Overweight in children - Christina Cherry

introduction

In recent years there has been a significant increase in overweight in children and adolescents. overweight is the most common child nutritional disorder in industrialized countries.
Studies in grade 1-4 elementary school students showed a rate of 12 percent overweight children.
According to the results of the MONICA project of the World Health Organization (WHO), every fifth child and every third adolescent in Germany is already classified as overweight. Half of these children are morbidly overweight.
A recent investigation by the conventional medical service in the Southwest Palatinate
(Rhineland-Palatinate) has shown that 20% the fourth graders are overweight.
In 9 percent of them are the signs of obesity (Obesity) pronounced. However, these are by no means special southwestern Palatinate conditions, but – as evidence in studies – representative figures for the whole of Germany.

It is expected that around 80 percent of overweight children will become fat adults. The World Health Organization therefore classified the morbid obesity as a chronic illness and experts even speak of the greatest epidemic of the 21st century.
Since obesity does not develop overnight, the first signs should be taken seriously and the children should be supported to keep their weight within the normal range. It is primarily about more exercise and healthier nutrition.
Children and young people should learn in particular that exercise is fun and healthy food tastes.
Under no circumstances should idealization of slenderness be conveyed, rather it should be about making children and young people aware of their own strengths and strengthening their self-confidence.
The treatment of overweight children is controversial.
The opponents are of the opinion that obesity grows out in old age, the children are unnecessarily burdened, eating disorder can arise, a label is put on the children and they are trimmed to the ideals of beauty in our society.
The supporters assume that the children’s psychological and physical stresses already exist in childhood and with targeted therapy concepts one would like to guarantee a long-term reduced body weight and thus a higher quality of life.

When is overweight?

Obesity is defined by an excessive increase in adipose tissue.
It is when the body weight is above the age and gender norms.
Any therapy must be preceded by medical diagnosis and body weight assessment
With the help of BMI (body mass index, body mass index) and the so-called weight percentiles, a distinction is made between normal weight, overweight and underweight. The terms overweight, obesity, obesity and obesity are often used interchangeably despite their different meanings. Obesity and obesity should not be spoken of because of their discriminatory nature.
To determine the BMI you need the child’s current weight and height.

The formula for calculating the BMI in the adult goes back to the Belgian mathematician Adolph Quetelet and reads:

Example: The child weighs 60 kg and is 1.40 m tall.
BMI = 60: (1.4 x 1.4) = 60: 1.96 = 30.6
In this case, the BMI is rounded up 31.

There is a percentile table for boys and one for girls. The age of the children is also taken into account.
The current Body mass index (BMI) is entered in the percentile table in combination with the age of the child and is read on the horizontal axis between BMI and age.
Values above the 85th percentile can be described as conspicuous and the child is overweight above the 90th percentile. Values above the 97th percentile mean there is obesity.
The fat distribution pattern is also included in the diagnosis.
A distinction is made between a female (gynoid) form, which mainly has increased fat tissue on the hips and thighs (so-called pear type) and a more male (androgenic, central, (abdominal) form, with a fat concentration especially in the abdominal region
(so-called apple type).
In adulthood, the risk of subsequent medical stress increases with the so-called apple type. There are controversial findings in children and adolescents. However, there is a risk that childhood overweight will stabilize and be maintained into adulthood .
Fat deposits in the abdominal region can be most precisely determined with the help of Computed Tomography and MRI represent.

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Causes and health effects of obesity in children

causes

Mostly there is a positive cause energy balance in front. This means that too many calories are ingested over a long period of time or too little due to a lack of exercise calories burned. Excess food energy is stored in fat deposits in the long term.
However, there are other causes of overweight. These forms make up only 5 percent of childhood obesity cases. Nevertheless, these disorders must be carefully excluded in overweight children.
A distinction is made between primary (too many calories or too little exercise or both combined) and secondary obesity. Secondary means that the overweight is due to endocrine (hormone system-related) or genetic (inherited) diseases. Medications can also cause obesity.

Endocrine causes

Endocrine (hormone system-related) causes include in particular the Cushing syndrome (including a full moon face, obesity) with impaired adrenal cortex function. There is an increased cortisol production.
This can be innate and acquired. Medication (for example, long-term use of cortisone preparations) can trigger Cushing’s syndrome.
Other endocrine causes include an underactive thyroid (hypothyroidism) or increased insulin production.
Acquired pituitary dysfunction (hypothalamus) is also possible, although very rare. This can be caused by injuries, infections or tumor growth.

hereditary diseases

There are some very rare inherited disorders associated with being overweight:

Prader – Labhart – Willi syndrome
This hereditary disease (dominantly inherited) goes hand in hand overweight, Short stature, reduced muscle tension and a mental handicap.
Bardet-Biedl syndrome
The children suffer from an intellectual disability, Retinitis pigmentosa (Based on the nervous parts of the retina up to blindness). overweight usually exists.
Alstrom syndrome
The children suffer diabetes, deafness, Retinitis pigmentosa, overweight Etc.

Genetic disposition

In twin studies, the genetic disposition as the cause of obesity has been examined in detail. Identical twins (identical in heredity), despite growing up in different living conditions, showed surprisingly similar rates of obesity.
This could prove a certain predisposition to the development of overweight. However, it is not the obesity that is inherited, but the susceptibility to becoming overweight.

Social factors

In 1997, studies in America found a link between overweight parents and their children.
The likelihood that the children will become overweight in the course of their life already increases if only one parent is overweight. Certainly, behaviors, eating habits and preferences for certain dishes also play a role within a social reference group. The role model function of the parents is of particular importance.
According to the latest study by the Federal Research Institute for Food and Food (presented by Consumer Minister Seehofer on January 30, 2008), there is a connection between high body weight and social background (education, income). For example, 35 percent of women from the lower social strata are obese. In the upper class, this share is only 16 percent.
Advertising and ideals of beauty also influence behavior in different ways. The development of `obesity is just as possible as the development of eating disorders.

Biological factors / energy balance

So far, it has not been possible to clarify clearly whether normal weight children and overweight children differ in terms of energy conversion based on their basal metabolic rate. Studies available so far deal with children who are already overweight and thus do not allow any conclusions to be drawn about the development of overweight.

Stress and emotional state

Food is often used as a substitute to suppress negative feelings and moods. Moods such as loneliness, sadness, fear, longing for love, feelings of guilt, boredom, anger, frustration, disappointment and fear of failure can trigger food intake.
Hunger takes a back seat and the natural hunger and satiety signals are ignored.
Also learned patterns such as: Eat plates empty so that the sun shines tomorrow, eat something before difficult tasks, food as a reward and consolation must be considered here.
Eating at certain usual times (without feeling hungry) also plays a role here.

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Physical activity

In fact, our children’s movement behavior has deteriorated dramatically in recent decades.
According to a long-term study by the AOK, the physical fitness of children dropped by 20 to 26 percent between 2001 and 2003 alone.
Elementary school students therefore only move an average of 1 hour a day. The rest of the time they spend at the school desk, doing their homework and spending their free time watching TV and computers.
In 1976, a ten-year-old child took six minutes to walk 1000 meters. Today it only manages an average of about 870 meters during this time.
Some toddlers already spend up to 4 hours a day in front of the TV or PC. In its Nutrition Report 2000, the German Nutrition Society (DGE) clearly points out that there is a connection between television consumption and obesity.
The reasons for this are quickly clarified: Those who move little use less energy – the result is an increase. Little exercise also means that fewer muscles are formed or even receded, which reduces the basal metabolic rate. Because fat children are reluctant to move at some point because it is getting more and more strenuous, the weight spiral begins to turn upwards.
In addition, the child’s physical development is closely linked to his or her mental development. Whenever we move, new circuits and networks form between the nerve pathways that can later be used for other services.
Children who move and romp regularly can concentrate better, attention is increased and they are more balanced.
Of course, physical activity can also be associated with a certain disposition. The natural urge to move varies from child to child. However, the role model of the parents and that of the wider social environment is much more important for the movement behavior of our children than this fact. If the parents lead the fun and joy of physical exercise and instruct the children, an important step towards normal-weight children has already been taken.

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Eating behavior and eating habits

Eating behavior, created by the role model function of parents and family, is shaped by habits. Not chewing properly, eating on the side, eating hastily, not enjoying food, eating while standing, eating while watching TV, reading while eating are the most common behaviors learned.
This also includes the so-called "snacking". It refers to eating behavior that is characterized by incessant eating on the side. These portions are usually only very small snacks, but are often high in calories and the daily energy intake quickly becomes positive.
Dietary habits and a preference for certain dishes within a family or social group are adopted.

power supply

Obesity is based on the fact that too much energy is supplied to the body or that too little energy is used. This creates a positive energy balance, i.e. the energy input is higher than the energy consumption.
The energy consumption is made up of basic metabolism (55 percent of the energy requirement), thermogenesis and the energy requirement for physical activity.
The basal metabolism is the amount of energy the body needs to maintain all important body functions. So, in complete calm.
The thermogenesis accounts for approximately 25 percent of the energy requirement. This is the process of heat generation through the "combustion" of food. Cold and food intake increase thermogenesis.
Depending on the level of activity, physical activity makes up the remaining 20 percent of the daily energy requirement

Energy requirements for children and adolescents

Average energy requirements of children and adolescents in kilocalories per day / guide values

1-4 years

Boys: 1100 kcal
Girls: 1000 kcal

4-7 years

Boys: 1500 kcal

Girls: 1400 kcal

7-10 years

Boys: 1900 kcal

Girls: 1700 kcal

10-13 years

Boys: 2300 kcal

Girls: 2000 kcal

13-15 years

Boys: 2700 kcal

Girls: 2200 kcal

15-19 years

Boys: 3100 kcal

Girls: 2500 kcal

For example, if a ten-year-old girl ate a bar of chocolate or 100 grams of chips a day she with about 500 kcal already covered a third of their daily energy needs.

Critical phases for the development of obesity

It is also possible to differentiate whether the overweight occurred early (“child-houd-onset obesity”) or late (“maturity / adult-onset obesity”).

There are basically three critical phases in the development of childhood overweight:

first year of life
between five and seven years ("adiposity rebound")
Puberty / adolescence

Medical consequences and health effects

Obesity in children not only has "aesthetic effects", it is also a chronic illness for the body and soul.

Subsequent physical stress

Even in children, obesity can lead to a number of other diseases. These risk factors are somewhat less widespread in children than in adults. The WHO classifies these consequential damages according to the probability of their occurrence.
High probability: Faster growth, stability of overweight, Dyslipidemia , increased blood pressure, cardiovascular problems
Medium probability: Disorders in sugar metabolism, fatty liver Low probability: orthopedic problems, sleep disorders, gallstones

The cardiovascular system of overweight children suffers from the extra pounds. It’s just like the child has to carry a backpack with weights around with him every day. In the worst case, permanent heart damage can occur.
About 60 percent of overweight children have postural problems, which is often expressed in stressful back pain.
Knee, hip and ankle joints are permanently exposed to large loads and arthrosis (joint wear) can develop early.
Diseases that otherwise only affect adults can also be observed in exceptional cases in overweight children. This includes the so-called sleep apnea. Because of the overweight, respiratory arrest occurs repeatedly during sleep, which can end with reflex-like startling from case to case.
As a result, sleep is not restful, the children are tired during the day, cannot concentrate, often complain of headaches and are not very productive.
Metabolic diseases are also a common consequence of being overweight. More and more affected children suffer from type 2 diabetes.

Read more on the topic: Diabetes in children

It is a type of diabetes that develops when the function of the pancreas becomes tired due to years of spikes in blood sugar.
It is no longer able to produce enough insulin to keep blood sugar levels normal. A form of diabetes develops, which used to occur mainly in older people and was therefore also called adult diabetes.
Other metabolic disorders such as fat metabolism disorders (e.g. increased cholesterol) and gout (increased uric acid in the blood) can develop. These two diseases are directly related to the excessive intake of animal fats (cholesterol) and the so-called purines from animal protein carriers.
Purines are broken down in the body, enter the blood as uric acid and are excreted via the kidneys. Increased blood lipids and increased uric acid in the blood is always an indication of a fat and high-calorie diet that contains many animal products such as meat, sausages and eggs.

Also read our article Consequences of being overweight

Subsequent psychological stress

More common than the above complications and comorbidities
the psychosocial stress of those affected.
Back pain is obvious and can be treated.
But much less noticeable but at least just as noteworthy are the, at first glance, invisible damage that the psyche can take through being overweight.
Above all, the often kinked self-esteem should be mentioned, which threatens to sink constantly due to the more or less open comments and looks in everyday life.
Overweight children and adolescents have a difficult time among their peers and, in general, also in society. They are often teased and ridiculed for their looks and have difficulty belonging.
This is not just about being fat, but also about other things that are associated with being overweight. These are prejudices such as fat are unsportsmanlike, boring, unattractive and generally do not correspond to the ideas of attractiveness.
A fat child is particularly deeply injured and unsettled when the criticism and condescension come from their own family. When parents and siblings start with statements such as: "You are too fat", "You do not get a dessert, you are too fat anyway", "Oh dear, take a look at what you look like", then even character-strengthened children will eventually become get the feeling that they are not right the way they are. You will feel more and more uncomfortable in your skin and be unhappy. Sometimes this misconception is tried to be eliminated with food and then the cycle is perfect from which it is difficult for the children to break out without targeted help.
Because of these mental stresses, serious psychological disorders such as anxiety, depression or eating disorders arise.