How do I deal with obese children

Overweight and obesity in children

Overweight: Body weight that is too high compared to body size (above the 90% percentile curve of same-sex peers; this corresponds to a BMI of ≥ 25). Today 18% of school beginners in Germany are already too fat, and by puberty this proportion increases to around 28%. Boys are at greater risk of becoming overweight.

Obesity(pathological overweight, obesity, obesity): An increase in body fat beyond the normal level (above the 97% percentile curve for same-sex peers; this corresponds to a BMI of ≥ 30). According to estimates, around 6% are currently obese in Germany - and sooner or later they have to reckon with health problems.

Leading complaints

First of all, being overweight does not cause any discomfort. Children get used to the extra pounds.

When to the doctor

In the next few weeks if

  • Your child seems too "plump" or is above the normal range of the corresponding growth curves.

In the next few days if

  • Your child gains weight relatively quickly and there are also other symptoms such as listlessness or shortness of breath when exerting themselves.

The illness

The development of the fat body in children

Children start their lives with a fat mass of around 11% of body weight, which increases to 25% by the end of the 1st year (Baby fat). This fat gain is genetically programmed.

The following phase is also programmed Regression of adipose tissue, up to the age of about 5½ years. At the end of kindergarten, the BMI has reached its minimum - at this age children should be slim. Only at the end of the 6th year of life does the fat mass slowly increase again (so-called adiposity rebound) and then decrease with puberty - v. a. in girls - strong too.

root cause

Overweight occurs - even in children - if the energy balance is positive over the long term. This means that on average, the child consumes more energy every day than it consumes.

Small differences are enough: if you eat or drink an additional 100 calories more every day, that's just 100 g of yoghurt, this excess is reflected in an additional 10 kg of body weight in a year. But how does this positive energy balance come about?

Risk factors for obesity

Most overweight children are likely to have various unfavorable circumstances, so-called risk factors. These include:

Inheritance. Children whose parents are also overweight are at high risk of being overweight. It is not only the "genes" that have an effect, but also, as a rule, social factors that affect the child via the parents.

Early coins. In part, the obesity of children can be traced back to early imprints. Even in the womb, the first course for later obesity may be set:

  • The prenatal programming of the metabolism is likely to play a role: children who are undersupplied in the womb switch their metabolism to "economy" in the long term. Because of this economical consumption of calories, they are more often overweight in the womb.
  • Likewise, maternal smoking during pregnancy significantly increases the risk of obesity later on.

Baby food. There are indications that feeding with infant formula favors obesity: the body weight of "bottle-necked children" is up to 650 g higher than that of breastfed children at the end of their first year of life. This is explained by the fact that children who are not or only partially breastfed consume 20% more calories than fully breastfed children. Breast-fed children not only have an overall lower risk of later obesity in childhood, but are also less prone to allergies.

As a US study shows, however, not all baby foods promote fatness. Rather, weight problems depend on whether the babies are fed from dried cow's milk or from hydrolysates, i. H. made from crushed egg whites. Hydrolyzate milk is mainly fed to infants with lactose intolerance. But it is also suitable for all other babies, as it prevents excessive weight gain and thus obesity. The reason: The intestine utilizes hydrolysates better than cow's milk protein and thus ensures a feeling of satiety earlier. As a result, the infants who were fed hydrolyzed milk also put on weight much more slowly in the study than those who were fed cow's milk.

Sedentary lifestyle. The increasing lack of exercise in children is clearly reflected in fitness tests: while in 1995 female students in Berlin at the age of 11 were able to jump an average of 3.10 m, 4 years later it was only 2.78 m. The boys are not behind: 10-year-olds who in 1970 got an average of 1150 m in a 6-minute sprint, today they don't even make it to the 900 m mark. According to recent studies, the sedentary lifestyle begins very early in childhood.

Eating behavior. Compared to adults, when children become overweight, lack of exercise plays a greater role than overeating, but this statement is difficult to confirm scientifically. The fact is that the portion sizes in the commercial food supply have increased significantly and that over half of toddlers regularly consume food that is too calorie-dense and too sweet (e.g. fruit gnomes or chocolate pudding). If, above all, fast food is consumed outside the home, the risk of becoming overweight increases more significantly than in a household in which people eat well-balanced regularly. However, this eating culture very often reflects the relationship culture in the family - which also explains the clear influence of the social background.

Social causes. When asked why children are less active today, the implicit question of guilt always resonates. A lack of exercise often has nothing to do with conscious decisions, but is at least partly due to changes in the living environment. The fact is that the world of children today is stronger isolated (fewer playing partners in the immediate vicinity), islanded (Friends are not within walking distance) and removed from the street is (the street as a margin is omitted). In addition, there are no important exercise routines for children (e.g. the way to school). At the same time, attractive but sedentary leisure activities such as television, mobile phones and computer games are available.

Obesity primarily affects a risk group of children from socially disadvantaged families as well as immigrant families. Studies have shown that boys and girls from socially disadvantaged families are three times more likely to be obese than those of high social status. Interestingly, the (over) weight of older siblings also has a measurable influence on fatness.

Sleep. Insufficient sleep is also associated with obesity in children and adolescents: every additional hour of daily sleep is said to lower the BMI by 0.48.

Physical causes. Very rarely, obesity in children is due to physical causes such as:

  • Hormonal imbalances. These include the slowing of the metabolism due to an underactive thyroid (hypothyroidism) or the overactive adrenal cortex, in which too much cortisol is formed, which prevents fat storage. a. promotes on the trunk of the body.
  • Hereditary diseases. Occasionally, diseases such as trisomy 21 or Prader-Willi syndrome and / or drugs such as neuroleptics, antidepressants and insulin) lead to weight gain.

Diagnostic assurance

Measure and weigh. There are several ways of judging whether a person is overweight or not. However, this is more difficult to determine in children than in adults. The simple calculation with weight and height (so-called body mass index, BMI) as with adults is only partially suitable. Since children go through various development phases in which physical fullness is normal (baby fat), age and gender must be taken into account in addition to body size and weight. For this reason, special curves (Percentile curves) are used, which include both height and weight, but also the age of the child.

As with adults with obesity, the doctor first rules out diseases as possible causes and examines the child for any damage that is already there.

Examination of blood, blood lipids, blood pressure and blood sugar levels. If the diagnosis of "overweight" or "obesity" is established, blood pressure and some blood values ​​are checked regularly on an empty stomach (cholesterol, HDL / LDL cholesterol, triglycerides, glucose and liver enzymes) in order to detect secondary diseases at an early stage.

treatment

There is currently no answer to the question of when therapy is advisable to an obese child. Long-term, d. H. Successes lasting over 3–5 years have not yet been proven with certainty. It is also not known whether the therapy is just useless or even harmful - possible disadvantages of the almost always unsuccessful weight reduction on the emotional development of the child cannot be ruled out. The health insurance companies currently only reimburse the costs of therapy in extreme cases and in the case of additional risk factors or illnesses.

Therapy goals. For children, it is of little help to prescribe a diet or to cut certain foods. For children who are still growing, it is usually sufficient to maintain their body weight, improve exercise habits and diet, and prevent complications of overweight and obesity.

Forms of therapy

  • Of the approximately 1,000,000 obese children in Germany, around 1.2% are currently in outpatient therapy programs treated. Such therapy programs are currently not available for children under 6 years of age.
  • A warning must be given against diets; they fail with most adults. In addition, it has been scientifically proven that children who repeatedly fight their excess weight with diets are more likely to have eating disorders such as bulimia or anorexia and gain significantly more weight overall.
  • Medicines and formula diets have so far not played a role in the treatment of overweight children.
  • Surgical therapy: It has been proven that obesity surgery is also effective in adolescents; however, complications cannot be ruled out. Banding of the stomach (gastric band) is only an option in older adolescents with severe obesity and also assumes that the other treatment approaches have been unsuccessful. The gastric band considerably limits the stomach's filling capacity; a feeling of satiety occurs more quickly. In this country, gastric bypass, a stomach reduction, is used as the surgical method. Compared to gastric banding, this enables greater weight reduction and re-operation is less necessary.

forecast

Overweight children tend to remain overweight even as adults. It is estimated that around 75% of all children with a BMI> 23 between the ages of 10 and 11 are even obese in adulthood.

Overweight and obesity have the same long-term consequences in children as obesity in adults, some damage already occurs in childhood. The earlier obesity begins, the more serious the subsequent diseases are:

Diabetes mellitus. In at least a third of obese children, disorders of the sugar metabolism can be detected, 1% already has type 2 diabetes.

Psychosocial Stress. Psychological problems and behavioral problems such as eating disorders (anorexia nervosa and bulimia), depression and low self-esteem are more common in overweight children (the causal relationship, however, like in adults, is not certain).

Disorders in the hormonal balance. The first menstrual period occurs earlier because of the increased production of estrogen in adipose tissue, and menstrual disorders are common. The growth in length in obese children often accelerates considerably (but since it comes to a standstill earlier, the final height is roughly the same).

Wear damage to the musculoskeletal system. There is an early threat of overstrain on the skeleton, v. a. a detachment of the growth plate of the femoral head (growth plate) as well as a growth disorder of the shins with the formation of bow legs. In addition, overweight people are more likely to suffer from back pain, flat feet, splay feet and flat feet.

Cardiovascular diseases. Being overweight increases cardiovascular risk factors and thus increases the risk of cardiovascular diseases such as stroke, heart attack and narrowing of the blood vessels (arteriosclerosis) in adulthood.

Inflammation. In very overweight people, inflammations develop easily between the skin folds (weeping eczema).

Obstructive Sleep Apnea Syndrome. The risk of breathing pauses during sleep (apnea) is increased in overweight teenagers.

Your pharmacy recommends

What you can do as a parent

Idol.

Measures against obesity should take place before and during pregnancy and infancy, but no later than kindergarten age. Because children primarily learn from their parents and see exactly what they are doing! That means: Parents have to set a good example, because they determine the everyday rules with which the children grow up. This includes, for example, the balanced composition of the menu, keeping meals together with the family - in peace and without disturbing your cell phone, PC or television! -, the frequency and type of snacks, but also a healthy exercise behavior. It is important to make a healthy lifestyle attractive and to teach children how to use food and their own bodies naturally. The parents and older siblings are important role models.

Accept.

A problem that should not be underestimated is the perception of the parents: While society is making childhood obesity an increasingly important issue, the parents seem to be caught in a kind of perception trap and do not notice the obesity of their children. In studies, only 10% of mothers underestimate their own weight - on the other hand, almost 30% underestimate that of their children.

Lifestyle.

If your child's weight is to change, everyone in the family must be part of the process; that is, your child does not have to change their lifestyle on their own. After all, everyone benefits from the healthier lifestyle.

Move.

Help your child get plenty of exercise regularly. You have many boundary conditions in hand:

  • Does your child have a suitable size bike? If not, consider getting one. If price is a problem, there are inexpensive used children's bikes almost everywhere.
  • Could your child go to school and the youth group by bike - but would prefer to take the bus? Then explain that when the weather is good, the bike is "on", but when it rains or freezes you continue to pay for the bus.
  • How do you spend the vacation? Holidays with built-in movement, whether in the mountains, with the bikes or on the farm are good - the plane trip with a beach holiday is rather unfavorable.
  • Offer activities and little adventures: for kindergarten children, for example, building a snowman in winter, picking flowers in spring, cycling to the outdoor pool in summer and collecting colorful leaves in autumn. For older children, "wild" camping in unknown surroundings is always a hit.
  • Children's birthdays can also be designed with activity and adventure: Instead of sharing media, for example, scavenger hunts up to the end of 3rd or 4th grade are always a "hit" - and ensure children's faces are satisfied.

Further information

  • www.a-g-a.de - An overview of the current outpatient therapy programs is provided by the Working Group on Obesity in Children and Adolescents at the University of Witten-Herdecke.
  • www.bzga-essstoerungen.de/allgemeine-infos/zu_dick_oder_zu_duenn/ - Information portal of the Federal Center for Health Education (BZgA, Cologne): With BMI calculator for children and adolescents.
  • www.adipositas-gesellschaft.de (Guidelines section) - Website of the German Adipositas Society. V., Hamburg: Here you will find the guideline for the prevention and treatment of obesity in children and adolescents.
  • C. Graf et al .: Sedentary lifestyle and malnutrition in childhood and adolescence. Consequences and therapy options. Deutscher Ärzte-Verlag, 2006.The causes and consequences of obesity are described from an interdisciplinary perspective, along with helpful preventive measures against a sedentary lifestyle. The aim of the book is to break the vicious circle of being fat so that fat children do not necessarily become fat adults. Recommendable.

Continue reading:

Overweight and obesity in adults

Causes of Obesity

Overweight - a balance sheet problem

Authors

Dr. med. Herbert Renz-Polster in: Gesundheit heute, edited by Dr. med. Arne Schäffler. Trias, Stuttgart, 3rd edition (2014). Revision and update of the sections "Description", "Symptoms and complaints", "When to see the pediatrician", "The disease", "Confirmation of diagnosis", "Treatment", "Prognosis" and "Your pharmacy recommends": Dagmar Fernholz | last changed on at 19:57


Important note: This article has been written according to scientific standards and has been checked by medical professionals. The information communicated in this article can in no way replace professional advice in your pharmacy. The content cannot and must not be used to make independent diagnoses or to start therapy.