Brief overview
- Treatment: Dietary changes and exercise program, for example as part of nutritional and behavioral therapy, or medication in the case of severe obesity.
- Diagnosis: Determination of BMI value and percentile as well as waist-hip circumference, physical examinations, ultrasound and blood tests if necessary, behavioral diagnostics
- Causes: Excessive and unhealthy diet, lack of exercise, genetic predisposition, psychosocial factors, thyroid and adrenal disorders, medications
- Symptoms: Reduced resilience, increased sweating, joint and back pain, sleep disturbances, shortness of breath to shortness of breath, social isolation (affected persons withdraw)
- Course and prognosis: Obesity promotes the development of secondary diseases such as cardiovascular diseases, high blood pressure, diabetes mellitus and mental illnesses, and reduces the life expectancy of those affected.
Overweight in children is very common
In industrialized nations, more and more people are suffering from obesity. Children are also affected by this. The study on the health of children and adolescents (KiGGS) by the Robert Koch Institute (RKI) found that ten to 20 percent of children and adolescents in Germany are overweight. At the age of three to ten, the figure is around 12.5 percent, and as high as 18 percent among eleven- to 17-year-olds. Between three and six percent of children and adolescents are severely overweight (obese). The results show that the incidence of overweight increases with the age of the children. There are no significant differences between the sexes. On a positive note, there has been no increase in the number of cases in Germany over the last ten years.
What to do for overweight children?
Whether and how overweight children are treated depends on the extent of the excess fat deposits, any concomitant diseases and the age of the person affected – overweight children between the ages of two and six sometimes grow out of it. For this reason, doctors here recommend maintaining weight as much as possible with a healthy, balanced diet and plenty of exercise. This way, there is a chance that the children will “grow out” of the fat deposits as they get older.
If children between the ages of two and six have obesity (severe overweight) without concomitant diseases, experts also recommend maintaining the weight as much as possible. Because of the secondary diseases that severe obesity causes, a reduction in weight is more favorable in the long term.
In the case of obesity in this age group, weight loss should always be aimed for – regardless of whether concomitant diseases exist or not.
What does treatment look like?
The treatment of childhood obesity usually follows a multidisciplinary approach that includes dietary counseling and changes, regular exercise and sports, and psychological support if necessary. In certain cases of severe childhood obesity, inpatient treatment is sometimes appropriate as part of a long-term treatment program.
Dietary changes
To treat childhood obesity, a balanced diet with regular meals is necessary. One possible method is the concept of the so-called “Optimized Mixed Diet” developed by the Research Institute of Child Nutrition (FKE) for children and adolescents between one and 18 years of age. According to this, the menu is composed as follows:
- Moderate: animal foods (milk, dairy products, meat, sausage, eggs, fish)
- Sparingly: high-fat and high-sugar foods (cooking fats, confectionery, snacks)
The German Federal Center for Health Education (BZgA) makes similar suggestions, but goes into more detail about the process and the role of parents in meal planning. The BZgA advises:
- Eat regularly, together and undisturbed (e.g., not in front of the TV)
- Make meals varied (plenty of plant-based and moderately animal-based foods as well as foods high in fat and sugar, plenty of liquids)
- Observe portion sizes (e.g. the amount of vegetables fits in two palms, the amount of fruit, meat and bread rather in one palm)
- Eat only until full (do not empty your plate when you are full)
- Do not use food as a reward
- Agree on rules of behavior
Physical activity program
Regular physical activity is essential to combat childhood obesity. Endurance sports such as swimming, cycling and dancing are particularly suitable. However, many children and adolescents are not motivated enough to follow through with their sports program on their own. In this case, sports groups are recommended: Those who pedal or splash in the water together with other overweight people usually have much more fun.
Overweight children should also get plenty of exercise in everyday life, for example by taking the stairs instead of the elevator and using a bicycle or their own feet to get to school instead of getting in a car or on the bus.
Therapeutic help
Other forms of therapy
If obesity (severe overweight) in children cannot be successfully treated by conventional therapeutic measures or if there are serious concomitant diseases, other forms of therapy should be considered. These include formula diets as well as medications to aid in weight loss. The decision should be made by a therapist who has experience in the field of childhood and adolescent obesity.
At what point is a child overweight?
How much weight is too much?
However, overweight in children is not as easy to determine as in adults.
As with adults, the pediatrician first determines the body mass index (BMI), i.e. the ratio between the body weight (in kilograms) and the square of the body height (in square meters). He then compares the calculated value with the values of gender- and age-specific growth curves (percentile curves). Physicians also refer to the value as BMI percentiles. This makes it possible to assess whether a child’s BMI indicates overweight or even obesity.
Accordingly, overweight is present in children and adolescents if the calculated BMI is above the age- and sex-specific 90th percentile (90th percentile means that 90 percent of all children of the same sex and age have a lower BMI).
The BMI table for children and adolescents looks accordingly as follows:
Overweight: BMI percentiles > 90 – 97
Obesity: BMI percentiles > 97 – 99.5
Extreme obesity: BMI percentiles > 99.5
This is usually followed by a physical examination. It includes, among other things, a blood pressure measurement and measurement of the child’s height and weight. In adolescents, the pediatrician also determines the ratio of hip to waist circumference to determine the body fat distribution. Based on this distribution, physicians distinguish between two types:
- Android type: fat pads mainly on the trunk of the body
- Gynoid type: fat pads mainly on the buttocks and thighs
Further examinations
In some cases, underlying diseases such as hypothyroidism also cause overweight in children. In suspected cases, the pediatrician therefore clarifies such causative diseases by additional methods such as blood tests.
If obesity (i.e. severe overweight) is present in children, doctors recommend additional psychological, psychosocial and behavioral diagnostics. It is possible that the affected person suffers from a serious underlying psychiatric illness (such as depression, eating disorder). Sometimes there are also severe psychosocial stresses such as behavioral and developmental disorders or extreme stressful situations in the family. It is important to clarify and consider these factors when choosing a form of therapy.
What are the causes of obesity?
Overweight in children has various causes, which usually occur in combination. For example, biological or physical conditions as well as environmental and psychosocial factors influence eating behavior and thus the risk of obesity.
Heredity
Large portions during pregnancy
If pregnant women regularly eat “for two”, exercise little and gain a lot of weight or even develop gestational diabetes, the risk of the child developing obesity later increases.
Smoking
Experts more often observe that obesity often occurs in children whose parents (especially mothers) smoked during pregnancy. In addition, active and passive smoking during pregnancy pose other health risks for the offspring, such as miscarriage and sudden infant death syndrome.
Unfavorable diet
Diet has a major impact on the development of childhood obesity, right from birth. For example, studies show that breastfed children are not as likely to be overweight as children who have received replacement milk with a bottle.
Children learn their eating habits largely within the family: if parents or older siblings eat unhealthily, the offspring often take over.
Lack of exercise
Sitting in front of the TV or computer for hours on end is a major contributor to the development of obesity in children. This is all the more true if they consume sweets, potato chips and the like on the side. Here, too, the role model function of parents comes into play: if they frequently spend their free time on the couch and also eat unhealthy foods, their offspring soon imitate them.
Psychosocial factors such as stress
Sleep deprivation
Experts have been observing for several years that sleep disorders are also on the rise among children and adolescents. They found that children who tend to sleep less tend to gain weight. They therefore suspect that these children have a higher risk of developing obesity.
Commercial influences
Advertising is everywhere. Many foods, especially those that tend to be considered unhealthy, are heavily advertised in various media. Children who spend an above-average amount of time in front of the TV, for example, see the numerous TV commercials correspondingly often. But advertising also appears in other media such as social media channels, which children as well as adults perceive casually or even consciously. These openly and subconsciously influence consumer behavior, leading to more unhealthy foods being bought and eaten.
Other diseases
How does obesity manifest itself in children?
Overweight children suffer from various complaints – depending on the extent of the excess fat deposits. They are often less physically resilient and tire more quickly during exercise and sports than normal-weight peers. Some children are short of breath during exertion and experience shortness of breath during sleep or even short nocturnal breathing pauses (sleep apnea). These complaints are most severe in cases of severe obesity.
Children who weigh too much also often experience increased sweating and orthopedic problems such as back or knee pain. The latter is due to the fact that a large body weight puts a lot of stress on the joints in the long term (especially spinal joints, hip, knee and ankle joints) and accelerates their wear and tear.
Obesity in children sometimes has psychological effects. Bullying by other children and constant admonitions from parents to eat less usually place a heavy burden on those affected, so that those affected often withdraw socially and isolate themselves.
Obesity has consequences
When treating obesity in children, one should aim for realistic goals and not expect quick successes, as these usually do not last. The better chances of lasting success result from small steps toward the goal (weight constancy or weight loss).
Overweight in children usually impairs their physical and mental development. This is especially true in cases of severe overweight (obesity). Possible consequences are:
- accelerated growth in length and earlier skeletal maturity (due to increased levels of a growth factor (IGF), which is increasingly produced in fatty tissue and in the liver)
- Insulin resistance (reduced response of the body’s cells to the blood sugar-lowering hormone insulin) and subsequent 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 results in enlarged breasts, technical term: gynecomastia)
- Earlier onset of puberty (earlier onset of first menstrual period, earlier onset of voice change, etc.)
- High blood pressure (hypertension)
- Increased blood fat levels
- Overuse of tendons, joints and muscles with consequences such as back pain, flat and splay feet, knock knees or bow legs, etc.
Possible psychological consequences of (severe) overweight in children and adolescents include increased stress, anxiety and depression.
How to prevent obesity in children?
Sports and regular exercise in everyday life are decisive factors in preventing overweight. A healthy and balanced diet is equally important. Since stress also contributes to the development of overweight in children, care should be taken to minimize existing stress or prevent it from arising in the first place. Hobbies, for example, are a good way to distract oneself or to recharge one’s batteries.
A healthy family environment provides strong pillars for an equally healthy development of the child. Parents and older siblings as well as grandparents should set an example and maintain a healthy lifestyle.
