In developed societies, obesity (OB) is the most common nutritional disorder during childhood and adolescence. Considered by who as the "epidemic of the 21st century" their frequency has increased progressively in the course of the last few years in relation to poor nutritional habits and the more sedentary, being our country one that presents a greater number of cases in Europe. 13.9% Of Spanish between 2 and 24 years the children and young people is obese and 26% are overweight. It is a source of physical and psychological disorders and tends to self perpetuate itself with serious repercussions on health during adult life.
WHEN WE SAY THAT A CHILD IS OBESE?
Obesity during childhood and adolescence is defined as an exaggerated increase of weight (at the expense of fat) which can mean a risk for health, either at the time that occurs or at later ages.
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Or Through physical examination : for the identification of children and obese adults uses the body mass index (BMI) or Quetelet index. BMI is calculated by dividing body weight (kg.) by height squared (m2). The pediatrician, measured and weighed to the child in every review of health and calculates BMI. Normal BMI values for each age are collected in graphs of percentiles (same as those used to control weight and height). According to the percentile in which the child is included in the diagnosis of normal, overweight (i.e., at risk for obesity) or obesity. For example; 8 Years John weighs 35 kg. and measures 138 cm. your BMI is 18.4 = normal, 8 years Pedro weighs 35 Kg. but measures 120 cm. your BMI is 24.3 = obesity. It is a very reliable index because changes in BMI in adolescence predicted elevations in young adults and is a valid indicator of the morbidity mortality in adults.
Or Other complementary tests : on occasions, will be necessary analyses of blood, ultrasound... to rule out complications. Child with high BMI should be controlled in following visits especially if presented associated risk factors.
RISK FACTORS:
· family history: cardiovascular disease, high cholesterol, diabetes or obesity
· personal background: high blood pressure, increased cholesterol, increased BMI greater than 2 points in the previous year or existence of concern over weight with emotional or psychological manifestations related to overweight or your perception.
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WHAT ARE THE CAUSES OF CHILDHOOD OBESITY?
There are two types of obesity: the OB exogenous or nutritional (responsible for 99% of the cases) and the secondary to different diseases (some syndromes, neurological and endocrine diseases) which constitute only 1%.
The nutrition OB is an anomaly which involves genetic and environmental factors. But the rapid increase in the number of cases is due mostly to environmental factors, i.e. some unhealthy eating habits, along with a decrease in physical activity.
· Children and especially teenagers often consume foods high in fat and low nutritional value: sweet pastries, ice cream, pastry, pre-cooked products, sugary liquids (queue, packaged juice), inlay... at the same time decreasing the consumption of fruits and vegetables.
· Sedentary lifestyle, associated many times a long time watching TV, leads to a decrease in energy expenditure and favours the development of obesity. It also contributes to go to school by car or bus, not play outdoors and the hours of study or computer. In addition child primetime slots feature a high number of ads that promote the intake of fast food with low nutritional value.
WHAT IS IMPACT OBESITY ON THE HEALTH OF CHILDREN?
The OB has important repercussions on health both in children and in adolescents that will then affect adult life. The most important are:
· psychological: loss of self-esteem and body image rejection, aggravated by social rejection suffered by his own colleagues.
· orthopedic (flat feet, hips and back disturbances).
· hypertension and cholesterol increased, especially in adolescents. I.e. becomes in a population with high risk of cardiovascular disease in adulthood.
· Other: In extreme cases respiratory alterations, fatty liver, gallbladder, digestive and skin alterations alterations.
The knowledge of these alterations by parents and patients is important to raise their awareness of the importance of the problem.
TREATMENT OF OBESITY.
The treatment of obesity is complex and requires a multidisciplinary team (pediatrician, dietitian and psychologist).It is mainly based on:
1) the establishment of a proper diet
(2) increasing physical activity
(3) modify eating habits
1. Diet: In the pediatric age group have to cover all the nutrients necessary to support adequate growth, so it does not tend to be severe restrictions.
Recommended:
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· a healthy diet (Mediterranean diet), that includes all groups of foods, rich in fruit, vegetables, legumes and foods rich in carbohydrates (pasta, rice and bread) slow absorption, nuts and fish.
· avoid "snacking", respect the schedule of meals,
· perform a full breakfast
· eliminate foods high in fats of poor quality (industrial pastry, salami, butter...) remove the visible fat from the meat, Cook the chicken without skin, used for cooking olive oil, avoid the fried and breaded and increase the consumption of white fish and decrease of meat
· some children can take low-fat milk
· increase the consumption of fiber to increase their feeling of satiety (bread or pasta integral)
· avoid consumption of sugary liquids (colas and packaged fruit juices)
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Or a full breakfast made up of dairy, cereals (bread, breakfast cereals, biscuits...) and fruit, not only improves the performance at school but that prevents the consumption of less nutritious foods to mean tomorrow. It is important that parents raise children with enough time so that they can have breakfast sitting and without hurry.
Or These are recommendations General and suitable also for the population in general. The child with obesity you should follow the instructions from your pediatrician and recommended diet must identify in each case.
2. Physical exercise: increasing physical activity is a key part in the treatment. It is important that the child chooses a sporting activity that can combine with other activities between 3 and 5 times a week. It is essential that you like because if not to abandon it soon. In addition you must walk to school (if relatively close) and climb the stairs whenever possible. Decrease the hours of television, the hours of computer and video games.
3. Modification of food habits: The school, next to the family, are the educational environments of greater influence on the acquisition of healthy eating habits and lifestyles.
Teresa out Masip
Pediatrician