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Definition:Obesity is defined as an excessive accumulation of body fat. Obesity is present when total body weight is more than 25 percent fat in boys and more than 32 percent fat in girls (Lohman, 1987). Although childhood obesity is often defined as a weight-for-height in excess of 120 percent of the ideal, skinfold measures are more accurate determinants of fatness (Dietz, 1983; Lohman, 1987).
A trained technician may obtain skinfold measures relatively easily in either a school or clinical setting. The triceps alone, triceps and subscapular, triceps and calf, and calf alone have been used with children and adolescents. When the triceps and calf are used, a sum of skinfolds of 10-25mm is considered optimal for boys, and 16-30mm is optimal for girls (Lohman, 1987).
A few extra pounds do not suggest obesity. However they may indicate a tendency to gain weight easily and a need for changes in diet and/or exercise. Generally, a child is not considered obese until the weight is at least 10 percent higher than what is recommended for the height and body type. Obesity most commonly begins in childhood between the ages of 5 and 6, and during adolescence. Studies have shown that a child who is obese between the ages of 10 and 13 has an 80 percent chance of becoming an obese adult.
The causes of obesity are complex and include genetic, biological, behavioral and cultural factors. Basically, obesity occurs when a person eats more calories than the body burns up. If one parent is obese, there is a 50 percent chance that the children will also be obese. However, when both parents are obese, the children have an 80 percent chance of being obese. Although certain medical disorders can cause obesity, less than 1 percent of all obesity is caused by physical problems. Obesity in childhood and adolescence can be related to:
* poor eating habits
* overeating or binging
* lack of exercise (i.e., couch potato kids)
* family history of obesity
* medical illness (endocrine, neurological problems)
* medications (steroids, some psychiatric medications)
* stressful life events or changes (separations, divorce, moves, deaths, abuse)
* family and peer problems
* low self-esteem
* depression or other emotional problems
As with adult-onset obesity, childhood obesity has multiple causes centering around an imbalance between energy in (calories obtained from food) and energy out (calories expended in the basal metabolic rate and physical activity). Childhood obesity most likely results from an interaction of nutritional, psychological, familial, and physiological factors.
* The Family
The risk of becoming obese is greatest among children who have two obese parents (Dietz, 1983). This may be due to powerful genetic factors or to parental modeling of both eating and exercise behaviors, indirectly affecting the child’s energy balance. One half of parents of elementary school children never exercise vigorously (Ross & Pate, 1987).
* Low-energy Expenditure
The average American child spends several hours each day watching television; time which in previous years might have been devoted to physical pursuits. Obesity is greater among children and adolescents who frequently watch television (Dietz & Gortmaker, 1985), not only because little energy is expended while viewing but also because of concurrent consumption of high-calorie snacks. Only about one-third of elementary children have daily physical education, and fewer than one-fifth have extracurricular physical activity programs at their schools (Ross & Pate, 1987).
Since not all children who eat non-nutritious foods, watch several hours of television daily, and are relatively inactive develop obesity, the search continues for alternative causes. Heredity has recently been shown to influence fatness, regional fat distribution, and response to overfeeding (Bouchard et al., 1990). In addition, infants born to overweight mothers have been found to be less active and to gain more weight by age three months when compared with infants of normal weight mothers, suggesting a possible inborn drive to conserve energy (Roberts, Savage, Coward, Chew, & Lucas, 1988).
There are many risks and complications with obesity. Physical consequences include:
* increased risk of heart disease
* high blood pressure
* breathing problems
* trouble sleeping
Child and adolescent obesity is also associated with increased risk of emotional problems. Teens with weight problems tend to have much lower self-esteem and be less popular with peers. Depression, anxiety, and obsessive compulsive disorder can also occur.
Obese children need a thorough medical evaluation be a pediatrician or family physician to consider the possibility of a physical cause. In the absence of a physical disorder, the only way to lose weight is to reduce the number of calories being eaten to increase the child’s or adolescent’s level of physical activity. Lasting weight loss can only occur when there is self-motivation. Since obesity affects more than one family member, making healthy eating and regular exercise a family activity can improve the chances of successful weight control for the child or adolescent.
Obesity treatment programs for children and adolescents rarely have weight loss as a goal. Rather, the aim is to slow or halt weight gain so the child will grow into his or her body weight over a period of months to years. Dietz (1983) estimates that for every 20 percent excess of ideal body weight, the child will need one and one-half years of weight maintenance to attain ideal body weight.
Early and appropriate intervention is particularly valuable. There is considerable evidence that childhood eating and exercise habits are more easily modified than adult habits (Wolf, Cohen, Rosenfeld, 1985). Three forms of intervention include:
Adopting a formal exercise program, or simply becoming more active, is valuable to burn fat, increase energy expenditure, and maintain lost weight. Most studies of children have not shown exercise to be a successful strategy for weight loss unless coupled with another intervention, such as nutrition education or behavior modification (Wolf et al., 1985). However, exercise has additional health benefits. Even when children’s body weight and fatness did not change following 50 minutes of aerobic exercise three times per week, blood lipid profiles and blood pressure did improve (Becque, Katch, Rocchini, Marks, & Moorehead, 1988).
2. Diet Management
Fasting or extreme caloric restriction is not advisable for children. Not only is this approach psychologically stressful, but it may adversely affect growth and the child’s perception of “normal” eating. Balanced diets with moderate caloric restriction, especially reduced dietary fat, have been used successfully in treating obesity (Dietz, 1983). Nutrition education may be necessary. Diet management coupled with exercise is an effective treatment for childhood obesity (Wolf et al., 1985).
3. Behavior Modification
Many behavioral strategies used with adults have been successfully applied to children and adolescents: self-monitoring and recording food intake and physical activity, slowing the rate of eating, limiting the time and place of eating, and using rewards and incentives for desirable behaviors. Particularly effective are behaviorally based treatments that include parents (Epstein et al., 1987). Graves, Meyers, and Clark (1988) used problem-solving exercises in a parent-child behavioral program and found children in the problem-solving group, but not those in the behavioral treatment-only group, significantly reduced percent overweight and maintained reduced weight for six months. Problem-solving training involved identifying possible weight-control problems and, as a group, discussing solutions.
Obesity frequently becomes a lifelong issue. The reason most obese adolescents gain back their pounds is that after they have reached their goal, they go back to their old habits of eating and exercising. An obese adolescent must therefore learn to eat and enjoy healthy foods in moderate amounts and to exercise regularly to maintain the desired weight. Parents of an obese child can improve their children’s self esteem by emphasizing the child’s strengths and positive qualities rather than just focusing on their weight problem.
When a child or adolescent with obesity also has emotional problems, a child and adolescent psychiatrist can work with the child’s family physician to develop a comprehensive treatment plan. Such a plan would include reasonable weight loss goals, dietary and physical activity management, behavior modification, and family involvement.