Obesity in children

Martina Feichter studied biology with an elective subject pharmacy in Innsbruck and also immersed herself in the world of medicinal plants. From there it was not far to other medical topics that still captivate her to this day. She trained as a journalist at the Axel Springer Academy in Hamburg and has been working for since 2007 - first as an editor and since 2012 as a freelance writer.

More about the experts All content is checked by medical journalists.

In the industrialized nations, obesity is a serious health problem among children and adolescents. Those affected usually take the excess pounds with them into adulthood - along with all the symptoms and secondary diseases that can result from being overweight. Read more about obesity in children here: causes, symptoms, diagnosis and therapy!

Overweight in children: description

In the industrialized nations, more and more people are overweight. Children are also affected: In Germany, depending on the definition, ten to twenty percent of all children and adolescents are overweight. About a third of them are actually obese (adipose). Expressed in numbers: In this country, 1.4 to 2.8 million minors are too fat and around 700,000 are obese.

Around the world, around ten percent of children between the ages of five and 17 are overweight. In Europe, every fifth child is too fat. Obesity among children is particularly widespread in the United States, where more than 30 percent of offspring weigh too many pounds.

Obesity in children: symptoms

Overweight children - depending on the extent of the excess fat deposits - suffer from various ailments. They are often less physically resilient and tire more quickly than normal-weight peers during exercise and sport. Some offspring get breathlessness and shortness of breath during sleep or even brief nocturnal pauses in breathing (sleep apnea) - especially if they are very overweight.

Increased sweating and orthopedic problems such as back pain or knee pain are also often observed in children who weigh too much. The latter is due to the fact that a large body weight puts a lot of strain on the joints in the long term (especially spinal joints, hips, knees and ankles) and accelerates their wear and tear.

Overweight children are often taller than their normal-weight peers when they enter puberty. The growth spurt that usually occurs during puberty is then less. If, on the other hand, overweight children are smaller than their peers, this should be specifically clarified by a doctor.

Obesity in children can also have emotional effects. Teasing from other children and constant admonitions from parents to eat less can be very stressful for those affected.

Obesity in children: causes and risk factors

Overweight in children can have various causes, which usually occur in combination:

Inheritance

Overweight in children often means that their parents and / or grandparents weigh too many pounds. Hereditary factors are one of several factors that determine body weight. But that doesn't mean that overweight parents inevitably have overweight children. That also depends on other factors like diet.

Large portions during pregnancy

If pregnant women regularly eat “for two”, do little exercise and put on a lot of weight or even develop gestational diabetes, the risk of the child becoming overweight later increases.

smoking

Very often obesity is observed in children whose parents (especially mothers) smoked during pregnancy. Active and passive smoking during pregnancy also harbor other health risks for the offspring, such as miscarriage and sudden infant death syndrome.

Poor diet

Diet has a major impact on the development of obesity in children, right from birth. Studies show that breastfed children do not become overweight as often as bottle-fed children.

As with adults, the same applies to children and adolescents: Those who take in more energy than they use in the long term are more likely to become overweight. In particular, the regular consumption of fast food (such as burgers, pizza, french fries), sweets and sweet drinks (soda, cola, etc.) promotes obesity in children.

Most children learn eating habits in the family: If mom and dad eat unhealthily, the offspring will take over.

Sedentary lifestyle

Sitting for hours in front of the television or computer is a major contributor to the development of obesity in children. This is all the more true when the offspring also consume sweets, chips & Co. on the side. Here, too, the role model function of the parents comes into play: If they spend most of their free time on the couch with a bag of chips, the offspring will soon follow suit.

stress

Anger or excessive demands at school, family disputes, neglect by parents - some children are exposed to stress on different levels and can often handle it poorly. Many then seek escape and consolation in food. In addition, stressed offspring are constantly energized and cannot relax. This also contributes to the development of obesity in children.

lack of sleep

Children who sleep little have a higher risk of becoming overweight than their rested peers.

Obesity in children: examinations and diagnosis

The pediatrician is the first point of contact to clarify overweight in children. He will first obtain important information from the parents and possibly the children themselves. They mainly affect eating habits, physical activity, possible complaints, underlying illnesses and psychological stress on the child, as well as the use of medication (such as cortisone). The doctor also asks whether other family members are already overweight or obese.

This is followed by the physical exam. It includes, among other things, a blood pressure measurement as well as the measurement of the child's height and weight.In adolescents, the ratio of hip to waist circumference is determined in order to determine the body fat distribution (android type: fat pads mainly on the trunk, gynoid type: fat pads mainly on the buttocks and thighs).

Obesity in Children: How Much Weight is Too Much?

Obesity in children is not as easy to determine as it is in adults. As with adults, the body mass index (BMI) is determined, i.e. the ratio between body weight (in kilograms) and the square of body size (in square meters). However, the calculated value must then be compared with the values of gender and age-specific growth curves (percentile curves) in order to be able to assess whether the BMI of a child means overweight or even obesity:

According to this, children and adolescents are overweight if the calculated BMI is above the age- and gender-specific 90th percentile (90th percentile means that 90 percent of all children of the same sex and age have a lower BMI).

With a BMI above 97 or 99.5. Percentile, there is even obesity (obesity) or extreme obesity (extreme obesity).

Further investigations

Overweight in children is rarely caused by an underlying disease such as an underactive thyroid (hypothyroidism). Such causal diseases must be ruled out when assessing the increased body weight.

On the basis of specific examinations, secondary diseases of overweight and especially obesity (such as lipid metabolism disorders, diabetes, gallstones) can be discovered at an early stage. This is done, for example, by measuring blood lipid levels and blood sugar as well as ultrasound examinations of the liver and gall bladder.

If children are obese (i.e. very overweight), psychological, psychosocial and behavioral diagnostics are also recommended. The person concerned may have a serious underlying psychiatric illness (such as depression, eating disorder). Sometimes there is also severe psychosocial stress such as behavioral and developmental disorders or extreme stressful situations in the family. These factors must be clarified and taken into account during therapy.

Obesity in children: treatment

Whether and how obesity in children is treated depends on the extent of the excess fat deposits, any concomitant diseases and the age of the person affected:

Obesity in children between two and six years old sometimes grows out. A constant weight is therefore recommended here: The offspring should maintain their current weight with a healthy, balanced diet and plenty of exercise in order to "grow out" of their fat pads as they get older.

If there is obesity (severe overweight) in children between two and six years of age without concomitant diseases, constant weight is also recommended. However, if comorbidities occur, those affected should lose weight.

Obesity in children over six years of age and adolescents only requires weight loss if there are comorbidities. Otherwise it is enough to hold the weight. In the case of obesity in this age group, on the other hand, weight loss should always be aimed for - regardless of whether or not there are concomitant diseases.

Obesity in children: what is the treatment?

Overweight in children should be treated according to a multidisciplinary approach that includes nutritional advice and changes, regular exercise and sport and, if necessary, psychological support. In certain cases of severe obesity in children, inpatient treatment as part of a long-term therapy program can be useful.

nourishment

To treat obesity in children, a balanced diet with regular meals is necessary. We recommend the optimized mixed diet, which was developed by the Research Institute for Child Nutrition (FKE) for offspring between one and 18 years of age:

Plentiful: low-calorie or free-calorie drinks, plant-based foods (vegetables, fruits, cereals, potatoes)
Moderate: animal foods (milk, dairy products, meat, sausage, eggs, fish)
Economical: foods rich in fat and sugar (edible fats, confectionery, snacks)

How many calories overweight children are allowed to consume during the day depends, among other things, on the individual therapy goal.

A specialist (such as dietitians, nutritionists) can help with the change in diet.

Move

Regular physical activity is essential if you want to combat obesity in children. Endurance sports such as swimming, cycling and dancing are particularly suitable. However, many children are not motivated enough to go through with their sports program on their own. Then sports groups are recommended: If you pedal or splash around in the water with other overweight people, it's usually a lot more fun.

Overweight children should also exercise a lot in everyday life, for example by taking the stairs instead of the elevator and using their bicycles or their own feet to get to school instead of getting into the car or bus.

Therapeutic help

Especially in the case of obesity (i.e. very overweight) in children, the therapy should also include psychological support, for example in the form of behavioral therapy or family therapy. The offspring receive help, for example, in changing their eating and exercise behavior as well as with possible psychological problems (such as depression or inferiority complexes).

Other forms of therapy

If obesity (severe overweight) in children cannot be successfully treated with conventional therapy measures or if there are serious comorbidities, other forms of therapy can be tried that have not yet been adequately examined. These include formula diets and medication to aid weight loss. The decision to do so should be made by a therapist who has experience in childhood and adolescence obesity.

Overweight in children: disease course and prognosis

When treating obesity in children, one should aim for realistic goals and not expect quick results, as these are usually not permanent. The better chances of lasting success come from taking small steps towards the goal (constant weight or weight loss).

Obesity in children can impair physical and emotional development. This is especially true if you are very overweight (obese). Possible consequences are:

Accelerated growth in length and earlier skeletal maturity (due to increased levels of a growth factor (IGF), which is increasingly formed in adipose tissue and in the liver)
Tearing of the connective tissue in the event of rapid or severe weight gain ("stretch marks")
Insulin resistance (decreased response of the body cells to the blood sugar lowering hormone insulin) and as a result diabetes mellitus
increased testosterone levels in girls with signs of masculinization (virilization) such as male hair; decreased testosterone levels in boys
increased estrogen levels in both sexes (in boys, this enlarges the breast, technical term: gynecomastia)
earlier onset of puberty (earlier onset of the first menstrual period, earlier onset of voice breakage, etc.)
High blood pressure (hypertension)
increased fat levels in the blood
Overuse of tendons, joints and muscles with consequences such as back pain, flat feet and splay feet, knock knees or bow legs, etc.

Particularly excessive weight in children can lead to high blood pressure, diabetes and increased blood lipid levels, which together promote hardening of the arteries (arteriosclerosis). This can cause coronary artery disease (CHD), heart attack and stroke. For this reason, those affected have a lower life expectancy than their normal weight peers.

Possible emotional consequences of (severe) obesity in children and adolescents are, for example, stress, anxiety and depression.

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