Update: October 2018
- Obesity and overweight – is there a difference?
- The reasons
- The clinical picture of obesity
- Consequences of obesity
- Question answer
Every year the number of children whose body weight increases
significantly higher than normal. Obesity in children and adolescents
spread all over the world, in the USA every second child
there is overweight, and the diagnosis of “obesity” is set 20
children from a hundred. AT России показатели веса у детей несколько лучше, но
make you think: about 15-20% have excess
body weight, and in 5 – 12% – obesity. And in 8 – 9% this
disorder registered in children living in the city that
associated with less physical exertion and poor nutrition
(preservatives, dyes, flavor enhancers). Obesity in children
age is a serious problem that requires action
due to the fact that 60% of adults have obesity “come from childhood”.
Obesity and overweight – is there a difference?
The term “obesity” means chronic disorder.
metabolism, which is characterized by excessive accumulation
adipose tissue, as a result, the patient’s weight significantly exceeds
age and constitutional features. In this way,
obesity is a disease that develops on admission to
organism of “excess” energy (food) exceeding it
energy consumption. A child is obese if mass
his body exceeds by 15% and more than the age norm, and the mass index
body (BMI) is equal to / greater than 30. This exchange violation
predisposes to the development of diseases of almost all organs and
Ofлишний вес еще не является болезнью, но при отсутствии мер
fighting it threatens to go into obesity. Overweight is said
when habitual clothes suddenly ceased to converge in buttons,
�”Bursting at the seams” or just does not fit. That is, overweight is
aesthetic defect that is a few extra
kilograms that interfere with life.
Body mass index
Body mass index (BMI) разработан бельгийским ученым и
allows you to assess the ratio of a person’s weight and height, that is,
Does body weight fit? Used to determine
obesity, underweight or when prescribing drugs for
The BMI is calculated as follows: human mass (kg) / (height
(m) * height (m)).
|BMI||Risk of disease||Power|
|25 – 29||Elevated||Ofбыточный вес|
|30 – 34||ATысокий||1 degree|
|35 – 39||Very tall||2 degree|
|40 and more||Diseases are available||3 degree|
The reasons ожирения у детей разнообразны и многочисленны, но в
the occurrence of the disease plays a role interaction of heredity and
external factors. Predispose to the occurrence of obesity
- Poor nutrition
Lack of strict (by the hour) diet with constant
snacking, neglect of homemade food, preference for fast food,
semi-finished products, crackers and nuts. Excessive consumption
sweets (contain easily digestible carbohydrates): packaged juices,
sweet carbonated drinks, chocolate and confectionery. Also
obesity contributes to a large daily calorie intake,
overeating, which leads to a glut of energy.
- Attitude to food in the family
The child adopts the behavior of the elders who created the cult of food
(for example, in a family it is customary to cook in large quantities
high-calorie meals). AT результате родители начинают уговаривать
child to eat supplements, punished for the uneaten portion, encourage
every meal with sweets or, on the contrary, forbids him
consumption, which leads to protest and an increase in eaten
prohibited food until adults see.
Sedentary lifestyle, lack of exercise,
replacement of active games in the open air with computer or viewing
TV, exemption from physical education lessons, refusal to visit
sports sections lead to the accumulation of calories and deposition
- Psychological problems
Inferiority complex and chronic stress cause problems
in dealing with parents and peers, academic failure, difficult
parental relationship, unhappy love. ATсе эти проблемы дети,
especially adolescents prefer to “jam” with an extra chocolate bar
bag of chips or nuts.
- Genetic predisposition
If both parents have obesity, then in 80% of cases
child will have a similar disorder. With obesity only
mother’s risk of development is 50%, and for father’s obesity –
- Acquired and genetic diseases
Obesity is often observed in children with genetic pathology.
(синдром Дауна, Коэна, Прадера-ATилли), с заболеваниями эндокринной
systems (Cushing’s syndrome, congenital hypothyroidism,
adipose-genital dystrophy), brain damage
(meningitis, encephalitis, consequences of TBI, brain surgery,
To provoke the development of obesity can problems that were present in
infancy and birth:
- Big weight at birth (4 or more kg);
- Excessive monthly weight gain;
- Artificial feeding (high-calorie mixes);
- Overfeeding a child;
- Violation of the rules and timing of the introduction of complementary foods;
- Smoking mother in the gestational period.
Pathogenesis of obesity
The mechanism of obesity is one, regardless of the cause.
The intake of large amounts of food in the body leads to
hyperinsulinism. ATыработка инсулина в значительном количестве –
This is a compensatory response aimed at tissue absorption.
body extra carbohydrates. Under the influence of insulin develops
hypoglycemia that causes hunger. Ofбыток энергии, поступающей
along with fatty foods, it accumulates in the cells of adipose tissue,
causing their hyperplasia, and, accordingly, an increase in body weight.
An increase in adipose tissue is accompanied by a change in work.
hypothalamus. Synthesis of adrenocorticotropic hormone increases, which
forms hypercortisolism and disrupts nuclear sensitivity
hypothalamus to the signals of saturation, hunger and others. Hyperinsulinism
leads to the frequent development of hypoglycemic conditions (hunger),
which creates a vicious cycle of obesity: hypoglycemia – hunger –
saturation (overeating) – hyperinsulinism – hypoglycemia –
Given the causes of the disease, there are 2 forms of obesity in
- exogenous constitutional due to genetic
predisposition (inherited not overweight, and features
metabolic processes in the body);
- alimentary, due to poor nutrition.
- exogenous constitutional due to genetic
- ATторичное (следствие врожденных и приобретенных патологий):
- endocrine (sclerocystic ovary, hypothyroidism, diseases
adrenal glands – Itsenko-Cushing’s disease);
- gene disease obesity;
- cerebral (diseases, injuries and tumors of the head
- medication (hormones, anabolic
- endocrine (sclerocystic ovary, hypothyroidism, diseases
Obesity, developed due to nutritional errors, is often
appears in children in critical phases of development:
- early childhood (from one to three years) – period
- preschool age (from 5 to 7 years) – the period of secondary
- puberty (12 to 17 years) – serious
hormonal changes that can trigger exchange
The degree of obesity in children:
- 1 degree – вес ребенка больше нормы на 15 – 29%;
- 2 degree – вес ребенка больше нормы на 25 – 49%;
- 3 degree – масса тела ребенка больше нормы на 50 – 99%;
- Grade 4 – the child’s weight is 2 times normal (100%).
AT 80% случаев ожирения среди детей преобладают 1 и 2 degree
The clinical picture of obesity
The clinical signs of the disease depend on the age of the child. AT
different age periods the clinical picture of obesity happens
different. Note that all symptoms of the disorder
appear on the rise, at a new stage of life, signs of illness
getting brighter. The main symptom of this pathology is
an increase in the subcutaneous fat layer. Obesity in a child under one year old
accompanied by the following symptoms: developmental delay
motor skills (late starts to hold the head, sit down,
get up), predisposition to allergic reactions and constipation,
reduced motor activity, frequent colds infections.
Nutritional obesity is accompanied by the deposition of fat
accumulations in the abdomen and thighs, in the pelvis, back and chest,
which manifests itself in the form of dangling fat folds, obese face
(double / triple chin, swollen eyes, overhanging cheeks) and
upper extremities (numerous waistings). In children –
schoolchildren join the increased body weight: shortness of breath, poor
exercise tolerance, increased blood pressure. Have
quarters of children at puberty are diagnosed
metabolic syndrome, including in addition to obesity,
insulin resistance, arterial hypertension and dyslipidemia
(blood triglyceride imbalance). Also ожирение может
accompanied by a violation of the metabolism of uric acid and
ATторичное ожирение сочетается с проявлениями основного
diseases. In obesity caused by congenital hypothyroidism,
acquisition of motor skills comes late (keep
head, sit down, get up), terms of teething too
are shifting. When acquired hypothyroidism (diagnosed in
adolescents as a result of iodine deficiency) obesity is combined with
weakness and fatigue, drowsiness, dryness and flaking of the skin,
violation of the rhythm of menstruation, declining performance.
Itsenko-Cushing syndrome (cushingoid obesity): fatty
accumulations are deposited on the neck, face, abdomen, while
limbs remain thin. Have девочек в периоде полового созревания
hirsutism and amenorrhea appear.
AT случае возникновения ожирения на фоне пролактиномы (опухоль
pituitary gland) an increase in the mammary glands (gynecomastia) is observed,
galactorrhea, headache, and girls have menstrual disorders
cycle. When sclerocystic ovaries in addition to obesity in girls have
place acne, increased oily skin, menstrual failures
cycle (oligomenorrhea and amenorrhea), excessive hair growth.
Adipose-genital dystrophy in boys is accompanied by
cryptorchidism, obesity, underdeveloped penis, and in girls
Consequences of obesity
Obesity not only affects the appearance of the child, which leads to
the formation of his inferiority complex, the appearance of difficulties
adaptations in the outside world, difficulties in communicating with people
social exclusion, but also provokes the development of a large number of
somatic diseases and reproductive disorders
The higher the degree of obesity, the greater the risk of disability of the child
and premature death. The likelihood of developing pathology increases
cardiovascular system (hypertension, angina pectoris,
heart failure and atherosclerosis). Obesity affects
condition of the digestive tract with the subsequent formation
pancreatitis, gastric ulcer and duodenal ulcer,
gastritis, cholecystitis, gallstone disease, fatty hepatosis
liver, hemorrhoids, chronic constipation.
Also, overweight children are at high risk.
on the development of insulin-dependent diabetes, thyroid diseases
glands and adrenal glands. Significant excess weight in childhood
reflected on the musculoskeletal system and contributes to
skeletal deformities, poor posture, flatfoot, valgus
(X-shaped) deformities of the legs, pathological fractures and
the development of osteoporosis (disrupted the formation of bone
Sleep disturbances occur: sleep apnea (respiratory arrest),
snore. The mental state of children suffers, they have noted
tendency to depression and deviant behavior, bulimia and
anorexia, drug addiction and alcoholism. In the future, these children
significantly increases the likelihood of malignant
Diagnostics ожирения и определение его степени включает изучение
history, type definition (mixed, artificial or
natural) infant feeding
today, the level of physical activity. Baby examination
includes the measurement of height and weight, waist and hip circumference, counting
BMI. All indicators are compared with special tables (norm
weight ranges from 25 – 50 – 75 centiles) and set
overweight or obesity. When conducting a mass inspection
apply the method of measuring the thickness of the skin fold.
In the diagnosis of obesity in order to determine its causes are involved
adjacent experts: children’s endocrinologist, neurologist,
gastroenterologist, geneticist. Additionally assigned laboratory
analyzes: blood biochemistry (sugar, glucose tolerance test,
cholesterol, triglycerides and lipoproteins, total protein and liver
samples, uric acid), hormones (thyroid-stimulating hormones, insulin,
prolactin, cortisol, estradiol). If necessary, carried out ultrasound
thyroid gland, electroencephalography, MRI of the pituitary gland.
Treatment ожирения у детей преследует следующие цели:
- weight loss;
- concomitant pathology therapy;
- maintaining reduced weight;
- prevention of weight gain.
First of all, the doctor must determine the cause of obesity, after
what for the child is selected individual treatment, which
includes the normalization of nutrition and the appointment of a therapeutic diet, therapeutic
physical education, if necessary, therapy with drugs and
(according to indications) surgical treatment.
A diet for a child is developed by a children’s nutritionist. Purpose
therapeutic nutrition is the inhibition of the formation of fat
sediments and stimulation of the destruction of accumulated sediments. Important
take into account that adherence to a therapeutic diet for three-year-olds and younger
contraindicated. Medical nutrition for obesity should be
diverse and balanced and include the following principles:
- Fractional nutrition
The child should eat often, up to 6 – 7 times a day, but
in small portions, with breaks between each meal not
more than 3 hours.
- Food processing
For younger children, food is boiled, steamed,
stew or bake (without crust). Older children are allowed occasionally
eat fried foods.
- Salt restriction
Exclude from the diet all pickles, pickles, smoked meats, fast food
and a variety of snacks (chips, nuts, crackers). Also limit
the amount of salt is up to 5 grams per day. Consumption of salty foods
causes thirst, and the intake of large amounts of fluid provokes it
delay in the body (edema).
- Fluid intake
Strictly abandon the use of sweet carbonated
drinks, packaged juices and nectars, replacing them with unsweetened
teas, herbal decoctions and freshly squeezed juices without sugar.
- Calorie distribution of food
Basic nutritious meals (meat, fish, poultry) should
consume in the first half of the day when physical activity
child high. The last meal should be no later than
3 hours before sleep (maximum at 19.00).
- Increased plant fiber
Vegetables, berries, fruits and a variety of greens the child should eat
without restrictions and in any form (raw, stewed, boiled). Of
fruits are not recommended sweet fruits: bananas, pears, persimmon,
figs, dates, grapes.
List of allowed products:
- lean meat, fish and poultry;
- low-fat dairy products, cottage cheese;
- boiled eggs;
- cereals: millet, buckwheat, barley, pearl barley, oats.
- wholemeal bread.
List of banned products:
- muffins, culinary products, cookies;
- White bread;
- semi-finished products and sausages;
- jam, raisins, honey, candy;
- chocolate and cocoa;
- spices and spices (increase appetite).
The doctor will appoint the child to exercise classes, which should be held
daily at least 60 minutes. Also, obese children need to
take walks regardless of the weather, participate in
outdoor games, swimming, riding
bike ride. Optimally write the child in the sports section.
Parents should introduce the notion of “violation of the regime” when
the child could not resist and ate the forbidden. As punishment
physical exercise required (10 squats, 5
pushups and so on). An effective method to combat excess
Weight is massage, which stimulates metabolism, improves
blood flow and lymph flow, normalizes muscle tone.
Drug and surgical treatment
Receiving drugs and dietary supplements for weight loss is not
recommended for children under 15 years old. With grade 3 disease possible
the appointment of orlistat and metformin under the supervision of a physician. how
An alternative to drug treatment is physiotherapy:
heliotherapy, hydrotherapy, mud therapy and more. Surgical
the correction is applied in extreme cases (the child’s weight exceeds
rate of more than 100%).
ATопрос: how должна проводиться профилактика
obesity in children?
Prevention of the development of the disease should begin in the period
gestation (nutrition, rejection of bad habits). AT
adolescence observe the rules and timing of the introduction of complementary foods,
keep breastfeeding as long as possible. Do not force
the child to eat up his portion, abide by the diet, not
increase its calorie content. You should also limit the number
animal fats and fast-absorbing carbohydrates (baking,
sweets), stimulate the child to maintain an active lifestyle
(games, sports sections, walks, hikes).
ATопрос: Можно ли ребенку устраивать разгрузочные
If the child is under the age of 10, from
Experiments better refrain. Older children can
stick to the meat and vegetable fasting day. For 300 – 350 grams
low-fat beef or chicken should be taken 600 – 1000 grams
fresh vegetables, such as cabbage. ATсю пищу разделить на 6 частей и
eat during the day, drinking plenty of fluids (herbal
teas and decoctions).
ATопрос: Чем можно заменить для ребенка сладости
Of course, fresh, but savory fruit. Infrequently, you can indulge
baby marshmallows (contains pectins), jelly and jelly.