Obesity in children: a serious epidemic

DR MARDEYAH BASSIER

‘IF obesity in South African children continues to increase at the current rate, 3,91 million school children will be overweight or obese by 2025,’ according to The Heart and Stroke Foundation South Africa, in October, 2016.

Obesity in children is a serious epidemic that has gripped South Africa and the world, and has negative long-term health implications if not addressed early.

What is the definition of obesity?

Obesity is defined as excessive fat accumulation in the body.

The standard measurement of body fat is determined by the body mass index (BMI). This measures the relationship between weight and height and is used in children aged two years and older.

Weight status is categorised by BMI percentile curves (graphs) as overweight, if plotted between the 85th and 95th centile, and obese, if above the 95th centile for age and gender.

Risk factors for the development of obesity in children

The most common causes of childhood obesity are related to environmental factors, with a small number linked to genetic diseases or hormonal disorders. Environmental influences include:

High caloric intake: these include energy-dense foods, sugar-sweetened beverages (including fruit juice), high-fat foods and high-salt foods. Families are increasingly being exposed to the aggressive marketing of the afore-mentioned foods and beverages, and together with reduced exposure to sound infant and child feeding practices are engaging in unhealthy eating trends.
Sedentary lifestyle: television viewing and video games. Watching television displaces physical activity, lowers the metabolic rate and may encourage unhealthy eating practices through food advertisements and the like.
Shortened sleep: mounting evidence points to an association between shortened sleep duration and obesity through possible alterations in the hormones that are involved in the regulation of appetite. There is also a longer time period in which to ingest food if sleep duration is curtailed.

Genetic factors and hormonal disorders account for less than one per cent of all cases of obesity.

Complications associated with childhood obesity

There are many adverse outcomes related to childhood obesity but a few of the more important ones are:

Cardiovascular disease

– Atherosclerosis – this is the hardening and narrowing of arteries from plaque build-up.

It ultimately increases the risk of adult coronary artery disease.

– Hypertension – the risk of high blood pressure is three times higher in children with a BMI above the 95th centile compared to those below the 95th centile.

– Hyperlipidemia – this is manifested by an elevation of LDL cholesterol and triglycerides, and a decrease in HDL cholesterol.

Gastro-intestinal

– Gallstones – gallbladder disease should be considered in any obese child who complains of persistent abdominal pain and non-specific symptoms, such as nausea and vomiting.

– Non-alcoholic fatty liver disease (NAFLD) – most children are asymptomatic but there may be non-specific complaints, such as fatigue and abdominal discomfort.

Endocrine

– Prediabetes and Type 2 Diabetes Mellitus are common comorbidities of childhood obesity. It is thus imperative to screen for these conditions in overweight and obese children.

Orthopaedic

– Blount disease – progressive bowing of the legs which is confirmed by radiography

– Slipped upper femoral epiphysis (SUFE) – obesity is a key risk factor for the development of SUFE and is characterised by the head of the femur slipping off the femoral neck.

Measures parents can take to prevent childhood obesity

Exclusive breastfeeding for the first six months of life, followed by the introduction of complementary foods at six months
Reduce intake of energy-dense foods
Increase consumption of fruits and vegetables
Decrease sugar-sweetened beverages, and increase water intake
Maintain appropriate portion sizes and avoid adult plates
Encourage regular physical activity/ active play
Limit screen time: no TV while eating and no televisions in the bedrooms
Ensure a good night’s sleep

Childhood obesity is a serious condition and has detrimental effects on health if not addressed early.