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Definition of Obesity

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Obesity is typically defined as being very overweight. The primary measure used in the assessment of obesity is body mass index (BMI). BMI is measured as:
BMI = w ÷ h²

  w = weight in kg
  h = height in metres
Generally, children whose BMI is greater than the 85th percentile are considered overweight; BMI greater than the 95th percentile are considered obese. Please see your physician for more information on BMI and BMI charts.

Risks Associated with Childhood Obesity

Childhood obesity is both an immediate and future health problem. There are a number of conditions that may be associated with childhood obesity some of which include:

  • Hypertension
  • Type II diabetes
  • Increased heart rate
  • Abnormal glucose metabolism
  • Sleep apnea
  • Cardiomyopathy
  • Pancreatitis
  • Chest wall restriction
  • Orthopedic problems
  • Hyperinsulinemia
  • Psychosocial problems:
    • Depression
    • Low self-esteem
    • Social isolation
    • Bullying
  • Eventual decreased rates of:
    • College acceptance
    • Socio-economic status
    • Marriage
Obese children who become obese adults tend to have more severe obesity in adulthood and earlier onset of co-morbid conditions. The association with adult obesity strengthens as children age and remain obese. This is due in part to the habits developed in childhood carrying over into adulthood.

Causes of Obesity

The causes of obesity are generally attributed to a combination of genetic and/or environmental factors. These are typically underlying factors driving an imbalance between the energy consumed by the individual and the energy expended.

On a practical level, the energy taken in, in terms of calories from food and beverages, is substantially greater than the energy expended. This imbalance in energy consumption and utilization can be derived from over-consumption and/or a lack of activity. Both sides of the energy balance can contribute to the level of obesity in the individual.

Children with the greatest risk of childhood obesity are those where there is a family history of obesity. Other factors that have been linked to childhood obesity include family lifestyle (smoking, poor eating habits, sedentary) and family medical history.

Treatments of Obesity

Treatments of obesity have historically been initiated in less than 20% of obese children. These treatments have predominantly not proven effective as they have been offered in a non-systemic, single-discipline format.

The current literature regarding the treatment of pediatric obesity suggests that the most successful therapy programs appear to emphasize a multi-focal, systemic, behavioural approach.

Long- term weight reduction has been reported to occur more successfully through frequent practitioner visits and inclusion of family in the treatment program. Overall weight reduction has been found to be greatest in programs where both the parent and child were targeted. To facilitate weight loss, families need to be taught to decrease intake and improve nutrient density. Without having detrimental effects on growth, successful dieting in children needs to focus on changing food preference, normalizing eating patterns with less emphasis on restriction and avoidance, and removing food as a reward system. In addition, encouraging increased physical activity, while decreasing sedentary activities, remains a mainstay of weight loss.

Treatment success is said to depend on the practitioner’s ability to implement appropriate treatment and provide close follow-up. Effective treatment and follow-up must be supported with the following:

  • Setting realistic goals that both parent and child can work toward together;
  • counselling to promote positive family attitudes toward healthy eating and exercise, and
  • educating parents and children in all areas of pediatric obesity, including causes, effects and treatments.

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