Pediatric Obesity

• Obesity used to be a problem in the developed world but is now a problem in Africa, including Nigeria, due to the westernization of our diets and lifestyle.
• There is a global rise in the prevalence of overweight/obesity.

• According to the WHO in 1990, 4.2% of children were overweight/obese worldwide, and by 2010, the prevalence was 6.7%.
• This is expected to reach 9.1% in the year 2020, showing an increasing trend in the number of children who are overweight and obese.
• In Africa, the prevalence was 8.5% in 2010 and is expected to reach 12.7% in 2020 (about 18 million children).
• The value is, however, lower in Asian children (4.9%).
• The prevalence of overweight and obese children in Nigeria (2007) was 13.7% and 5.2% respectively, while underweight children had a prevalence of 8.5%.
• Globally, it has been found that overweight and obesity have tripled in the last three decades.

• BMI (Body Mass Index) - weight in kilograms divided by the square of the height in meters (kg/m²).
• It is a guide to predict body fat based on height and weight.
• The definition of obesity is a Body Mass Index (BMI) that exceeds the age-gender-specific 95th percentile.
• Those whose BMI is between the 85th and 95th percentiles are overweight and are at increased risk for obesity-related co-morbidities.
• Obesity can be defined as excess body fat or adipose tissue.
• Studies have suggested that 30% fat in females and 20–25% in males constitute the level of fat to be defined as obese.

• Genetic factors
• Socioeconomic factor
• Physical inactivity
• Dietary habits
• Secondary causes also occur, such as the use of steroids in children, which can result in obesity.

Genetic factors

• Obesity tends to run in families. Such families have a low metabolism of their foods compared to others. However, it has been found that it is not strictly genetic; dietary factors also contribute.

Socioeconomic factor

• Families with a non-working parent have been found to be a contributing factor to obesity, as they consume more calories than those with working parents.

Physical Inactivity

• A lot of children are not active anymore, and the reasons include:
• Sitting in front of TV, video games, etc., for long hours; some tend to eat and munch a lot of junk foods while watching, increasing the risk of obesity.
• Many schools no longer involve children in outdoor games due to fear of physical injury and potential lawsuits.
• Fear of abuse (such as kidnapping or pedophilia) if children are allowed to play outside the home.

Dietary Habits

• Children's dietary habits have shifted from eating normal healthy meals of fruits, vegetables, and whole grains to consuming fast food and junk food due to convenience for some parents.
• Eating when not hungry.
• Consuming high-calorie, unhealthy meals before having a real healthy meal.
• Eating while watching TV or playing video games.

Secondary Causes of Obesity

• Secondary causes include the use of steroids in children, which can result in obesity.
• Other secondary causes include
• Cushing's syndrome
• Laurence-Moon-Bardet-Biedl syndrome
• Prader-Willi syndrome
• Pickwickian syndrome

• Early recognition of children at risk for overweight or already overweight is essential because family counseling and treatment interventions are more likely to be successful before obesity becomes severe.
• History should explore possible predisposing factors, associated comorbidities, and complications.
• Assess dietary and physical activity history, focusing on patterns and potential areas for change.

Physical Examination

• Collect anthropometric data, including weight, height, and calculation of BMI.
• Data should be plotted on age-appropriate and gender-appropriate growth charts and assessed for weight gain trends and upward crossing of percentiles.
• Assess blood pressure, adiposity distribution (central versus generalized), markers of comorbidities (acanthosis nigricans, hirsutism, hepatomegaly, orthopedic abnormalities), and physical stigmata of genetic syndromes (e.g., Prader-Willi syndrome).

Laboratory Studies

• These are generally reserved for children who are overweight (BMI > 95th percentile) or who have evidence of comorbidities or both.
• Useful laboratory tests may include:
• Fasting lipid profile
• Fasting insulin and glucose levels
• Liver function tests
• Thyroid function tests (if there is evidence of plateau)

Psychological Effects

• Children can become isolated and develop depression and anxiety, often due to low self-esteem from peer pressure. This may worsen obesity from reduced physical activity.
• Low self-esteem may lead to eating disorders such as bulimia and anorexia nervosa.
• Children may suffer from chronic fatigue due to poor sleep.

Physical Health Risks

• Asthma: A significant number of overweight children have asthma.
• Diabetes: Type 2 diabetes, formerly known as adult-onset diabetes, is increasingly prevalent among overweight children and adolescents. The CDC estimates that one in three American children born in 2000 will develop diabetes in their lifetime.
• This type of diabetes in the young has been dubbed ‘diabesity’. The global rise in obesity and Type 2 diabetes in children has prompted the International Diabetes Federation to call for urgent action, warning of a twin epidemic.
• Heart Disease: Early indicators of atherosclerosis, a common cause of heart disease, begin in childhood, often linked to high cholesterol and triglycerides associated with poor eating habits and overweight.
• Gallstones: The occurrence of gallstones is significantly higher in obese individuals.
• High Blood Pressure: Overweight children are more likely to develop high blood pressure, further increasing their risk of heart disease.
• Liver Problems: Obesity increases the risk of nonalcoholic steatohepatitis (NASH), also known as fatty liver.
• Menstrual Problems: Obesity may cause early puberty in girls and can contribute to uterine fibroids or menstrual irregularities later in life.
• Sleep Apnea: Overweight children are at risk for obstructive sleep apnea, a serious breathing disorder characterized by brief interruptions of breathing during sleep, which can lead to heart failure and cardiac arrhythmias over time.
• Orthopedic Problems: Obesity can cause early onset of back and knee pain due to excess weight on the limbs and back, and can lead to deformities such as tibia varus. Other musculoskeletal issues include slipped capital femoral epiphysis (SCFE).

Complications of CHildhood Obesity

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Complications of CHildhood Obesity

• The management of childhood obesity involves the whole family, not just the child, because family lifestyle may contribute to the development of obesity.
• Social support is crucial to encourage the child to lose weight.
• Parents must take the lead in helping their child reach and maintain a healthy weight, as they have the most control over their child's activities and habits.
• The child’s physician and nutritionist play a role in diagnosing, monitoring, and encouraging the child to lose weight.
• Community involvement is essential, as seen in initiatives like Michelle Obama’s ‘Let’s Move’ program, which promotes healthier meals in fast food restaurants and increased physical activity in schools.

Psychological Management

• Family support is the most important factor; the obese child should not be singled out, and the entire family should adopt a healthy lifestyle.
• Parents should encourage their child, show love, avoid criticism, and set a good example by practicing healthy habits.
• Parents should be empathetic, especially towards children who are anxious or isolating themselves from peers.

Dietary Management

• Aim for a gradual weight loss of about 1 kg per month to ensure sustainable weight management.
• Eat more fruits, vegetables, and whole grains.
• Reduce fatty meal intake and provide low-fat milk for childr

Dietary

• Families need to be counseled on age-appropriate and healthy eating patterns starting from infancy.
• Promote breastfeeding.
• Emphasize the transition to complementary and table foods for infants and the importance of regularly scheduled meals and snacks instead of grazing.
• Encourage age-appropriate portion sizes for meals and snacks.
• Teach children to recognize hunger and satiety cues, guided by reasonable portions and healthy food choices by parents.
• Children should never be forced to eat when they are not hungry, and food should not be overemphasized as a reward.
• Parents should avoid:
  • Forcing the child to eat when not hungry.
  • Insisting that the child finishes their meal.
  • Allowing the child to rush through meals.
  • Using food as a reward or source of comfort.

Physical Activity

• The importance of physical activity should be emphasized. Options include organized sports, school-based activities, or activities of daily living such as walking more, using stairs, and engaging in active play.
• Time spent in sedentary behaviors, such as television viewing and video/computer games, should be minimized.
• Television in children's rooms is linked to more screen time and higher rates of overweight, and parents should be made aware of these risks.
• Clinicians may need to help families find alternatives to sedentary activities, especially if there are barriers like unsafe neighborhoods or lack of supervision after school.

Benefits of Physical Activity in Children

• Encourages weight loss and helps maintain a healthy weight.
• Lowers blood pressure.
• Improves self-esteem.
• Strengthens bones.
• Reduces stress.
• In weight reduction, energy output through exercises should be greater than energy intake.

Good Sleep

• Scheduled sleep times help children lose weight, as poor sleep can lead to fatigue, sluggishness, and increased daytime sleepiness, contributing to weight gain.

• Cushing's Syndrome
• Laurence-Moon-Bardet-Biedl Syndrome
• Prader-Willi Syndrome
• Pickwickian Syndrome

• Weight loss in children is a result of family input, especially from parents, and the community at large.
• To prevent a younger generation with a high prevalence of chronic non-communicable illnesses, the time to act is NOW!