Description
Obesity among children has reached pandemic proportions in both developed and developing nations. Childhood obesity and being overweight are known to negatively affect both physical and mental health. Children who are overweight or obese are more likely to be overweight into maturity and to experience non-communicable diseases like diabetes and cardiovascular disease earlier in life. It is thought that obesity is an illness with several underlying causes because the process underlying its development is not entirely understood. The global rise in obesity prevalence is mostly due to environmental variables, lifestyle choices, and cultural context.
Summary Listen
- Obesity in children and adolescents is a critical public health concern, characterized by excess body fat. It's defined using BMI growth charts, with overweight being above the 23rd adult equivalent and obesity above the 27th adult equivalent, according to IAP charts. While BMI is commonly used, it has limitations as it doesn't account for lean mass and ethnic differences. Central adiposity, measured by waist circumference, is a better indicator of obesity-related risks.
- Globally, obesity rates have tripled, with developing countries bearing a significant burden. India has the second-highest number of obese children globally, with prevalence ranging from 15-25% across socioeconomic strata. This rise is linked to increased availability of processed foods and sedentary lifestyles. Obesity is also considered a form of malnutrition due to deficiencies in essential nutrients despite high caloric intake.
- Exogenous obesity primarily results from an imbalance between energy intake and expenditure, influenced by environmental, biological, genetic, and behavioral factors. Predictive factors include parental obesity, over-nutrition during infancy, and catch-up growth in IUGR babies. Lifestyle and diet choices, particularly excessive consumption of sugary beverages, packet foods, and screen time, contribute significantly. The COVID-19 pandemic exacerbated the issue due to disruptions in routines and increased screen time.
- Classifying obesity involves differentiating between physiological (exogenous) and pathological causes. Pathological causes include endocrine disorders, monogenic or genetic syndromes, and medication side effects. Identifying dysmorphic features, developmental delays, or sudden growth changes is crucial in suspecting pathological obesity.
- Complications of obesity are numerous, affecting various organs and systems, including the brain (pseudotumor cerebri), metabolic system (metabolic syndrome, type 2 diabetes), cardiovascular system (dyslipidemia, hypertension), endocrine system (precocious puberty, PCOS), musculoskeletal system (joint pain), digestive system (gallstones, NAFLD), and psychosocial well-being (depression). This highlights the importance of screening for risk factors like family history, ethnicity, and signs of insulin resistance.
- Evaluating an obese child involves a thorough history, including onset, duration, antenatal history, developmental milestones, family history, and dietary habits. Physical examination includes measuring BMI, waist circumference, blood pressure, and assessing for signs of insulin resistance (acanthosis nigricans), Cushingoid features, or other dysmorphic signs. Diagnostic investigations include CBC, LFT, lipid profile, HbA1c, and potentially hormone levels or imaging based on clinical suspicion.
- Management involves a tiered approach, starting with lifestyle modifications (diet and exercise). The "5-2-1-0" rule (5 fruits/vegetables, 2 hours or less of screen time, 1 hour or more of physical activity, and 0 sugary drinks) is a helpful guideline. The "plate method" encourages balanced meals with half the plate filled with fruits and vegetables, a quarter with protein, and a quarter with carbohydrates. If lifestyle interventions fail after 3-6 months, pharmacotherapy (e.g., orlistat) or bariatric surgery may be considered in eligible adolescents.
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About the Speakers
Dr Tejasvi Sheshadri
MBBS, MD Paediatrics, Fellowship in Paediatric, Adolescent Endocrinology and Diabetes
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