Hello Doctor, how can one prevent and manage overweight or obesity in children? Merina
Dear Merina
Obesity is an important public health issue. In Uganda, despite lower overall rates compared to high-income countries, estimates suggest around 4–5 per cent of young children (under 5) are overweight, with higher rates in urban areas like Kampala, reaching up to 6 per cent for urban children aged 5–17, and studies showing over 10 per cent overweight or obese in some school-aged groups. This indicates a rising concern, as obese children are likely to become obese adults.
Aetiology
Overeating?
Although there is no conclusive evidence that obese children eat more than children of normal weight, behaviours relating to diet and activity, plus energy-dense foods now widely consumed, including high-fat fast foods and processed foods, are linked to most cases.
School buses?
Children’s energy expenditure has undoubtedly decreased. Fewer children walk to school; transport in cars has increased; less time at school is spent on physical activities; and children spend more time in front of small screens (video games, mobile phones, computers, and television) rather than playing outside.
Endogenous causes
Since over-nutrition accelerates linear growth and puberty, obese children are relatively tall and usually above average (50th centile) for height compared to peers. Therefore, if a child is obese and short, an endogenous cause must be considered. These include:
- Hypothyroidism: low activity of the thyroid gland, resulting in slowing of growth and mental development in children and metabolic changes in adults.
- Cushing syndrome: a disorder from prolonged exposure to high cortisol levels, causing symptoms like a round face, weight gain (especially abdomen/back), thin skin, easy bruising, high blood pressure, fatigue, and bone loss.
- Prader–Willi: obesity, eating too much, poor linear growth, abnormal body structure, and undescended testes in males; this should be considered in children who are obese with learning disabilities or abnormal structures.
- Gene defect (leptin deficiency): the brain cannot receive signals to stop eating or regulate energy, leading to severe, early-onset obesity, extreme hunger, increased infections, and hormonal issues like delayed puberty.
Changes in lifestyle
Weight maintenance is a more realistic goal than weight reduction and will result in a demonstrable fall in BMI on their centile chart as height increases. This can be achieved by:
- Healthier eating, regular meals; eating together as a family; choosing nutrient-rich foods lower in energy and glycaemic index (releasing glucose slowly), increased vegetable and fruit intake; healthier snack options; decreased portion sizes; drinking water as the main beverage; reduced sugary drink intake; involvement of the entire family in sustainable dietary changes.
- Increased physical activity by walking, cycling for transport, undertaking household chores, and playing, at least 60 minutes per day.
- Limiting television and other small-screen recreational activity to less than 2 hours per day.
Prevention
A reduction in time spent on small screens appears to be the most effective single factor.
Drug treatment and surgery
- Drug treatment has a part to play in children over 12 who have extreme obesity (BMI >40 kg/m²) or BMI >35 kg/m² with complications.
- Bariatric surgery is generally not considered appropriate in children but for adults.
Questions answered by Dr Molino Binywasiki, Clinical head, Equity Afia
Kimbua(Kenya)
