Obesity: complications in kids

Globally, more than 22 million children younger than five are currently suffering from obesity, according to Dr Ilse Kerr, who recently spoke at a workshop on obesity.

In school-going children, this figure increases to 155 million. It is also estimated that by the year 2020, half the girls and a third of all boys in the world will be overweight.

These statistics are most disturbing and, translated into everyday life, they imply that if you have two children, one of them is destined to be overweight or obese.

Risk factors
Risk factors that predispose children to overweight or obesity are high birth weight (in excess of 4 kg) and parental obesity.

Children with one or more parents or siblings that are overweight are at much greater risk than children in families that are not obese. Dr Kerr pointed out that this burden of risk is a combination of genetics and environmental factors.

If your parents are overweight, then you may have a genetic disposition to obesity. On the other hand, families with obese members may be inclined to overeat and to have the attitude that food is a source of love and comfort, thus encouraging children to overindulge.

Metabolic complications
Children who are overweight or obese may develop just as many complications as obese adults. We tend to think that children will grow out of their puppy fat and that this will not have any negative consequences on their future lives, but research shows that this is not true.

More than 60% of obese children between the ages of five and 10 years already have at least one risk factor for developing coronary heart disease, while 25% have two or more risk factors.

Forty-five percent of all newly diagnosed type 2 diabetics are children. In the past, type 1 or insulin-dependent diabetes mellitus was the most common type of diabetes in children. This is no longer the case. With the exponential increase in obesity, even young children are being diagnosed with type 2, or what used to be called "age-onset", diabetes.

Most people would not believe that children can develop gallstones (also a disease that was always classified as a disease of the over-40s), but more and more obese children are being treated for gallstones.

Poor prognosis
The prognosis for children with obesity is also not good. It has been calculated that if an individual is obese before the age of eight years, the chances are good that he or she will have a BMI of 41 (gross obesity) as an adult.

And if 50% of children are overweight or obese by 2020, then 50% of the adults they will develop into will be grossly obese.

Who should be treated?
Dr Kerr stated that all children between the ages of two and six years whose weight exceeds the so-called 95th percentile for age should be intensively treated.

In addition, all children with a BMI exceeding the 95th percentile should also be treated, because by the age of six there are only two years left before these children reach the dangerous age of eight, which will doom them to gross adult obesity.

Treatment
Treatment of the obese or overweight child should consist of a multi-pronged attack:

  • Control of the child's environment – the entire family should eat low-fat, healthy food and no high-energy foods or beverages should be available in the home or at school. This is one of the most difficult aspects of treatment, especially in what dieticians call 'food-dysfunctional families'. No child will lose weight in a family that has cupboards full of junk food, or where the children are given pocket money to buy as much food as they want at the school tuck shop, or where take-aways are staple fare.
  • Monitoring of the child's behaviour – this is also difficult and parents may come up against a lot of opposition, particularly in the form of peer pressure.
  • Rewarding successful changes in behaviour – children who achieve even modest goals of weight loss or increasing their activity levels should be given as much encouragement as possible (of course not in the form of sweet treats, but perhaps rather by taking them for an outing, or buying them new clothes or toys).
  • Increasing physical activity – this is probably the single most important factor that can aid weight loss in children. Encourage your child to be more active, not to sit in front of the TV or computer for days on end, take her for walks so that she can exercise in safety. Get those kids moving.
  • An early intervention, like breastfeeding, may play a more important role than was previously suspected. Breastfed children are less inclined to become overweight than bottle-fed babies, so there is one great gift all mothers can give their children and that is to breastfeed them as long as possible – at least for the first six months of the child's life.
  • Pharmacological interventions – this is an aspect of treatment that is still not fully researched. Most of the weight-loss medications that can be used in adults (Xenical, Reductil etc.) have not been extensively tested in youngsters. The rule is that only teenagers with a BMI exceeding 40 and who have stopped growing, should be considered for pharmacological interventions in obesity.

If you have a child that is struggling with overweight or obesity, the first step should be to consult a clinical dietician, so that the child can be assessed, a diet can be worked out for him or her (one that assists with weight loss but still permits normal growth), and the child's progress can be monitored.

The dietician will also suggest solutions to help your child become physically active. As a parent, you need to do your bit by preparing the child's diet, keeping high-energy foods out of the house, monitoring her progress and encouraging her every step of the way. – (Dr Ingrid van Heerden, DietDoc)

Any questions? Ask DietDoc.

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