking/eating, heavy on meat/oil, light on vegetables/fruit. Greed for large pieces, large amounts, greasy and thick.
(4) less physical activity: less exercise, less ways to exercise, less sports facilities.
(5) Sedentary lifestyle: little room for activity, laziness, overburdened with study, overprotective.
(6) lifestyle behavior: lack of nutritional knowledge, unscientific food selection, improper feeding, poor eating habits.
6.Prevention.
(1) population level prevention.
The first level of prevention of obesity from two aspects, one is through various social organizations and media in the population to carry out universal social mobilization, so that people have a correct understanding of obesity (neither paralysis, nor tension and fear), change the bad lifestyle, dietary habits and unreasonable dietary structure, etc., so that the level of risk factors of obesity in the population is greatly reduced, so as to control the obesity
The occurrence of obesity. On the other hand is to improve the identification of risk factors susceptible people and give timely medical supervision to control the progress of obesity.
(2) Prevention in infancy and early childhood.
Emphasize breastfeeding. Moderate feeding according to the actual needs of infants during artificial feeding. Avoid feeding solid food during the first 3 months of life. At 4 months after birth, if the child has become obese, attention should be paid to avoid continuing to consume excessive calories, especially at 6 to 8 months after birth for obese children to minimize the amount of milk, replaced by fruits and vegetables; with whole rice, a comprehensive replacement for refined rice and flour products. Parents should not use food as a means of rewarding or punishing young children for their behavior.
(3) preschool prevention: develop good living habits and eating habits. Do not favor sugary, high-fat, high-heat foods. Develop the habit of participating in various physical activities and labor. For example, do not take the car when you can walk, climb up and down the stairs by yourself, and do not take the elevator. Make it a habit to have some physical exercise every day. The formation of the above habits has a significant impact on lifelong lifestyles, especially in combating sedentary lifestyles in adulthood.
(4) Adolescence and early adolescence prevention: This is a critical period and a dangerous period. Especially for girls, in addition to increased body fat, psychological stress, worry, and conflict also increase. The pursuit of a slim body shape has caused many girls to trigger a misconception about weight loss, one-sided pursuit of dieting, fasting, and blindly taking diet foods or drugs, resulting in injury or death. The focus of health education in this period is to strengthen the guidance of nutritional knowledge and dietary arrangement, guidance of exercise prescription training, correct understanding of obesity, etc.
For already obese or may be obese young people should be professional physicians to give individual guidance and encourage both parents to participate in the joint arrangement of children’s lives.
Six, obese children’s dietary adjustment
Diet adjustment not only refers to the calorie intake for strict calculation and control, selective eating or avoid eating certain food. Also includes the ingestion behavior, food cooking way to adjust.
For the very young, or just occurring mild to moderate obesity can be treated according to less strict diet modification program (informalintakemodification). This program consists of asking obese people to eat more fiber or non-fine processed foods. The diet should be less or no high-calorie, high-fat, small-sized foods, fried foods, soft drinks, Western-style fast food, sweets, cream products, etc. Cut food into small pieces, eat slowly, and take small bites. Do not take too long to eat, and distract your child from food in appropriate ways during meals. Teach your child how to make appropriate food choices and how to substitute different foods. Encourage children to make independent food choices and decisions in their lives.
Limit the amount of food consumed by children with moderate to severe obesity. The daily calorie intake for children under 5 years old is 2512.08J～3349.44J (1cal=4.1868J), for children over 5 years old is 3349.44J～5024.16J, and for adolescents is 6280.2J～8374.6J (Table 1). Specific recipes can be made according to individual economic status, tastes, customs, and habits. Depending on the situation, a six-meal-a-day system (breakfast, lunch, dinner, morning, afternoon and evening snacks) is possible. Protein, vitamins, minerals and trace elements should be adequately supplied. Strictly abstain from foods that tend to cause fat accumulation. After the effect of weight control, carry out the maintenance period calorie supply.
VII. Exercise prescription for obese children
1, design principles: safe, interesting, inexpensive, easy to adhere to long-term, can effectively reduce fat.
2, design elements: should pay attention to the movement with weight movement, in these movements distance is more important than speed. Attention should also be paid to flexibility sports.
3, the form of exercise: aerobic exercise, alternating aerobic exercise with anaerobic exercise, skill exercise.
4, prescription development: test individual aerobic capacity. The peak intensity is controlled at 90% of the metabolic equivalent unit, and the average intensity is between 60% and 70%. Find the safe boundary point. Distribute the task of fat loss evenly over a period of 3 months.
5, the prescription content: including exercise intensity, exercise frequency, exercise time, exercise duration. Exercise intensity to the average intensity, generally 50% of the maximum oxygen consumption (about 60% to 65% of the maximum heart rate). Exercise frequency is 3 to 5 times per week. Exercise time is 1 to 2 h. Exercise period to 3 months as a phase, a year as a cycle.
6, training program: each training must first make preparatory activities (i.e., warm-up exercises), in each training activity to have a small rest. At the end of the exercise must have recovery exercise (i.e., cold body exercise). Stop training immediately in case of physical discomfort/injury. Need to teach self-protection techniques.
Eight, obese children’s behavior correction program
1.Behavior analysis: analyze the baseline behavior through interviews with obese people, talks with parents, teachers and observations. Find out the main risk factors.
2.Formulate behavior correction program: determine the target behavior of behavior correction according to the main risk factors in the behavior pattern of obese people and set up intermediary behavior. Develop the speed of behavior correction, reward / punishment, positive / negative induction and other specific content.
3, obese people record behavior diary: the content includes the first response to stimulation/stimulus control, the experience of the behavior correction process, difficulties, experience and experience.
4.Symposium: including parents, (grand) grandparents, teachers and other relevant personnel. In order to understand the life of obese children, learning environment, personal characteristics. At the same time, assist in creating an environment that helps obese children persist in weight control training.