CHILDHOOD OBESITY: CAUSES, CONSEQUENCES AND PREVENTION - NUTRITION - 2025

The childhood obesity is a health problem characterized by excessive amount of body fat in children. Specifically, it is an accumulation of neutral fat in adipose tissue that exceeds 20% of body weight.

In turn, overweight is excess body weight for a given height from fat, muscle, bone, water, or a combination of all these factors. Overweight, obesity and the rest of the problems derived from weight are a caloric imbalance, in which much fewer calories are burned than are consumed. Factors can be genetic, behavioral, and environmental.

According to the World Health Organization (WHO), childhood obesity is growing at an alarming rate, reaching 42 million overweight children around the world. For example, in countries like the United States, it has doubled in children and quadrupled in adolescents in the last 30 years.

This worrying trend every day weighs more in a socio-economic way in developed countries and emerging powers, such as Mexico or Brazil, but fortunately these unhealthy habits can be modified.

When is there childhood obesity?

For the WHO, a person with a Body Mass Index (BMI) equal to or greater than 25 determines overweight. If the BMI is equal to or greater than 30 it is obesity. It should be noted that, although as a general rule they serve as a good meter to identify the fat problem, it is important to consider the BMI as an indication because it may not correspond to the same level of thickness for all people.

Obesity is one of the main problems of the 21st century, assuming a great determining factor in the health and well-being of those who suffer from it. In a study carried out by the DUKE-NUS Graduate Medical School in Singapore, they argued that a child with obesity from the age of 10 will entail a medical expense of around 13,000 euros more throughout her life than a child with normal weight.

It is a worrisome disease since obese and overweight children tend to remain so in adulthood, increasing the chances of suffering from cardiovascular diseases or diabetes at an early age. Also, being obese or overweight can lead to low self-esteem and depression.

These non-communicable diseases (NCDs) cause 35 million deaths per year, most of them at very premature ages. This amount could decrease significantly with the fact of fighting childhood obesity and modifying eating habits. They would not only suppose a health benefit, but also a relief to the socioeconomics of the countries.

Types of childhood obesity

According to Vague (1947), obesity is associated according to the distribution of excess fat, distinguishing two types:

• Central or visceral (android). Accumulation of fat in the trunk and abdomen. The body widens creating an apple effect.
• Peripheral (gynoid). The glute-femoral region is where fat accumulates. The body flares out creating a pear effect.
• Generalized. Difficult to distinguish it since it does not have any type of specific fat distribution.

Although there are discrepancies in the scientific community, the central and generalized fat distribution are the most frequent in children and adolescents who suffer from obesity.

Causes

Obesity and being overweight have as their main trigger the energy imbalance between the calories consumed and expended. This is mainly promoted through:

Intake of hypercaloric foods

Currently the market offers a wide variety of foods rich in saturated fats, sugars, trans fatty acids or salt, as well as sugary drinks. They are products that provide many calories but few essential nutrients for the body such as vitamins or minerals.

The ease of obtaining these products in any food establishment or the direct advertising on minors, promote an attractive market that triggers enormous consumption.

Sedentary lifestyle

Outdoor games, excursions or other physical activities have led in recent years to spending extracurricular time in front of the television, computer, mobile phone or video game consoles.

This new lifestyle in children further encourages weight problems, as well as a deterioration in their growth and health due to the lack of exercise or sports.

Hereditary history

Although it has been the subject of research for many years, it was not until 2013 when the American scientific journal International Journal of Obesity published a study in which it showed that there are up to 32 inherited genes identified as

risk factors for obesity.

Although the genetic variants discovered are few, they serve to confirm that children of obese parents are more likely to suffer from weight problems.

Consequences

There are many consequences that obesity or overweight promotes. They are usually classified into psychological or emotional or physical effects.

-Psychological or emotional effects

A society marked by appearances and aesthetics can trigger some psychological effects in obese children such as:

• Low self-esteem (undesirable physical appearance or poor athletic skills)
• Insecurity and fear of rejection
• Difficulty relating
• Bullying by peers
• Anxiety
• Depression

-Physical effects

The effects on the body of the child suffering from obesity are the most varied, although we can highlight three in particular: insulin resistance, metabolic syndrome and type 2 diabetes.

Insulin resistance

Insulin is a hormone that nourishes cells with glucose (or sugar) from food. Thanks to this process we obtain the necessary energy for our daily life.

The problem arises when these cells do not let insulin pass and glucose ends up circulating in the blood in excess. This causes damage to the body which, adding excess calories and insufficient activity, triggers diabetes.

Type 2 diabetes

Developed type 2 diabetes, it is common to suffer symptoms that alter the child's body. Some of them are:

• Frequent urination
• Persistent thirst
• Excessive hunger
• Weightloss
• Fatigue and states of irritability

-Metabolic syndrome

It occurs when obese children accumulate abdominal fat, have low levels of HDL cholesterol or “good cholesterol” (responsible for eliminating LDL cholesterol or “bad cholesterol”), have high triglycerides, suffer from hypertension and be glucose intolerant.

These problems lead to heart problems and type 2 diabetes.

-Others

Although less frequent, there have been cases in which children with obesity have developed these problems:

• Apnea. Impairment of adequate breathing during sleep. Snoring and the brief moments in which they stop breathing, cause the individual to wake up and therefore not rest properly. It causes problems with performance in school or difficulty concentrating.
• Fatty liver. It is produced by the accumulation of fats or triglycerides in the liver. Diseases such as cirrhosis can develop in an organism that does not have a healthy liver to filter the blood.
• Menstrual disorders. Obese girls reach puberty at an earlier age. This is because fat interferes with the hormones responsible for regulating menstrual cycles.
• Tibial problems. Excess weight on the tibia can prevent it from developing properly.
• Acanthosis nigricans. It is what is commonly recognized as an occlusion of the skin in certain parts of the body such as the armpits, the neck, or in other places where the skin has folds.

Cholesterol, diabetes, heart problems, high blood pressure or damaged joints are often the complications suffered by children with obesity. However, the list can be expanded as they grow, with the following pathologies being common in adulthood:

• Endocrine system. Glucose intolerance, type 2 diabetes, metabolic syndrome, effects on growth and puberty, and nulliparity.

• Cardiovascular system. Hypertension, hyperlipidemia, increased risk of coronary heart disease in adulthood.
• Gastrointestinal system. Nonalcoholic fatty liver disease, cholelithiasis.
• Respiratory system. Obstructive sleep apnea, obesity hypoventilation syndrome.
• Musculoskeletal system. Slipped femoral head, tibia vara (Blount's disease).
• Neurological system. Idiopathic intracranial hypertension.
• Skin. Furunculosis, intertrigo.
• Cancer of the breast, colon or endometrium.
• Disability

Prevention

To prevent overweight and obesity and carry out a healthy lifestyle, we must educate habits from childhood. Parents, schools, and institutions must make efforts to ensure that children avoid unhealthy diets and sedentary activities that promote obesity. Some of the recommendations for educators are:

-Healthy family eating plan, taking into account caloric needs and energy consumed. A strong breakfast, avoiding pastries, sugary drinks, gummies, pre-cooked meals or fast foods (fastfood) and increasing the consumption of vegetables and fruits are some of the recommendations of pediatricians and nutritionists.

-Search for activities for the minor or the family to stay active. Walking, cycling, skating or practicing an extracurricular sport are some of the recommendations.

-Limit the use of televisions, computers, video games or derivatives to less than 2 hours a day. Eating in front of the television is a habit that must be eradicated.

-Control of the child's weight, growth, body mass index and waist circumference. Analytical or pediatric consultations for good advice can help prevent weight problems linked to genetics.

-Sleep properly. Lack of sleep and increased food calories often go hand in hand. It is recommended that children do not have video game consoles or televisions in their room to avoid their use being prolonged at night.

-Educational centers must promote healthy eating through subjects or dining rooms and develop physical activity.

In turn, the WHO has drawn up a list of recommendations directed at the institutional level, responsible for combating this problem in children and young people:

-Development of policies that reduce the promotion of foods rich in saturated fats, trans-fatty acids, free sugars or salt in environments where children gather (schools, kindergartens, parks, family care services, etc.).

-Policies, programs and interventions to publicize the levels of physical activity to communities and the general public in order to promote its dissemination and acceptance.

Some interesting facts about childhood obesity and being overweight

-Although most cases of childhood obesity occur in developed countries, 80% of deaths related to this problem occur in low- and middle-income countries.

-Overweight and obesity rank fifth in mortality risks worldwide.

-In Greece, 45% of boys are obese or overweight.

-In the United States, more than a third of children and adolescents were overweight or obese in 2012.

-While in 1980, 7% of those under 11 years of age in the United States were obese, in 2012 they exceeded 18%.

-In 2014, in countries such as Greece, Italy, New Zealand, Slovenia and the United States, 30% or more of its child population (5-17 years) suffered from obesity or overweight.

-It is estimated that by 2017, obesity problems will cost the Mexican health service between 5.4 and 7.7 billion dollars.

-It is believed that the child population with obesity will increase to 70 million by the year 2025.

References

1. WHO (2010). Set of recommenedations on the marketing of foods and non-alcoholic beverages to children.
2. Daniels SR, Arnett DK, Eckel RH, et al. Overweight in children and adolescents: pathophysiology, consequences, prevention, and treatment. Circulation 2005; 111; 1999–2002.
3. Vague J. La differentiation sexuelle facteur determinant des formes de l´obesité. Presse Medicale 1947; 53: 339-348
4. Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of childhood and adult obesity in the United States, 2011-2012. Journal of the American Medical Association 2014; 311 (8): 806-814.
5. US Preventive Services Task Force. Screening for Obesity in Children and Adolescents: Recommendation Statement. AHRQ Publication No. 10-05144-EF-2, January 2010.