- Obesity is a symptom complex that results from an excessive accumulation of body fat. Obesity is diagnosed when total body weight is more than 25 percent fat in boys, and more than 32 percent fat in girls. Alternatively, childhood obesity may also be defined in terms of weight-for-height in excess of 120 percent of the ideal.
- In the U.S., about 14% of children over age six and 12% of adolescents are overweight. The number of overweight children and adolescents has more than doubled in the last three decades.
- Generally, obesity usually occurs in the 1st year of life, at 5-6 years of age, and during adolescence.
- Heavier and taller than others according to age and sex
- Enlarged breasts
- Pendulous abdomen
- White or purple stretch marks on the abdomen
- The penis may appear small but it is usually normal size
- Puberty may occur early
- Menarche (onset of menstruation) may be early
- Obesity of extremities
- Relatively small hands
- Excessive eating -- overeating during early childhood and adolescence results in an increase in the number of body fat cells, as they not only increase in size but also multiply in number. In adulthood, weight loss may decrease the mass of fat cells, but not their number. Thus losing weight for adults who were obese as children becomes that much harder.
- Genetic factors -- may also play a role in determining the number of fat cells one develops as a child. Inheritance certainly plays a role. If either parent is obese, offspring will have a 30% higher risk of developing obesity. According to studies, babies born to obese mothers are less active and gain more weight by age three months, compared to babies of normal weight mothers, suggesting a possible inherited drive to gain weight.
- Parental modeling of eating and exercise -- can affect the children's weight gaining behaviors. Fifty percent (50%) of parents of elementary school students do not exercise regularly.
- Eating junk food and fried food
- Eating in front of the TV
- Frequent snacking
- Using food as a reward and gift
- Aversion to exercise, such as walking and running
- Measures of relative weight, weight-stature indices, body circumference, and skinfold thickness
- Triceps skinfold thickness more than 85th percentile for age and sex
- The body mass index (BMI) for screening adolescents for obesity, defined as weight/stature squared correlated with blood pressure, blood lipid levels, and blood pressure
- Overall body fat more than 95th percentile for age and sex
- More than 30 on the BMI scale
- Second level of screening including family history, concerns about weight, measures of blood pressure, total cholesterol level, annual incremental increase in BMI
- Physical activity and the development of healthy eating habits are the primary defenses against childhood overweight, as well as the way to reduce weight during childhood. Care must be taken in restricting diet during the adolescent period of rapid growth, however, as nutritional imbalances could result in a slow down of essential growth, with far-reaching implications for adulthood. Under 19 years of age, children should not be put on weight loss programs without monitoring by a physician.
- A comprehensive approach including physical exercise, nutrition, and behavior modification can set the stage for a lifetime of successful weight management. Such a program should include the following:
- Personalized dietary modification supervised by health care professionals.
- An exercise program that is safe, effective, and acceptable for overweight children. A graduated and easy exercise prescription, adjusted to individual capabilities, will induce more active participation and higher compliance.
- Behavioral and psychological counseling to help child understand the benefits of losing weight and how to go about it.
- Family participation and support.
- Healthy Snacking: Between-meal snacks can be part of a healthy diet as long as healthy food choices are made. Recommended snacks include:
- Sandwiches or tortillas with reduced-fat toppings
- Bagels with reduced-fat cream cheese
- Cereal with milk (fat 1 1/2% or skimmed)
- Reduced-fat cheese
- Reduced-fat crackers
- Frozen fruit bars
- Reduced-fat chips or pretzels
- Granola bars
- Brown rice cakes or whole grain cakes
- Pumpkin cakes
- Raw vegetables with fat-free dip
- Label-reading guidelines for choosing healthy snacks:
- Less than 150 calories per snack
- Low fat snacks containing less than 5 to 10 grams of total fat, of which saturated fat is less than 2 grams
- Low sugar snacks containing less than 10 to 15 grams of sugars, such as white sugar or high-fructose corn syrup
- Adopting a formal exercise program or simply becoming more active is invaluable in burning fat, increasing energy expenditure, and transforming fat to muscle. But exercise alone is not going to be enough without behavior modification and good nutrition.
- However, exercise has additional benefits. Even if body weight does not change as a result of 50 minutes of aerobic exercise three times a week, blood lipid profiles and blood pressure is significantly improved.
- Behavioral approaches need to be conducted with family support and professional counseling. Many behavioral approaches used with adults have been successfully applied to children and adolescents. Such strategies include:
- Keeping a diary on food intake and physical activity
- Taking more time to eat
- Eating less often
- Restricting eating to the dining room table (no TV, etc.)
- Using rewards and incentives for desirable behaviors
- Increased blood pressure, total cholesterol, serum triglycerides, low density lipoprotein (LDL), very low density lipoprotein (VLDL), and decreased high density lipoprotein (HDL)
- Increased blood insulin
- Emotional/psychological problems such as low self-esteem
- Social stress
- Obese adolescents have a 70 percent
higher risk of becoming overweight adults, with all the
attendant medical risks and complications of obesity, such
as high blood pressure, heart attack, and diabetes.
- The risk of becoming an obese adult
increases with the severity of childhood obesity, onset in
adolescence, and family history of obesity. For
example, an overweight 15 year old is 17 times more likely
to become an overweight adult, than a normal-weight
- More and more children are
becoming overweight nowadays due to an overall decrease in
physical activity brought about by our relatively sedentary,
modern lifestyle (transportation, television, computer
games, Internet, etc.), aggravated by a monumental increase
in the amount of high calorie foods consumed, such as fast
foods, fatty foods, and snacks. Though many obese children
are called "lazy", in fact it is their increased bulk that
makes it more difficult for them to exercise. Additional
weight acts as a deterrent to exercise by reducing stamina,
increasing stress on joints, and causing pain in the limbs
responsible for supporting the excess weight. This all
conspires to create a vicious cycle of weight gain,
inactivity, low self-esteem, and nervous, compensatory
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