Degree of obesity in children by BMI. Rules for following a children's diet for the proper treatment of obesity

1. Primary obesity. Arises due to poor nutrition or is inherited. Moreover, it is not obesity itself that is inherited, but concomitant disorders of the body’s metabolic processes. If a mother is diagnosed with obesity, then in 50% of cases these disorders will be passed on to the baby. If the father has 38%, both have 80%.
2. Secondary obesity. Caused by acquired diseases, for example, of the endocrine system.

There are 4 in children:

• I degree (weight is 15-24% higher than normal);
• II degree (weight is 25-49% higher than normal);
• III degree (weight is 50-99% higher than normal);
• IV degree (weight is more than 100% above normal).

In 80% of cases of primary obesity, degrees I and II are diagnosed. The presence of slight excess weight in a child, as a rule, does not cause any concern for parents. Most often they are happy good appetite child, and treat pediatricians’ diagnoses with a grin, arguing their position as “well, he feels fine.”

If the diet is not followed at the first stage of obesity, then the disease continues to progress and passes into stage II. Shortness of breath appears excessive sweating, the child begins to move less and show a bad mood more often. However, even here parents are in no hurry to treat their child. The disease continues to develop. If in the first two stages the situation can be corrected by diet, then in the subsequent stages everything is much more complicated.

If a child’s weight is more than 50% higher than normal, then grade III obesity is diagnosed. At this time, the teenager’s leg joints begin to ache, blood pressure rises, and blood sugar levels fluctuate. The child himself becomes irritable, complexes appear, which leads to depression. The situation is aggravated by ridicule from peers. It is at this stage that parents begin to do something. However standard diet unable to solve a problem of this magnitude.

Complications and consequences

Health problems can begin, including with slight excess weight. Therefore, you should not hope that everything will go away on its own; it is necessary to treat the child at the first signs of illness.

Obesity increases the risk of developing diseases:

• Decreased immunity;
• Cardiovascular system: hypertension (increased blood pressure), angina pectoris (pain in the center chest), atherosclerosis (artery disease);
• Musculoskeletal system: chronic diseases joints, poor posture, foot deformity;
• Diabetes;
• Ailments of the digestive system: pancreatitis, fatty hepatosis (which can lead to cirrhosis of the liver);
• Chronic cholecystitis, cholelithiasis;
• Dysfunction of the gonads in adolescents: underdevelopment of the genital organs in boys, disruption of menstruation in girls;
• Hemorrhoids, constipation, fistulas.

Excess weight causes problems in children nervous system, which will lead to:

• Eating disorders: from bulimia to;
• Sleep disturbances, snoring, etc.;
• Frequent headaches, depression.

Due to the threat of complications, treatment of obesity in children should not be delayed.

In children under three years of age

Obesity in children in the first year of life is diagnosed quite often, but it is more of an advisory nature than a serious diagnosis. The development of the disease in children under one year of age is associated with:

• Heredity;
• Maternal smoking during pregnancy;
• Feeding with high-calorie formula;
• Incorrect introduction of the first complementary foods;
• Overfeeding;
• Wrong diet;
• Late onset of crawling and walking;
• Low mobility.

Breastfeeding in the first year of life is a good prevention of obesity in infants.

Most often, the solution to a problem identified in a child under three years of age is diet. At timely treatment the disease goes away in 2-3 years.

When diagnosing obesity in children, a centile table is used, which shows the relationship between their age, weight and height. Information is collected about the child’s diet and diet and the corresponding diseases of his close relatives. The value for children from one to three years is not indicative.

In school-age children and adolescents

With the start of school life, children begin to move less and use their pocket money to buy buns, chocolates and other high-calorie foods. Add to this the stress that schoolchildren experience in an unfamiliar environment, and the reasons for weight gain become obvious.
Obesity in children and adolescents is most often caused by:

• Lack of sleep;
• Mainly sedentary lifestyle;
• Lack of diet;
• Hormonal changes in the body (puberty);
• Stress.

It is worth noting that teenage obesity most often progresses into adulthood.

Diagnosis of obesity in schoolchildren and adolescents, as in children under three years of age, begins with a medical history. Height, weight, chest, waist and hip circumferences are measured, and BMI is calculated. Using special centile tables, the relationship between these parameters can be traced and the correct diagnosis can be made.

To determine the cause of obesity in children, the following is prescribed:

• blood for biochemistry, which is used to determine the level of sugar, cholesterol and other substances that increase the risk of complications in obesity. If glucose levels are elevated, additional tests are prescribed.
• Blood and urine tests for hormones to determine endocrine disease.
• Computed tomography or magnetic resonance imaging when pituitary disease is suspected.

In addition to a pediatrician and nutritionist, you may have to see an endocrinologist, neurologist, gastroenterologist and other doctors. It all depends on what additional diseases will have to be treated.

Features of treatment

If you notice your child is overweight, you should definitely contact a nutritionist. Most likely he will only need special diet. Obesity in its early stages is much easier to treat. If obesity has already reached stage III or IV, then you need to act as soon as possible.

First of all, treatment of obesity in children requires nutritional correction.

The diet includes:

• Reducing the size of 1 serving;
• Compliance with the regime of fractional five meals a day (preferably with the whole family). In this case, dinner should not be later than three hours before bedtime;
• Replacing sugary store-bought drinks with water;
• Inclusion of fresh fruits, berries and vegetables in the daily diet (in case of diabetes mellitus, sweet fruits should be excluded);
• Exclusion from the diet of fatty meat and fish;
• Sufficient water intake;
• Limiting the consumption of “fast” carbohydrates: flour products, pasta, ;
• Limit the consumption of sweets (for sweets, give your child honey, dried fruits, marmalade, marshmallows and dark chocolate), and if you have diabetes, you should exclude sugar-containing foods as much as possible;
• Limit salt consumption, exclude pickled and pickled vegetables from the diet;
• Eliminate fast food, chips, snacks, etc.

During this period, any diet that involves, as well as, is contraindicated for the child. Since they will only worsen the course of the disease. Your daily routine should include walking for at least 30 minutes and playing sports 3-5 times a week. It is advisable to do exercises in the morning.

Drug treatment, like specialized treatment, is prescribed only by a doctor.

Obesity is one of the most common problems in the world, which does not lose its relevance.

If previously obesity was found mainly in adults, now doctors are increasingly diagnosing this problem in children. To begin the fight against this disease, you need to find out the reasons for its occurrence.

What degrees of obesity exist in children, the symptoms and description of the disease of degrees 1, 2, 3 and 4, as well as the formula for calculating the body mass index of a child from 1 to 10 years and older can be found in our review.

Description of the disease, causes

Obesity is a chronic pathology. It is characterized by metabolic disorders that lead to the accumulation of fat in the body.

Excess body weight is dangerous for children: it can cause diseases of the gastrointestinal tract, heart, and damage to the endocrine gland.

The baby can be cured, but The disease is quite difficult to treat. Doctors recommend paying attention to nutrition and reconsidering the baby’s entire lifestyle. It is important that he is regularly physically active and gets enough sleep.

In some cases, medications aimed at normalizing metabolism help fight the disease.

• Hereditary predisposition.
• Impaired metabolism.
• Poor nutrition, consumption of fatty, unhealthy foods.
• Absence physical activity.
• Neuroendocrine diseases.
• Wrong daily routine.
• Regular lack of sleep.
• Chromosomal and other genetic syndromes.
• Hemoblastosis.

These factors provoke weight gain in children. To cure the baby, it is necessary to identify the underlying cause. Then you will be able to reduce weight and maintain the achieved result.

Classification

Doctors distinguish two forms of pathology: primary and secondary. Primary is characterized by congenital pathologies that cause obesity.

A variation of this form of the disease is exogenous constitutional obesity (caused by heredity in children).

Symptoms of the primary form:

• Slow metabolism.
• Dyspnea.
• Discomfort in the abdomen.
• Feeling bloated.

The secondary form is a consequence of eating unhealthy foods and lack of physical activity. This also includes endocrine obesity which is caused malfunction thyroid gland, adrenal glands.

Symptoms of this form include:

• Children begin to walk and sit later than their peers.
• Increased fatigue, drowsiness.
• Acne.
• Oily skin.

Hypothalamic

This is one of the types of disease with rapid deposition of fat masses. Excess fat appears quickly, especially often deposited in the abdomen, thighs, and buttocks.

Appears due to changes in the hypothalamus and pituitary gland. This leads to the person having uncontrollable appetite, he takes in more calories than he needs.

Symptoms of this type:

• Rapid accumulation of fat mass.
• Increased sweating.
• Dark spots.
• Pressure surges.
• Crimson-blue stripes in areas of fat deposits.
• Headache.
• Increased fatigue.
• Hormonal imbalances.

With this type, the disease is considered acquired. A person who has not previously suffered from it can gain 20-30 kg in two years.

Normalizing the functioning of the hypothalamus and pituitary gland will help restore weight.

Constitutional-exogenous

The main reason for the appearance of this type of disease is heredity, which is complemented by increased appetite. Fat can be deposited in different places human body.

People with this type of pathology do not eat correctly, so in order to normalize body weight they are advised to review the menu and exercise more.

In addition to fat accumulation, patients experience the appearance of acne, the skin becomes oily. Symptoms of the disease include drowsiness, fatigue, abdominal discomfort.

Endocrine

With this form fat accumulates due to gland dysfunction internal secretion . Usually, the synthesis of certain hormones is carried out incorrectly, so the fat layer grows.

Symptoms of endocrine obesity:

• Increased appetite.
• Constipation.
• Nausea.
• Bloating.
• Bitterness in the mouth.
• Decreased potency.
• Violation menstrual cycle.

Patients experience swelling, joint pain, shortness of breath even with minor physical activity.

Possible anxiety, irritability, mood swings, weakness, disturbed sleep, insomnia and headache.

Nutritional

Occurs due to lack of physical activity and poor nutrition. Endocrine system works correctly and is not damaged. Fat accumulates gradually, usually in the abdomen and thighs.

Symptoms:

• The fat layer is growing.
• Discomfort in the abdomen.
• Flatulence.
• Heaviness in the stomach.
• Weakness.

To normalize body weight, The baby is advised to move more and eat right.

It is easy to cope with this type of disease, since there are no significant disturbances in the functioning of organs.

Stages (table by age)

Doctors distinguish four stages of the disease. To determine them, body mass index is calculated. This is a formula that includes the baby's height and weight.

The results are divided into stages or degrees of obesity in children:

• The first is that the weight norm exceeds by 15-24%.
• The second one exceeds the norm by 25-50%.
• Third - excess normal indicators is 50-100%.
• Fourth - the indicators exceed the norm by more than 100%.

The photo shows all degrees of obesity in children (1, 2, 3 and 4):

The following indicators are the norm for different ages:

In this article we will discuss, what diet for obesity stage 1 or 2, as well as in more severe forms - stages 3 and 4, the most effective and aimed at long-term results. Childhood obesity– this is a condition when a child’s weight exceeds the age-height standard by 15 percent. Treatment of obesity in children- this is, first of all, a whole range of measures aimed at normalizing metabolism, increasing muscle tone and strengthening, choosing a diet and products. There are four degrees of obesity in total. The first degree of obesity is characterized by excess weight by approximately 15-20 percent, the second degree of obesity is an excess of body weight by 21-50 percent, the third is 50-100 percent, and finally, the very last, fourth stage, is characterized by excess weight by more than 100 percent.

Treatment of obesity in children– this is a very long and labor-intensive process.
The basis of obesity treatment is adherence to a dietary diet, which categorically excludes overeating and city eating. Doctors prescribe a diet combined with physical activity. No medications are used for children (with the exception of stage 4 obesity). There is cholesterol control.

It should be noted that childhood obesity has two forms– primary and secondary. Most often, primary obesity is directly related to errors in nutrition, that is, overfeeding, and secondary obesity is a consequence congenital diseases. For example, due to insufficient thyroid function. I must say, such degrees of obesity both first and second only causes psychological discomfort, rather than physical. At these stages, the child has no special health complaints.

The point is that on early stages structural and functional changes have not yet entered into force. It seems that this just overweight and he can do no harm children's body, but now it’s worth thinking about it and taking yourself seriously. In the first and second stages of childhood obesity, weight increases slowly but surely, which is very dangerous in terms of complications. and, consequently, the functioning of the musculoskeletal system is disrupted. Joint pain and limited mobility can be expected.

Weakness, irritation, loss of strength, bad mood, swelling and nausea in a child are problems that are closely related to the third and fourth stages of obesity. At these stages, the body changes pathologically. In particular it changes the cardiovascular system and gastrointestinal tract.
IN modern conditions very difficult to overestimate influence of proper nutrition on the child's well-being. Until 8-10 years of age, no spices or seasonings are added when preparing lunch. It is best to avoid sugar. Instead, use glucose, fructose and honey. Margarine is a source of toxic trans fats. Replace margarine and butter with olive and sunflower oil. Also, you should avoid industrial mayonnaise. Do not buy semi-finished products, but rather cook your own food. Diet for obesity should be based on high-quality meat, fish and fermented milk products. Include vegetables and fruits, as well as cereals, in your diet.

As emphasized above, treatment of obesity in children nd is rarely associated with the use of drugs - for effective treatment obesity of any degree, it is important to strictly observe proper nutrition regimen and adhere to a strict diet that includes healthy foods made from natural raw foods. Below you will find useful tips on compliance with the diet for obesity degrees 1,2,3 and 4 in children, recommendations for choosing products - first and second courses, and also desserts and drinks for weight loss.

Next article.

A condition in which the child’s body weight is more than 15% higher than the age norm, and such an indicator as the body mass index is equal to or more than 30.

Research data in the CIS countries show that in Ukraine, Russia, Belarus and other countries former USSR 12% of children are overweight. 8.5% who live in cities suffer, and among children living in rural areas, this percentage is about 5.5.

Today, the number of obese children in the world is growing, so pediatricians should pay serious attention to this problem, as should pediatric endocrinologists. In more than half of adults diagnosed with obesity, these processes began in childhood or adolescence. The more obesity progresses in a child, the higher his risk of having endocrine, cardiovascular, reproductive and. Obesity also increases the risk of disorders and diseases of the gastrointestinal tract and musculoskeletal system.

Obesity in children is a preventable condition, so it is important to pay attention to preventive measures, which will be discussed in detail below.

Classification of obesity in children

There are 2 forms of obesity in children:

• primary
• secondary

Primary can be nutritional (which is associated with an incorrect diet) or exogenous-constitutional (passed on “inherited” from parents). At latest form the child does not inherit fat mass, and features of the flow of metabolic processes in the body.

Nutritional obesity most often occurs at this age:

• up to 3 years
• 5-7 years
• 12-16 years old

Secondary obesity in children can be endocrine - with diseases of the ovaries in female children, as well as diseases of the adrenal glands and/or thyroid gland. The criteria for determining obesity in children today are still under discussion among specialists. Researcher Gaivoronskaya A.A. suggests dividing obesity into four degrees:

• I degree- excess normal weight by 15-24%
• II degree- excess of normal weight by 25-49%
• III degree- excess of normal weight by 50-99%
• IV degree- excess of normal weight by 100% or more

According to statistics, primary obesity in 80% of children is grade I-II.

What provokes / Causes of Obesity in children:

Obesity in children can be caused by a number of reasons. Factors among and genetics take part in its development. In 100% of cases, the essence of obesity is an energy imbalance, which is caused by reduced energy intake and increased consumption energy.

If both parents have obesity, then there is an 80% chance that their son or daughter will have the same disorder. If only the mother suffers from obesity, then the child’s probability of having a similar condition is 50%, and if only the father, then 38%.

Children at risk are those who were born weighing more than 4 kg, as well as those who have monthly weight gain above the norm, who are on artificial feeding. Obesity in infants can occur due to feeding him high-calorie formulas in excess quantities or violations.

Most children are young and school age obesity occurs when the diet is disrupted and the child receives little physical activity. Obesity appears if the diet is dominated by “fast” carbohydrates (easily digestible), solid fats (obtained from “fast food”), carbonated water, store-bought juices and teas with sugar. However, obese children usually do not have enough protein, fiber and water in their diet.

An important factor is sedentary lifestyle. Obesity threatens those who do not engage in any sport or play active games, does not go to physical education lessons or is inactive during them. Also risk factors: intense mental stress, leading to frequent spending time at the computer or on the couch watching TV.

Cause of obesity ( excess weight) in children can become serious pathological conditions:

• Prader-Wili syndrome
• Down syndrome
• Cohen's syndrome
• Lawrence-Moon-Biedl syndrome
• Itsenko-Cushing syndrome
• adipose-genital dystrophy
• , encephalitis
• traumatic brain injury
• brain tumors
• neurosurgical intervention

Sometimes obesity can provoke such emotional reasons:

• accident
• entering the first grade of school
• death of relatives
• a child witnessed a murder or other crime

Pathogenesis (what happens?) during Obesity in children:

Pathogenesis of obesity does not depend on its cause. Excess food, especially those high in carbohydrates, causes hyperinsulinism. The consequence is hypoglycemia, which makes the child feel hungry. Insulin is the main lipogenetic hormone that has an anabolic effect and affects the synthesis of triglycerides in adipose tissue.

Accumulation of fat above normal is accompanied by a secondary change in function. The production of adrenocorticotropic hormone increases, hypercortisolism appears, the sensitivity of the ventromedial and ventrolateral nuclei to signals of hunger and satiety is impaired, etc.

Researchers consider obesity in children to be inflammatory chronic processes. Cytokines of adipose tissue and changes in the lipid composition of blood serum, as well as activation of lipid peroxidation processes, are important in the pathogenesis.

Adipocytes adipose tissue synthesize enzymes that regulate lipoprotein, leptin and free fatty acid. If the “food center” does not respond to leptin, then after eating the child is not satisfied. The amount of leptin is related to the amount of insulin in the body. Hunger centers also regulate cholecystokinin, serotonin, and norepinephrine.

The mechanism of nutritional thermogenesis is realized, among other things, by thyroid hormones and enteral hormones of the duodenum. If the concentration of the latter is low in the body, then after eating the child still wants to eat. Appetite also increases due to abnormal high concentration endogenous opiates or neuropeptide-x.

Symptoms of Obesity in Children:

Main symptom of obesity in children, the layer of subcutaneous fatty tissue becomes larger. Signs of obesity also include delayed development of motor skills, inactivity, a tendency to allergic reactions, constipation, and the incidence of various infections.

At nutritional obesity in children doctors are watching body fat in the abdomen, hips, pelvis, back, chest, arms, face. At the age of 7-16 years, in such cases, symptoms appear: decreased tolerance to physical activity, shortness of breath, increased blood pressure. By the age of sixteen, ¼ of children have metabolic syndrome, which is manifested not only by obesity, but also by insulin resistance, arterial hypertension and dyslipidemia. If a child is obese, there may also be a disorder of uric acid metabolism.

Secondary obesity in children occurs as a result of the underlying disease, the manifestations correlate with its symptoms. For example, with a diagnosis of “congenital hypothyroidism,” a child begins to hold his head up, sit and walk late, teeth erupt later than healthy babies. Acquired hypothyroidism is recorded in children in puberty, if it develops in the body. In addition to obesity, in such cases, patients experience such symptoms as weakness, fatigue, decreased school performance, a tendency to sleep at the wrong time, the skin becomes dry, and in girls the menstrual cycle is disrupted.

At Cushingoid obesity in children(Itsenko-Cushing syndrome) fat deposits appear in the neck, face, and abdomen, while the arms and legs remain slender. During puberty, girls may also experience amenorrhea.

If obesity in children is combined with prolactinoma, then the mammary glands become enlarged, which is scientifically called gynecomastia. This also applies to boys. The following symptoms are also typical:

• headache
• galactorrhea

Obesity plus polycystic ovary syndrome gives the following symptoms (combined with the formation of excess weight): acne, oily skin, irregular menstrual cycle, overgrowth hair. With adiposogenital dystrophy, male patients have cryptorchidism, obesity, an underdeveloped penis, underdevelopment of secondary sexual characteristics, and female patients have amenorrhea.

Complications of obesity in children

Obesity poses a risk of the following diseases:

• hypertensive
• atherosclerosis
• diabetes mellitus type 2
• angina pectoris
• chronic cholecystitis and cholelithiasis
• haemorrhoids
• constipation
• (which can later develop into cirrhosis of the liver)

Overweight and obese children often have eating disorders such as boudimia and anorexia, as well as sleep disorders such as sleep apnea and snoring. Due to the increased load on the child’s bones and muscles, scoliosis, posture disorders, hallux valgus, arthrosis, flat feet. If a person has been obese since childhood, then his risk of never conceiving a child increases.

Among the psychological consequences of obesity, it is worth highlighting melancholic states and depression, social isolation, ridicule from classmates and comrades, deviant behavior, etc.

Diagnosis of Obesity in Children:

The doctor collects an anamnesis, including finding out how the child was fed from birth to 1 year, the features of the baby’s diet today, and clarifies the level of physical activity. An objective examination includes anthropometry for the following indicators:

• waist circumference
• body mass
• body mass index
• hip volume

There are special centile tables that compare data. Based on them, it is possible to determine whether the child has overweight body or obesity. During mass inspections, thickness measurements may be used skin fold, as well as the bioelectrical resistance method (to determine the relative mass of adipose tissue in a child’s body).

To determine the etiology of obesity, consultations with specialists such as pediatric neurologist, endocrinologist, geneticist and gastroenterologist. Doctors may prescribe biochemical analysis blood:

• glucose tolerance test
• glucose
• lipoproteins
• uric acid
• triglycerides
• protein
• liver tests

Also necessary are such hormonal profile studies:

• prolactin
• insulin
• T4 St.
• blood and urine cortisol

Additional research methods(needed only in some cases):

• Ultrasound examination of the thyroid gland
• MRI of the pituitary gland
• Electroencephalography

WHO activities in diagnosing obesity in children

On 4.2006, the WHO Standard Indicators for Child Development were released, which set out the criteria by which children under 5 years of age are diagnosed as overweight or obese. And for children from 5 years old, as well as for teenagers World Organization health, the Development Background Data was released using data from the National Center for Health Statistics.

Treatment of Obesity in Children:

The first step to getting rid of obesity is to review the eating habits and diet of not only the child, but also his family. Without refusal fast carbohydrates(sweets) you can’t lose weight or you can, but only slightly. Children find it difficult to give up this eating habit, so following a diet can be stressful for them. It is necessary to instill habits in the child and those with whom he lives healthy image life - healthy lifestyle.

Where to start correcting nutrition

• First of all, you need to reduce the portion size - the food that the child eats at one time.
• Replace sweet store-bought drinks with water (mineral still or from the tap, filtered).
• Include berries in your diet: bananas, apples, strawberries, oranges, blackberries, melons, watermelons, raspberries, etc.
• Products high in protein should be low-fat. It is necessary to exclude pork and give preference to chicken. Low-fat fish is also welcome.
• Include as much as possible in your diet fresh vegetables And vegetable dishes, which reduce hunger and avoid constipation.
• Must be avoided trendy diets, especially those that are based on the consumption of only one product (mono-diets: watermelon, buckwheat, etc.).
• It is necessary to introduce the concept of “routine violation” - when a child has eaten something unplanned and harmful. There is no need to scold the child for such violations. It is necessary to establish a useful punishment: squat 20 times or do press exercises 30 times. The “bicycle” exercise, push-ups, jogging, hula hoop twirling, etc. are also suitable.

Make your child's life more active. You can enroll him in sports sections, just give your child the right to make his own choice. To do this, you can take him to sports clubs, show him what types of sports activities there are, so that he can choose. A fun (and useful) activity would be, for example. Physical exercise should be regular.

In some cases, obesity can occur due to hypothalamic-pituitary disease, when the child has a disrupted hormonal system, has bulimia, etc. Then the child experiences a feeling of hunger at night, increased appetite throughout the day, pink stretch marks on the hips, shoulders, abdomen, hyperpigmentation of the elbows, neck, etc. Treatment in such cases is as follows:

• low calorie diet
• meals 6 times a day (fractional)
• organization fasting days(vegetables, protein)
• systematic therapeutic exercises
• active motor mode
• massage
• physiotherapy

Obesity in children can be treated in a sanatorium, but only if this was recommended by the attending physician. Holidays in health resorts by the sea are useful, because metabolic processes in the body are quickly normalized under the influence of fresh sea air.

If the child's appetite is higher than normal, the doctor may prescribe laxatives, anorexigenic and thyroid medications.

Homeopathic remedies for the treatment of excess weight in children:

• antimonium crudum
• black cohosh
• lycopodium
• Chelidonum
• Hepel
• Graphites Cosmoplex S
• Testis compositum
• Thyroidea compositum
• Ovarium compositum (for girls)

Treatment with drugs should be accompanied by the supervision of the treating endocrinologist. Sometimes there is a need to resort to operational methods treatment - for example, if obesity and its complications threaten death in the near future. The branch of surgery that treats obesity is called bariatrics.

Why can't you fast?

When losing weight, according to experts, body weight should decrease by 500-800 g per week. But these indicators may differ depending on the child’s age, weight and health indicators. Sometimes a doctor can develop a diet for an obese child that will allow him to lose 1.5 kg of excess weight in 1 week. But such diets must be carried out under strict medical supervision.

Diets that offer to lose more than what is stated above in a short period of time can harm your health, and seriously. In addition, after such diets, weight can quickly return, since self-preservation modes are triggered in the body (the body thinks that hunger has set in, and then tries to gain weight in reserve).

During the fasting period, the energy deficit in the body is replenished with glucose. When there is no more glucose in the blood, the breakdown of glucose stores in the form of glycogen begins. The body only has enough for 24 hours of fasting. Then the proteins begin to break down, and, as you know, our body is built mainly from proteins - including the heart muscle. And the breakdown of fats begins only last.

When a child is starving or has an incorrect diet, the body lacks necessary microelements and vitamins. This leads to the fact that the metabolism slows down, so the weight “stands” and does not decrease. If the weight decreases sharply, the body’s adaptation does not have time to start. Therefore, weakness appears in the muscles, the skin sags, and the functioning of the gastrointestinal tract is disrupted.

Diary of food and energy expenditure for obese children

You can understand the reason for a child’s excess weight if you keep a special food diary for 1 week. It records absolutely everything that was eaten throughout the day - during main meals and for snacks. It will be useful to count the calorie content of what you eat and make calculations for proteins, fats, and carbohydrates. In the same diary you can count the calories burned. If consumption, according to your calculations, exceeds consumption, then the reason for excess weight in children is clear - overeating.

Medicines that reduce the absorption of fats and carbohydrates

Such drugs are used as prescribed by a doctor in some cases of obesity in children to reduce the absorption of fats and carbohydrates. This way you can reduce energy value consumed food, which has a positive effect on the process of losing weight.

Several years ago, a drug such as xenical () was popular. It blocks lipase ( digestive enzyme), which promotes the absorption of fats in the gastrointestinal tract. Therefore, about 30% of the fats that were eaten “exit” from the body without being deposited anywhere. Xenical has become a new step in the treatment of obesity. But practice has shown that taking a fat blocker will not help those who eat too much fatty foods. Undigested fats, passing through the intestines, lead to indigestion, causing flatulence, diarrhea, etc.

Therefore, the patient has to choose between taking fatty foods and the above-mentioned medicine. When stopping the medication and switching to normal, healthy eating, weight and intestinal condition are normalized. That is, xenical has a psychotherapeutic rather than a physical effect.

Famous similar drug- chitosan. It binds the fat contained in food into indigestible compounds, in the form of which it leaves the body. Independent research suggests that chitosan helps only if a person eats a low-calorie diet. Both drugs do not affect the absorption of carbohydrates, which are the main nutritional problem in overweight children.

Among carbohydrate blockers called (acarbose), lipobay and polyphepan. They call adverse reactions, which are worth remembering when using these remedies to treat children:

• fermentation processes
• rumbling in the stomach
• flatulence
• digestive tract disorders

Thus, an obese child, even when taking special medicines from obesity you will have to part with junk food and form healthy eating habits.

Prevention of Obesity in Children:

Parents, doctors and teachers/educators should be involved in the implementation of preventive measures against childhood obesity. The first step is for parents to understand how important proper nutrition and a healthy lifestyle are. It is necessary to educate the child to have adequate eating habits and organize his regime for the required level of physical activity.

The second step is to develop the child's interest in physical culture and sports. This should not only be done by teachers and parents. Parents themselves should be examples of a healthy lifestyle, and not dictators who say one thing and do the opposite. There is a need to develop screening programs to identify obesity and its complications among children and adolescents.

Which doctors should you contact if you have childhood obesity:

Endocrinologist

Pediatric neurologist

Pediatric gastroenterologist

Is something bothering you? Do you want to know more detailed information about Obesity in children, its causes, symptoms, methods of treatment and prevention, the course of the disease and diet after it? Or do you need an inspection? You can make an appointment with a doctor– clinic Eurolab always at your service! The best doctors will examine you, study external signs and help identify the disease by symptoms, advise you and provide necessary help and make a diagnosis. you also can call a doctor at home. Clinic Eurolab open for you around the clock.

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Other diseases from the group Children's diseases (pediatrics):

Doctors never tire of repeating that obesity is a real war, where there is only one enemy, but there are countless victims. This problem modernity is aggravated by the fact that children find themselves on the “battlefield”.

According to statistics, every second child in the United States suffers from overweight, every fifth is obese. In Western European countries these numbers are lower, but they are growing steadily. The disease already goes beyond hereditary predisposition. Increasingly, physical inactivity and abuse of fast foods and trans fats are cited as the main reasons.

Causes

As in adults, obesity in children is difficult to treat. In order for therapy to be successful, it is necessary to first find out the causes of the disease. To do this, doctors collect anamnesis and conduct all kinds of laboratory tests.

The most common factors causing excess weight include:

• excess calorie intake;
• physical inactivity;
• hereditary predisposition;
• metabolic disease;
• hypothalamic tumor, hemoblastosis, skull trauma;
• neuroendocrine diseases: hypercortisolism, hypothyroidism;
• lack of sleep;
• lack of daily routine;
• long-term use of glucocorticoids, antidepressants;
• gene mutations;
• chromosomal and other genetic syndromes: Prader-Willi, Ahlstrom, Cohen, fragile X chromosome, Down, pseudohypoparathyroidism.

All these risk factors need to be identified in a timely manner in order to begin necessary treatment. Unfortunately, parents often wait until the last minute, until first-degree obesity turns into third-degree obesity with all the complications and consequences for life and health.

Symptoms

The clinical picture of the disease is closely related to age characteristics child. So at certain stages of his life the symptoms may be different. As a rule, signs of obesity develop progressively, that is, they appear more and more clearly with each stage.

Preschool age:

• overweight;
• severe allergic reactions;
• dysbacteriosis;
• constipation

Junior school age:

• overweight;
• excessive sweating;
• shortness of breath when walking and physical activity;
• deformation of the figure due to the appearance of fat folds in the abdomen, hips, buttocks, arms and shoulders;
• high blood pressure.

Adolescence:

• pronounced symptoms described above;
• fast fatiguability;
• menstrual irregularities in girls;
• dizziness, frequent and severe headaches;
• swelling of the limbs;
• aching pain in the joints;
• depressed, depressed state;
• conscious isolation from peers.

In adolescence, the disease reaches a new level, covering not only physiology, but also psychological condition child. Being overweight prevents him from fully communicating with his peers. This often leads to maladaptation, antisocial behavior and even autism.

Diagnostics

Having noticed the first signs of the disease in your child, you don’t need to hope that it’s temporary, this happens to everyone, it’s all age-related and will soon pass. You need to contact an endocrinologist as soon as possible, who will diagnose correct diagnosis and will give appropriate recommendations.

History taking:

• birth weight;
• age of onset of obesity;
• growth dynamics;
• presence of type II diabetes mellitus and cardiovascular diseases;
• neurological complaints: headaches, vision problems;
• psychomotor development;
• height and weight of parents.

Objective data:

• androgen-dependent dermopathy: hirsutism, oily seborrhea, acne;
• arterial pressure;
• waist circumference;
• distribution of fatty tissue across parts of the body;
• height;
• stage of sexual development.

Laboratory diagnostics:

• blood chemistry;
• lipid profile;
• Ultrasound of the liver to determine its enzymes;
• glucose tolerance test to determine insulin resistance;
• Here are the hormones that will need to be tested: thyroid, cortisol, ACTH, leptin, parathyroid hormone, proinsulin, prolactin, LH, FSH, SSSH, testosterone, anti-Mullerian hormone, growth hormone;
• 24-hour blood pressure monitoring.

Instrumental studies:

• bioimpedansometry;
• MRI of the brain;
• ophthalmological examination;
• polysomnography;
• Ultrasound of the abdominal cavity;
• ECG, ECHO-KG.

Molecular genetic studies:

• determination of karyotype;
• search for gene mutations.

Specialist consultations:

• physical therapy doctor;
• gastroenterologist;
• geneticist;
• gynecologist;
• nutritionist;
• cardiologist;
• neurologist;
• otolaryngologist;
• psychologist;
• endocrinologist

There is no need to be afraid that if obesity is suspected, the poor child will be put through all these studies and tests. After collecting anamnesis, the doctor will make assumptions about what factors caused the disease and prescribe only those diagnostic methods which are necessary to confirm the diagnosis.

Age characteristics

Due to adipose tissue is formed in the body with different intensity, there are stages of childhood obesity associated with age-related characteristics:

• in children under one year of age, the first accumulation of adipose tissue occurs and obesity is not diagnosed;
• 1-3 years is a critical period when parents and relatives overfeed the baby with sweets - this is the first stage when symptoms of the disease may appear;
• 3-5 years - fat growth stabilizes, weight problems are rarely observed;
• 5-7 years - the second critical stage, characterized by the growth of body fat;
• 8-9 years - for school-age children in primary school Weight problems are rarely reported because active life, physical education, lessons allow them to expend a sufficient amount of calories;
• 10-11 years is also a relatively calm stage, but here it is very important for parents to prepare the teenager for the upcoming puberty and instill in him healthy eating habits;
• 12-13 years old - it is at this age that serious hormonal changes occur in the teenage body due to puberty, which often becomes the impetus for gaining extra pounds.

Knowing the critical periods in a child’s life, parents can be more attentive to the problem of excess weight at these stages. This will fix everything initial stages when the disease has not yet started.

Classification

Doctors have more than one classification of childhood obesity: according to etiology, consequences, degrees, etc. In order for parents not to wander into them, it is enough to have minimal information.

Firstly, the disease can be:

• primary - due to heredity and congenital pathologies;
• secondary - acquired as a result of poor nutrition and physical inactivity.

Secondly, there is a special table that will help determine obesity in a child based on body mass index (BMI), which is calculated using the formula:

I (BMI) = M (weight in kilograms) / H 2 (height in meters).

• I degree

Slight excess weight in a child does not cause concern among parents. They even rejoice at his excellent appetite and plump cheeks. Pediatricians' diagnoses are not taken seriously, always appealing feeling good your child. In fact, stage 1 obesity can be easily cured by exercise and proper nutrition. But because of this behavior of adults, this happens extremely rarely.

• II degree

The disease gradually progresses, leading to stage 2 obesity. At this stage, shortness of breath and increased sweating appear. Children move little and are often in bad mood. Problems begin with physical education at school and social adaptation in the classroom.

• III degree

At this stage, the disease is already manifesting itself with all its might, so it is difficult not to notice it. The joints of the legs begin to ache, blood pressure rises, and blood sugar levels fluctuate. The child becomes unbalanced, irritable, and depressed.

So parents themselves can determine the degree of obesity at home. This will allow you to seek medical help in a timely manner.

Norm and pathologies

In addition to degrees, a table by age will allow you to identify excess weight, where, according to WHO data, pathological values body weight. The parameters will be different for boys and girls. In addition, they still need to be adjusted depending on growth.

Weight of girls 1-17 years old, according to WHO

Weight of boys 1-17 years old, according to WHO

If the child is very tall, it is possible to slightly increase the parameters given in the table.

Treatment

Parents and the child themselves will have to mandatory go through the School of Obesity. This is what doctors call a set of measures to correct eating behavior and adequate physical activity. This motivational training is considered the basis of therapy. It is there that they are laid out in every detail. clinical guidelines for the treatment of pathology.

Nutrition

First of all, for childhood obesity, diet therapy is prescribed, compiled according to Pevzner’s table No. 8. Without it, it is impossible to treat this disease.

A special diet for obese children according to Pevzner recommends including in their diet following products in this volume:

• bread (coarsely ground or bran) - up to 170 grams per day;
• fermented milk products up to 1.5% fat - 200 g;
• (minimum potatoes) - 220 gr;
• chicken, turkey, lean meat and fish - 180 g;
• , buckwheat and barley porridge- 200 gr;
• vegetables in unlimited quantities, prepared in any way;
• unsweetened fruits - 400 gr;
• tea, uzvar, freshly squeezed juices - in any quantity.

Sample menu for stage 2 obesity

In the first degree, the diet can be diversified with honey, higher-fat dairy products, sweet fruits, and fried foods. At 3 degrees vegetable oil and any indulgences in food are excluded.

• reducing portion sizes;
• mode of fractional 5 meals a day;
• dinner - 3 hours before bedtime;
• drinking plenty of plain water;
• complete exclusion of fast food, chips, snacks, soda.

Children's dietary dishes:

• cottage cheese-banana dessert;
• beet and carrot casserole;
• dried fruit pastille;
• lazy meatball soup;
• meat soufflé;
• curd cheesecakes;
• chicken cutlets in a double boiler and others.

Recipes

• Steamed meatballs

Remove tendons and film from 150 grams of lean beef and grind through a meat grinder 2-3 times. Boil a tablespoon of rice, cool, and stir into the minced meat. Pass through the meat grinder again, add a quarter of a boiled egg and 5 g butter. Beat the whole mass with a blender. Roll small meatballs, place them in a frying pan, thinly greased with oil, pour cold water, boil for 10 minutes.

• Vegetable soup

Chop 2 small and 2 stalks of celery. Chop the onion. Mix chopped vegetables, add 100 grams of white beans, 4 cherry tomatoes cut into halves. Pour 500 ml vegetable or chicken broth. Cook after boiling for half an hour. Season to taste sea ​​salt. Before serving, add a little low-fat sour cream.

• Cupcakes

Grind 1 medium banana and a handful of almonds in a blender. Mix them with grated carrots. Add 200 grams of oatmeal, 10 ml of honey, 20 ml of lemon juice. Fill the molds with the resulting mass and place in the freezer. After 2 hours, move them to the refrigerator for an hour. Serve with tea.

Physical exercise

Treatment of obesity in children cannot be done without adequate physical activity. It assumes:

• daily exercise for at least 1 hour (if more is encouraged);
• It is better to devote most of such activities;
• games;
• competitions;
• travel;
• recreational activities;
• various complexes.

Drug treatment

Due to age-related contraindications for most drugs drug treatment diseases are limited.

IN certain cases, according to specialists, the child may be prescribed the following medications:

• Orlistat - allowed from 12 years of age, helps fats to be absorbed into small intestine;
• - prescribed from 10 years of age for type II diabetes mellitus.

The use of drugs such as Octreotide, Leptin, Sibutramine, growth hormone is limited to clinical and scientific research and is not recommended for the treatment of childhood obesity.

According to research, dietetics, physical education and drug therapy have low efficiency. As a result, childhood obesity is being treated in some countries. surgical methods. However clinical trials showed that the use of bariatrics in children and adolescents (when compared with adults) is accompanied by numerous postoperative complications, low compliance, and frequent relapses in weight gain. In the Russian Federation, performing such operations to treat obesity in those under 18 is prohibited.

Prevention

Parents should know how to prevent childhood obesity:

• full awareness of proper nutrition;
• breastfeeding up to 6 months;
• physical activity;
• playing sports;
• constant monitoring of BMI, timely identification of children with this indicator more than 10 at the age of 2-9 years;
• instilling healthy eating habits;
• walks in the open air.

If all this is put into practice from the very beginning early age, children and adolescents will never be diagnosed with obesity.

Complications

The worst thing in all this is what this pathology threatens. Unfortunately, parents do not always represent the full danger of the disease. Meanwhile, the consequences can be the most serious - up to fatal outcome(at 3rd degree).

Among the most common complications:

• apnea;
• arterial hypertension;
• gynecomastia;
• hyperandrogenism;
• dyslipidemia;
• cholelithiasis;
• delayed or accelerated sexual development;
• pathology musculoskeletal system: osteoarthritis, Blount's disease, spondylolisthesis;
• violations carbohydrate metabolism: insulin resistance, impaired glucose tolerance, fasting glycemia;
• fatty liver: hepatosis and steatohepatitis are the most common conditions in children;
• relative androgen deficiency;
• diabetes mellitus type II;
• gastrointestinal diseases: inflammation of the pancreas, gastritis, hemorrhoids, constipation;
• liver failure;
• mental illness, psychosocial disorders;
• male decline reproductive function, female infertility in future.

Parents must understand that obese children are unhappy. Therefore, their main task is to prevent such a development of events, and if this has already happened, to do everything to cure the child. The sooner adults come to their senses, the greater the chances of recovery and a prosperous life he will have in the future.