Overweight and obesity in children

Overweight: Body weight too high compared to body size (above the 90% percentile curve of same-sex peers; this corresponds to a BMI of ≥ 25). In Germany, 18% of school beginners are already too fat, by the time puberty this proportion rises to around 28%. Boys are at higher risk of becoming overweight.

obesity (pathological overweight, obesity, obesity): An increase in body fat beyond the normal level (above the 97% percentile curve of same-sex peers; this corresponds to a BMI of ≥ 30). According to estimates, around 6% are currently obese in Germany – and sooner or later they will have health problems.

Leitbeschwerden

At first, being overweight does not cause any discomfort. Children get used to the extra pounds.

When to the doctor

In the next few weeks, though

  • Your child to you "chubby" appears or is above the normal range of the corresponding growth curves.

The next few days, though

  • Your child is gaining weight relatively quickly and there are additional complaints such as listlessness or shortness of breath when you exert yourself.

Show background information

Problems with infants

Health problems in adolescence

The illness

The development of the fat body in children

Children start their lives with a fat mass of around 11% of their body weight, which increases to 25% by the end of the first year (puppy fat). This fat gain is genetically programmed.

The following phase of the is also programmed Regression of adipose tissue, until the age of about 5½ years. At the end of kindergarten, the BMI has reached its minimum – at this age, children should be slim. Only at the end of the 6th year of life the fat mass slowly increases again (so-called adiposity rebound) and then decreases with puberty – v. a. in girls – strong too.

root cause

Obesity arises – even in children – if the energy balance is positive in the long run. This means that the child consumes more energy on average each day than it consumes.

There are small differences: Eat or drink an additional 100 calories a day, that’s just 100 g of yoghurt, this excess is reflected in an additional 10 kg body weight in a year. But this creates this positive energy balance?

Risk factors for obesity

For most overweight children, various unfavorable circumstances come together, so-called risk factors. These include:

heredity. Children whose parents are also overweight are at high risk of becoming overweight. Not only do they work "Gene", but also usually social factors that affect the child through the parents.

Early mintings. In part, the overweight of children can be traced back to early imprints. The first course for later overweight may already be set in the womb:

  • The prenatal programming of the metabolism is likely to play a role: Children who are undersupplied in the womb have a long-term metabolism "saving mode" around. Because of this economical calorie consumption they are more often overweight in the womb.
  • Maternal smoking during pregnancy also significantly increases the later risk of obesity.

Baby food. There is evidence that feeding with baby milk favors overweight: So the body weight is from "bottles of children" compared to breastfed children at the end of the first year of life up to 650 g higher. This is explained by the fact that children who are not or only partially breastfed consume 20% more calories compared to fully breastfed children. Breastfed children are not only less at risk of later overweight in childhood, they are also less prone to allergies.

However, as a US study shows, not every baby food promotes fatness. Rather, weight problems depend on whether the babies receive food from dried cow’s milk or from hydrolyzates, i.e. H. from crushed proteins. Especially hydrolyzed milk is fed to infants with a lactose intolerance. But it is also suitable for all other babies, since it prevents excessive weight gain and thus overweight. The reason: the intestine utilizes hydrolysates better than cow’s milk proteins and thus ensures an early feeling of satiety. As a result, infants fed hydrolyzate milk in the study also increased much more slowly than babies fed cow milk.

lack of exercise. The increasing lack of physical activity among children is clearly reflected in fitness examinations: in 1995, Berlin schoolgirls could still jump an average of 3.10 m in 1995, but 4 years later it was only 2.78 m. The boys are not inferior: 10-year-olds, who in 1970 made an average of 1150 m in a 6-minute sprint, can not even make it to the 900 m mark today. According to recent studies, the lack of exercise begins very early in infancy.

eating. Compared to adults, lack of exercise plays a greater role than overeating in the development of overweight in children, but this statement is scientifically difficult to confirm. The fact is that the portion sizes in the commercial food supply have increased significantly and that over half of the young children regularly consume too low-calorie and too sweet children’s food (e.g. fruit gnomes or chocolate pudding). Especially fast food outside of the house consumed, the risk of becoming overweight increases more than in a household in which regular eating is carried out. This food culture very often reflects the relationship culture in the family – which explains the clear influence of the social background.

Social causes. When asked why children move less today, the implicit question of guilt always resonates. A lack of exercise often has nothing to do with conscious decisions, but is at least partly due to changes in the living environment. The fact is that children’s lives today are stronger isolated (fewer partners in the immediate vicinity), verinselt (Friends are not within walking distance) and entstraßlicht (there is no road as a leeway). In addition, there are no important movement routines for children (e.g. going to school). At the same time, attractive but sedentary leisure activities such as television, cell phones and computer games are available.

Obesity primarily affects a high-risk group of children from socially disadvantaged families and immigrant families. Studies have shown that boys and girls from socially disadvantaged families are three times as likely to be obese as those with high social status. Interestingly, the (over) weight of older siblings also has a measurable influence on getting fat.

sleep. Too little sleep is also associated with being overweight in children and adolescents: every additional hour of daily sleep is said to lower the BMI by 0.48.

Physical causes. Very rarely, obesity in children is based on physical causes such as:

  • Hormonal imbalances. These include slowing down the metabolism due to an underactive thyroid (hypothyroidism) or overactive adrenal cortex, in which too much cortisol is formed, which prevents fat accumulation. a. on the trunk.
  • Hereditary diseases. Occasionally, diseases such as trisomy 21 or Prader-Willi syndrome and / or medications such as neuroleptics, antidepressants and insulin) lead to weight gain.

diagnosis

Measure and weigh. There are different ways to judge whether a person is overweight or not. However, this is more difficult to determine in children than in adults. The simple calculation with weight and height (so-called body mass index, BMI) as with adults is only suitable to a limited extent. Since children go through various development phases in which physical abundance is normal (baby fat), in addition to height and weight, age and gender must also be taken into account. For this reason, special curves (percentiles) that include both height and weight, but also the age of the child.

As with adults with obesity, the doctor first excludes diseases as possible causes and examines the child for existing damage.

Examination of blood, blood lipids, blood pressure and blood sugar levels. Is the diagnosis "overweight" or "obesity" blood pressure and some blood values ​​are checked on an empty stomach (cholesterol, HDL / LDL cholesterol, triglycerides, glucose and liver enzyme) in order to identify secondary diseases at an early stage.

treatment

There is currently no answer as to when therapy is advisable for an obese child. Long-term, d. H. Successes lasting over 3–5 years have so far not been reliably proven. It is also not known whether the therapy is of no use or maybe even harming – possible disadvantages of the almost always failing weight loss on the emotional development of the child are not excluded. The health insurance companies currently only reimburse the costs of therapy in extreme cases as well as additional risk factors or illnesses.

treatment goals. It is of little help to children on a diet or to cut out certain foods. For children who are still growing, it is usually sufficient to maintain body weight, improve physical activity and nutrition, and prevent complications from being overweight and obese.

therapy

  • About 1.2% of the approximately 1,000,000 obese children in Germany are currently in outpatient therapy programs treated. Such therapy programs have not been available for children under 6 years of age.
  • Warnings about diets must be made; they fail in most adults. In addition, it has been scientifically proven that children who repeatedly fight their excess weight with diets have more frequent eating disorders such as bulimia or anorexia and overall gain significantly more weight .
  • Medications and formula diets have so far played no role in the therapy of childhood overweight.
  • Operative therapy: It has been proven that overweight surgery is also effective in adolescents; however, complications cannot be ruled out. Banding of the stomach (gastric band) is only possible in older adolescents with severe obesity and also assumes that the other treatment approaches have been unsuccessful. The gastric band considerably limits the gastric filling capacity; a feeling of satiety occurs more quickly. In this country, gastric bypass, a gastric reduction, is used as the surgical method. In comparison to the gastric band, a higher weight reduction is made possible, and a follow-up operation is less necessary.

forecast

Overweight children usually remain overweight as adults. Estimates assume that approximately 75% of all children aged 10–11 years have a BMI > 23, are obese even in adulthood.

Overweight and obesity have the same long-term consequences in children as obesity in adults, some damage occurs already in childhood. The earlier the obesity begins, the more serious are the subsequent complications:

Diabetes mellitus. At least a third of obese children have disorders in their sugar metabolism, 1% already have type 2 diabetes.

Psychosocial stress. Psychological problems and behavioral problems such as eating disorders (anorexia nervosa and bulimia), depression and low self-esteem are also more common in overweight children (the causal relationship, however, is not established as in adults)..

Disorders in the hormonal balance. The first menstrual period occurs earlier due to the increased estrogen production in the adipose tissue, cycle disorders are common. The length growth in obese children also often accelerates strongly (since it comes to a standstill earlier, the final size is approximately the same).

Wear and tear on the musculoskeletal system. Signs of overload appear early on the skeleton, v. a. a detachment of the growth plate of the femoral head (growth plate) and a growth disorder of the shins with the formation of bow legs. Suffer additionally Overweight rather under back pain as well as lowering, spreading and flat feet.

Cardiovascular disease. Obesity increases cardiovascular risk factors and thus increases the risk of cardiovascular diseases such as stroke, heart attack and narrowing of the blood vessels (arteriosclerosis) in adulthood.

inflammation. In very overweight people, inflammation easily develops between the skin folds (oozing eczema).

Obstructive sleep apnea syndrome. The risk of breathing interruptions during sleep (apnea) is increased in overweight teenagers.

The pharmacist recommends

What you can do as parents

Idol.

Measures against obesity should be taken before and during pregnancy and in infancy if possible, but at the latest in kindergarten. Because children learn primarily from their parents and see exactly what they are doing! That means: Parents have to set a good example, because they determine the rules in everyday life with which the children grow up. This includes, for example, the balanced composition of the meal plan, keeping meals together with the family – in peace and without interference from a cell phone, PC or running TV! -, the frequency and type of snacks, but also health-promoting physical activity. The aim is to make a healthy lifestyle attractive and to teach children how to use food naturally and their own bodies. The parents and older siblings are an important role model.

Accept.

One problem that should not be underestimated is the perception of parents: While society is increasingly focusing on child overweight, parents seem to be sitting in a kind of perception trap and do not perceive the overweight in their children. For example, only 10% of mothers in studies underestimate their own weight – while almost 30% underestimate that of their children .

lifestyle.

If you want your child’s weight to change, everyone in the family must participate in the process, which means your child doesn’t have to change their lifestyle on their own. After all, everyone benefits from a healthier lifestyle.

Move.

Help your child exercise regularly and a lot. You have many boundary conditions in hand:

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Christina Cherry
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