Overweight and obesity in children

Currently, the terms "childhood obesity" and "overweight" are used equally often in pediatrics, with the term "overweight" being preferred.

Obesity (Latin: adipositas, alimentary obesity)- a chronic eating disorder characterized by excessive accumulation of fat tissue in the body.

Read also: Obesity - Information Overview

ICD-10 codes

• E65-E68. Obesity and other forms of overnutrition.
• E66. Obesity.
• E66.0. Obesity due to excess energy intake.
• E66.8. Other forms of obesity.
• E66.9. Obesity, unspecified.
• E68. Consequences of excess nutrition.

Epidemiology of childhood obesity

In economically developed countries, including Russia, 16% of children are already obese and 31% are at risk of developing this pathology, which is more common in girls than in boys.

According to the WHO Regional Office for Europe (2007), the prevalence of obesity has increased threefold over the past twenty years, reaching epidemic proportions. According to epidemiological studies, if a father is obese, the probability of its development in children is 50%, if the mother has this pathology - 60%, and if both parents have it - 80%.

The causes of the obesity epidemic are considered to be changes in the composition of the diet (increased consumption of energy-rich foods), eating habits (eating at fast food restaurants, frequent use of ready-made breakfast cereals), insufficient consumption of fruits and vegetables, and a sharp decrease in physical activity.

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What causes obesity in children?

In the vast majority of children, obesity is not associated with hereditary or endocrine diseases, although the role of hereditary predisposition to obesity is considered established. Genetically determined metabolic features and the structure of adipose tissue are of leading importance in the formation of a positive energy balance:

• increased number of adipocytes and their accelerated differentiation from fibroblasts;
• congenital increased activity of lipogenesis enzymes and decreased activity of lipolysis;
• increasing the intensity of fat formation from glucose;
• decreased formation of leptin in adipocytes or a defect in its receptors.

Pathogenesis of obesity

One of the main pathogenetic mechanisms of obesity development in children is energy imbalance: energy consumption exceeds energy expenditure. As has been established at present, the pathogenesis of obesity is based not only on energy, but also on nutrient imbalance. Obesity in children progresses if the body is unable to ensure oxidation of incoming fat.

Childhood Obesity: Types

Obesity in children currently has no generally accepted classification. In adults, the diagnosis of obesity is based on the calculation of BMI [the ratio of body weight (in kilograms) to a person's height (in meters) squared]. BMI can overestimate the obesity of trained athletes or muscular children, however, BMI calculation is the most reliable and accurate method for determining excess body weight. Other methods for assessing obesity are also used, but they are either very expensive (ultrasound, CT, MRI, X-ray absorptiometry), or require special equipment (calipers), or are poorly reproducible (measuring waist and hip volume), or have no standards for childhood (bioelectrical impedance analysis).

How to recognize obesity in children?

Obesity in children is not accompanied by specific changes in the results of a general blood test and urine analysis. A biochemical blood test reveals:

• increased levels of cholesterol, triglycerides, low-density lipoproteins, free fatty acids;
• reduction of high-density lipoprotein levels;
• acidosis;
• hyperinsulinemic type of glycemic curve.

Obesity screening

Systematic (once a quarter) monitoring of weight and height indicators with determination of BMI and blood pressure.

Treatment of obesity in children

Obesity in children should be treated with the following goals - achieving energy balance between energy consumption and expenditure. The criterion for the effectiveness of obesity treatment in children is weight loss. A necessary condition for diet therapy in all age groups is the calculation of nutrition by proteins, fats, carbohydrates, as well as calories, with a comparison of actual and recommended consumption.

How to prevent obesity in children?

Obesity diagnosed in childhood persists in 2/3 of adolescents, and the frequency of its detection increases by 3-4 times.

As established during a 10-year prospective observation of the dynamics of the main risk factors for cardiovascular diseases, more than half of the subjects remained overweight and a third had hypercholesterolemia; every fourth had a high level of HDL cholesterol and every fifth had a high level of triglycerides.

What is the prognosis for obesity in a child?

Childhood obesity has a favorable prognosis for life.