Q: What is obesity?
A: Obesity is body weight more than normal for that particular age, sex and height.
Q: What are the causes of obesity?
A: The primary cause of obesity in children is either due to overeating, inadequate exercise or eating disorder. Other rare causes of obesity are due to hormonal or genetic problems. Usually obesity due to overeating causes the child to be tall, though ultimately the adult height may be less.
Q: What are the complications of obesity?
A: Obesity can lead to many complications. Also, history of heart disease, hypertension in first blood relatives increases the risk of complications in the child. Obesity can lead to bowing of the legs and pain in the hip joint due to excess weight on the bones and joints. Sometimes, the child may develop severe headaches, which can even lead to loss of vision. The child may suffer from daytime sleepiness or breathing difficulty during sleep. Obese females may develop a condition called as "polycystic ovary disease" which can lead to excess hair over the body and problems with the menses. Chances of Diabetes, High BP, gall bladder disease and raised cholesterol also increases. There is increased risk of heart disease as adults.
Q: How is an obese child managed?
A: The child is first assessed for the degree of obesity. BMI (Body Mass Index- determined by weight and height) is calculated to determine the severity of obesity. The child is evaluated for the cause of obesity. An X-ray of the hands and/or the feet is taken to determine the age of the bones (bone age helps to determine the cause of the obesity). Specific tests may be required for specific genetic and hormonal conditions. A thyroid test may be done routinely to rule out decreased functioning of the thyroid gland.
Once, the child has been evaluated for the cause and complications of obesity, the treatment is initiated. The main criteria of treatment is weight control in all overweight children of 2 years of age. i.e. maintenance of baseline weight. It allows a gradual decrease in BMI as the child grows in height. For children more than 7 years of age, weight maintenance may be continued if there are no secondary complications. However if the child is severely obese or has associated complications, then weight loss is recommended. It is recommended to have a weight loss of 0.5 kg per month. The goal should be to achieve a BMI below the 85th percentile.
If weight loss is very rapid, then there are chances of developing gall bladder disease and malnutrition. Also, height may start slowing. Emotional problems may arise in the child. The child may develop eating disorders and develop low self-esteem.
No drugs are recommended for causing weight loss in children.
The family and all caregivers should participate in the treatment program. The family should be taught to monitor eating and activity in the child. The best way to achieve all this is diet modification and increase the activity level of the child. Instead of calculating the amount of calories consumed in a day, reduction or elimination of specific food may reduce the calories without making the patient feel hungry or deprived. The patient can be refrain from eating one or two high caloric foods such as biscuits, ice cream, fried foods etc. Even a 100-kcal deficit per day could lead to a 5-kg loss of weight in a year. Another way to maintain weight is to reduce inactivity. The best way to do that would be to limit television viewing to 1 to 2 hours per day.
The goal of therapy is healthy eating and activity and not attainment of ideal body weight.
Last updated on 22-10-2001