Overview
It is a nutritional disorder in which the child’s weight exceeds the normal range.
It is characterized by overweight, high appetite and fatigue.
The onset of the disease is often related to genetics, unhealthy eating habits, low activity level and other factors.
It can be treated by lifestyle modification, psycho-behavioral interventions, and medications.
Definition
Childhood obesity is a nutritional disorder in which body fat accumulates excessively and body weight exceeds the reference value due to the fact that the body’s consumption is lower than its energy intake over a long period of time.
Classification
Classification according to the cause
Simple obesity: no obvious endocrine, metabolic disease etiology, clinical common.
Secondary obesity: obesity secondary to neuro-endocrine-metabolic disorders based on obesity, such as hypothyroidism, Cushing’s syndrome.
Classification according to the distribution site of adipose tissue
Centripetal obesity: also known as abdominal obesity or visceral obesity, visceral fat increases, waist-to-hip ratio increases.
Peripheral obesity: also known as homogeneous obesity or subcutaneous fat type obesity, fat homogeneous distribution, fat accumulation in the buttocks is significantly more than the abdomen.
Morbidity
Can occur at any age, but is common in school-age children.
It is more common in boys than girls.
At present, the rate of overweight and obesity in children continues to rise, and in some cities in China, overweight and obesity in school-age children has reached more than 10%.
Causes
Causes
Environment
Food choices, physical activity environment, parents’ poor dietary behavior and lifestyle habits and other factors, resulting in children’s energy intake and physical activity to reduce the increase in the “obesogenic environment”.
Diet and exercise patterns
Maternal malnutrition or overnutrition during pregnancy.
Overfeeding of infants after birth.
Unhealthy eating habits, such as sweet tooth, fast food, eating too much, eating too fast, and using too much oil in cooking.
Too little activity can cause obesity even if you don’t eat much.
Heredity
The vast majority of obesity is caused by a combination of genetic and environmental factors.
The younger and more serious the age of obesity, the greater the possibility of genetic factors.
Parents are obese offspring of obesity as high as 70% ~ 80%; one parent is obese, the incidence of obesity in the offspring of about 40% ~ 50%; both parents are normal offspring of obesity only 10% ~ 14%.
Endocrine metabolic diseases
Cushing’s syndrome, hypothyroidism, growth hormone deficiency, hypogonadotropic hypogonadism, hyperinsulinemia, polycystic ovary syndrome, and hypothalamic-pituitary disease can cause secondary obesity.
Intestinal environment
Changes in intestinal flora may be associated with the development of obesity, e.g., the intestinal flora of the genus Mycobacterium avium may be reduced in children with obesity.
Psychosomatic factors
Such as trauma or psychological abnormalities can lead to overeating in children.
Drugs
Medications such as glucocorticoids (e.g., hydrocortisone, dexamethasone, etc.), antiepileptic drugs (e.g., phenytoin sodium, phenobarbital, etc.) and antipsychotics (e.g., clozapine, olanzapine, quetiapine, risperidone, etc.) can lead to weight gain in children.
Symptoms
Main Symptoms
Strong appetite
Very good appetite, especially for greasy and sugary foods, such as a fondness for fatty meats and sweets.
Easily fatigued
Mild obesity is mostly without this symptom.
Obviously obese people often experience fatigue, shortness of breath or leg pain during activities.
Severe obese people because of the excessive accumulation of fat, restricting the thorax and diaphragm movement, so that the lung ventilation is insufficient, can appear shallow and rapid respiration, and in serious cases, lead to hypoxia, purple lips, and even life-threatening.
Developmental abnormalities
Early sexual development and early cessation of growth may result in a lower height than that of the same age group.
Changes in body shape
It may be manifested as abundant subcutaneous fat, abdominal swelling and sagging, and severe obesity may cause skin lines to appear on the chest, abdomen, buttocks and thighs due to excessive subcutaneous fat.
Due to overweight, overloading of the two lower limbs when walking may lead to knee valgus and flat feet.
Complications
Obstructive sleep apnea hypoventilation syndrome
This disease occurs as a result of partial or complete obstruction of the upper airway. Obese children with excess abdominal fat and large neck circumference are prone to this disease.
The manifestations are obvious snoring during sleep, paroxysmal apnea, open-mouth breathing, inability to sleep quietly and easy to wake up.
Childhood type 2 diabetes
Type 2 diabetes mellitus in children is also known as non-insulin-dependent diabetes mellitus. With the increase of obesity in children, the incidence of type 2 diabetes mellitus in childhood is gradually increasing.
The onset of the disease is often insidious, symptoms are not obvious, and high blood sugar is often found during physical examination.
Consultation
Department of Medicine
Pediatric Internal Medicine
When your child is overweight and meets the criteria for overweight or obesity, it is recommended that you consult a doctor promptly.
Endocrinology
When your child’s sexual development is significantly ahead of schedule, or growth has stopped, you can also visit the Endocrinology Department.
Preparation
Consultation: Registration, Preparation of documents, Frequently Asked Questions
Tips
Parents can keep a detailed record of their child’s weight change for the doctor’s reference.
Preparation Checklist
Symptom list
Pay special attention to the time of onset of symptoms, special manifestations, etc.
How is the child’s food intake? What does he/she like to eat?
Is the child physically active? How long is the average day of activity and roughly what type is it?
Does your child have shortness of breath, chest tightness or muscle pain after activity?
Does the child snore a lot while sleeping?
Medical History Checklist
Does anyone in the child’s family have a history of obesity?
Did the mother suffer from malnutrition or overnutrition during pregnancy?
Does the child have any endocrine metabolic disorders such as Cushing’s syndrome, hypothyroidism, or growth hormone deficiency?
Has the child been recently traumatized or suffered from a psychological disorder?
Does the child have a history of medication use such as glucocorticoids, antiepileptic drugs and antipsychotics?
List of medications
Medication use in the last 3 months, if available in a box or package, bring with you to the doctor’s office
Glucocorticosteroids: e.g. hydrocortisone, dexamethasone, etc.
Antiepileptic drugs: e.g. phenytoin sodium, phenobarbital, etc.
Antipsychotics: e.g. clozapine, olanzapine, quetiapine, etc.
Diagnosis
Diagnosis is based on
Medical history
Family history of obesity.
The mother had malnutrition or overnutrition during pregnancy.
Endocrine metabolic disorders such as Cushing’s syndrome, hypothyroidism, and growth hormone deficiency.
Recent trauma or psychological abnormalities.
Have a history of medication use such as glucocorticoids, antiepileptic drugs and antipsychotics.
Clinical manifestations
Appetite is excellent, with a preference for sweets and high-fat foods.
Obviously obese people may have symptoms such as shortness of breath after activity, easy fatigue, and leg pain.
Physical examination reveals an abundance of subcutaneous fat, with obvious accumulation of fat in the cheeks, shoulders, breasts, and abdominal wall. Occasionally, white or purple lines can be seen on the abdomen.
Blood biochemical examination
Check triglycerides, total cholesterol, LDL cholesterol, uric acid, and blood glucose.
Elevated triglycerides, elevated total cholesterol, and elevated LDL cholesterol may be present.
Diagnostic Criteria
Diagnostic criteria vary by age, and the following indicators may be used for reference.
＜Infants <2 years old
The standard deviation score is calculated according to the World Health Organization (WHO) 2006 Child Growth and Development Standards by referring to the average of the corresponding body weights of the normal population of the same age, sex and length.
A weight greater than 2 standard deviations from the mean weight of the reference population is considered “overweight”.
A weight greater than 3 standard deviations from the mean weight of the reference population is considered “obese”.
Children ≥2 years of age
It is recommended to use Body Mass Index (BMI) for diagnosis, BMI=Weight (kg)/Height2 (m2).
Children aged 2-5 years can refer to the BMI reference thresholds for overweight and obesity for children aged 2-5 years in China as defined in the “Growth Curve of Body Mass Index for Children and Adolescents Aged 0-18 Years in China”.
For children aged 6-18 years, please refer to the BMI reference points for school-aged children aged 6-18 years for screening overweight and obesity in the “Screening for Overweight and Obesity in School-Aged Children and Adolescents” for the reference points for BMI by gender and age.
At the age of 18 years, the BMI for both sexes is 24 kg/m2 and 28 kg/m2 as the cut-off points for overweight and obesity.
Differential Diagnosis
The majority of childhood obesity is simple obesity, mainly related to excessive calorie intake, drugs and endocrine diseases can also cause obesity, need to be differentiated from.
Cushing’s syndrome
Similarity: both have obesity.
Differences: Cushing’s syndrome is mainly centripetal obesity, that is, visceral fat increased significantly and limbs relatively thin, accompanied by a full moon face, buffalo back, skin purple lines, increased blood cortisol.
Hypothyroidism
Similarity: both have obesity.
Differences: This disease may present with a bloated face, slow weight gain, accompanied by chills, loss of appetite, dry skin and other symptoms, which can be differentiated by measuring the thyroid function.
Treatment
The treatment of childhood obesity is aimed at restoring the child to a healthy state, and is based on the principle of reducing the child’s weight to a near-ideal state without affecting the child’s health and growth.
Lifestyle Intervention
Dietary modification
Parents are advised to prioritize recipes that are low in fat, low in carbohydrates and high in protein for their children.
Parents should limit their children’s intake of foods high in sugar, such as candies, desserts and sugary drinks. Avoid or minimize unhealthy eating patterns.
Help your child develop good eating habits, such as slowing down the pace of eating, chewing slowly, and avoiding looking at electronics while eating.
Don’t reward your child with food too often.
Exercise properly
It is difficult to lose weight by controlling diet alone, and you need to exercise at the same time.
Children because of obesity activities after easy fatigue is not willing to exercise. Parents can choose the children like and effective and easy to adhere to the movement, such as running in the morning, walking, cycling, etc., the amount of activity to the exercise after easy and happy, do not feel fatigue as a principle.
If there is fatigue, panic and shortness of breath after exercise, as well as a big increase in appetite, it suggests that the activity is too much, and parents need to pay attention to adjusting the amount of activity.
Children can gradually extend the duration of each exercise session, increase the frequency and intensity of exercise within their ability, and form a long-term exercise habit.
At least 60 minutes of moderate to high intensity physical activity per day is recommended.
Develop good sleep habits
Parents should cultivate a good sleep routine for their children and avoid engaging in exciting activities before bedtime.
Psychological and Behavioral Interventions
Correct unhealthy behaviors and lifestyles of children, paying attention to gradual progress and not pushing too much.
Encourage the child to stick to diet control and exercise to enhance confidence in losing weight.
Parents of children who are withdrawn and have low self-esteem should often encourage their children to participate in group activities and help them establish a healthy lifestyle.
For children with emotional trauma or psychological abnormalities, psychological counseling treatment is available when necessary.
Medication
Pharmacologic therapy for children with obesity is generally only indicated if weight gain is not controlled or complications improved after formal intensive modified lifestyle interventions, or if there are contraindications to exercise.
Weight-loss medications are not recommended for children younger than 16 years of age, and medications such as orlistat may be chosen as appropriate for children 16 years of age and older.
If type 2 diabetes is present in children over 10 years of age, metformin may be applied as prescribed.
Metabolic Weight Loss Surgery
Metabolic weight loss surgery is an invasive operation, which should be carefully selected for children, and the indications for the surgery are not yet standardized.
There are no standardized indications for this procedure. For both adults and children, sleeve gastrectomy and Roux-en-Y gastric bypass are the most widely used surgical procedures for weight loss at home and abroad.
Prognosis
Cure
Some children can regain normal weight with no effect on life through diet control and increased exercise.
41% to 80% of childhood obesity can continue into adulthood, increasing the risk of hypertension, diabetes, coronary heart disease and other diseases.
Harmful
Childhood obesity if left untreated can develop complications such as obstructive sleep apnea hypoventilation syndrome and type 2 diabetes, affecting children’s health.
Children with severe obesity may suffer from low self-esteem, loneliness, timidity and other psychological disorders due to the fear of being ridiculed.
Daily
Daily Management
Diet management
Parents should supervise their children to reduce the intake of high-calorie and high-fat food, such as fatty meat, cakes, candies and chocolates.
Parents should cook food with appropriate ratios of protein, fat and sugar, giving preference to low-fat, low-sugar and high-protein foods, and at the same time ensure the intake of dietary fiber.
Encourage your child to eat more satiating and low-calorie foods on a daily basis, such as radish, winter melon, cucumber, pumpkin and apple.
Cultivate your child’s good eating habits by not being picky about what they eat, eating smaller and more frequent meals, not being too hungry or too full, and chewing and swallowing slowly when eating.
Life management
Parents help their children to make an exercise program and encourage them to keep exercising for at least 1 year.
Fix the time and place for family meals.
Supervise children not to watch TV or listen to the radio etc. while eating.
Remove the TV set from the child’s bedroom and limit the time spent watching TV and playing games.
Psychological support
Help the child to recognize and deal with the problem of obesity.
Encourage the child to talk about fears and worries and help the child to accept his/her own image.
Parents should always show their children that they do not dislike or care about them.
Guide the child to participate in normal social activities and establish a healthy lifestyle.
Follow-up and review
Parents should monitor the child’s growth and development, such as changes in height and weight, and review the child’s condition at regular outpatient visits.
Prevention
Pregnant women should eat less high-fat food in the second trimester to prevent overweight of the fetus.
After birth, babies should be breastfed and complementary foods should be added reasonably. In childhood, a balanced diet should be taken to avoid overfeeding.
If there are obese parents, children’s weight should be tested regularly to prevent obesity.
Parents should encourage children to participate in outdoor sports.
Actively treat Cushing’s syndrome, hypothyroidism, growth hormone deficiency and other diseases.
Apply glucocorticosteroids, anti-epileptic drugs and anti-psychotic drugs in strict accordance with the doctor’s instructions, and do not stop, change or alter the dosage of the drugs on your own.