Obesity In Childhood

Summary

Childhood obesity is an important medical and social problem. Its frequency is increasing, its treatment more difficult, and its role as a risk factor for the development of many diseases at a later age is large. It is a pathological condition due to increased adipose tissue due to hypertrophy or fat cell hyperplasia. Childhood obesity is predominantly hyperplastic - due to increased numbers of fat cells. This explains the unsuccessful treatment and the danger of continuing for life, because fat cell hyperplasia is an irreversible process.

What causes it?

Obesity is a heterogeneous syndrome and many factors are responsible for its development, such as:

• genetic predisposition;
• nutrition;
• decreased physical activity;
• damage to the central nervous system;
• endocrine disorders;
• stress;
• social factors.

All these factors lead to the development of obesity mainly through disturbed energy balance. It results in increased energy intake and reduced energy costs.

The familial nature of obesity has been demonstrated in a number of clinical and experimental studies showing that parents with obesity are more likely to have obesity children. For two parents, the incidence reaches 80%, one for 40%, and in the absence of obesity for parents, 10%.

What are the disease changes?

The disease changes have not been fully elucidated, but the underlying causes of obesity are thought to be:

positive energy balance;
impaired fat metabolism associated with increased liposynthesis and decreased lipolysis.
The involvement of the sympathetic nervous system has also been discussed in recent years. It is reported that it affects food intake, energy storage, and its consumption.

Obesity has certain metabolic disorders - hyperinsulinemia, hyperlipoproteinemia, hyperuricemia and hyperuricuria. Hyperinsulinemia is the most characteristic endocrine symptom of obesity. Its onset is accompanied by the development of insulin resistance.

What are the symptoms?

Clinically, obesity is divided into two forms:

Primary obesity - occurs in 95% of people and is associated with increased energy intake;
Secondary obesity - is a symptom of another disease.
Obese children are characterized by:

• increased appetite;
• increased thirst;
• easy fatigue;
• decreased physical activity;
• neurotic manifestations.

Subcutaneous adipose tissue in such children is generally increased. In high-grade obesity, a fat hump is formed at the level of the seventh cervical vertebra and a fat apron of the abdomen. Boys experience gynecomastia and adipomastia, and their genitals are submerged in fat and give the impression of underdevelopment. After puberty, adipose tissue tends to gynecoid or android type distribution, as it does in adults. The gynecoid or pear type is more characteristic of the female. Subcutaneous adipose tissue accumulates in the abdomen, hips, pelvis, and thighs. The Android obesity or apple type is more common in men. In this case, the adipose tissue accumulates in the area of ​​the face, neck, shoulder girdle, chest and upper half of the abdomen.

Other characteristic symptoms are: acne, abdominal stretch marks, hips, breasts, acanthosis. The face may be facies lunata with flushed cheeks. Increased blood pressure is noted. Flat feet and X-shaped feet are a common symptom.

How is it diagnosed?

Obesity is also estimated by the body mass index, which is calculated by the formula: body weight in kilograms divided by height in square meters. In practice, the most commonly used tables are the percentage of overweight according to height and gender. According to them, obesity is divided into four stages:

• First degree - 15 - 30% above normal body weight;
• Second degree - 30 - 50% above normal body weight;
• Third degree - 50 - 100% above normal body weight;
• Fourth grade - 100% or more above normal body weight, ie, the weight is twice the normal for height and age.

The diagnosis of obesity is easy to make when it comes to primary obesity. A problem arises in the diagnosis of secondary obesity, which is combined with another disease. It is combined with significant abnormalities in growth, puberty, bone maturation, intellectual development, and other symptoms characteristic of the underlying disease. Cushing's disease, Prader-Willi syndrome, Turner's syndrome, polycystic ovary syndrome, hypothyroidism, etc. are considered as such.

How is it treated?

Childhood obesity is difficult to treat, successes are unsatisfactory and results are not lasting. Only 25% of children achieve long-term weight loss, about 25% have no change and in 50% of children, despite treatment, obesity progresses. Treatment is a combination of diet and increased motor activity.

A balanced diet with calorie reduction of up to 800 calories per day in pre-school age and up to 1000 - 1200 calories per day in school age is most appropriate. In order to ensure normal growth, sufficient complete proteins must be imported. Ultimate diets with rapid weight loss are not recommended in childhood. Weight loss medicines are forbidden in childhood. It is recommended to avoid overfeeding.

The activity should be tailored to the age of the child. The loads must be gradual, systematic and with a gradual increase in load.

How to protect yourself?

Preventing obesity involves providing the right diet and maintaining a normal body weight for the breastfeeding period throughout childhood, and is the best prevention of childhood obesity.

What are the recommendations after the diagnosis?

The prognosis of obesity depends on the onset of its development, its extent, duration and complications. The earlier its onset, the higher its degree, the worse the prognosis and the greater the risk of it remaining for life with all its adverse effects. After the diagnosis of obesity, it is necessary to strictly follow the instructions of the treating team of specialists - pediatrician, endocrinologist, nutritionist and others. Based on the degree of obesity and the age of the child, individual diet and exercise regimens are prepared to reduce weight. Treatment is extremely necessary because high-grade childhood obesity poses enormous health risks in the future.