Childhood Obesity

Original Editors - Alexander Dow, Andrea Civitarese, Lynne Turner, Alison O’Brien, Rachael Le Page, Courtney Ferguson as part of the Queen Margaret University's Current and Emerging Roles in Physiotherapy Practice Project
Top Contributors - Andrea Civitarese, Rachael Le Page, Lynne Turner, Kim Jackson, Lucinda hampton, Courtney Ferguson, Alison O' Brien, Alexander Dow and Rachael Lowe

Introduction

Overweight and obesity are defined as ''abnormal or excessive fat accumulation that presents a risk to health''.

Childhood obesity is one of the most serious public health challenges of the 21st century. The problem is global and is steadily affecting many low- and middle-income countries, particularly in urban settings. The prevalence has increased at an alarming rate. Globally in 2016, the number of overweight children under the age of five, is estimated to have been over 41 million. Almost half of all overweight children under 5 lived in Asia and one quarter lived in Africa. Overweight and obese children are likely to stay obese into adulthood and more likely to develop noncommunicable diseases (eg diabetes and cardiovascular diseases) at a younger age. Overweight and obesity, as well as their related diseases, are largely preventable. Prevention of childhood obesity needs high priority.

The BMI provides the most useful population-level measure of overweight and obesity. However, it should be considered as a rough guide because it may not correspond to the same body fat percentage in different individuals. It is difficult to develop one simple index for the measurement of overweight and obesity in children and adolescents because their bodies undergo a number of physiological changes as they grow.

Why Does This Matter?

Childhood obesity is associated with a higher chance of premature death and disability in adulthood. Overweight and obese children are more likely to stay obese into adulthood and to develop noncommunicable diseases (NCDs).

This less than 2 minute video is a worthwhile watch.

 

Double Burden of Malnutrition

Many low- and middle-income countries are now facing the so-called double burden of disease. As they continue to struggle with the problems of infectious diseases and under-nutrition, at the same time they are experiencing a rapid increase in risk factors of NCDs such as obesity and overweight, particularly in urban settings. This double burden is caused by inadequate prenatal, infant and child nutrition, which is then followed by exposure to high fat, energy dense, micronutrient poor foods and a lack of physical activity as the child grows older.

Etiology

The fundamental cause of childhood overweight and obesity is an energy imbalance between calories consumed and calories expended.

Global increases in childhood overweight and obesity are attributable to several factors.

1. There has been a global shift in diet towards increased intake of energy-dense foods that are high in fat and sugars but low in vitamins, minerals and other healthy micronutrients.
2. There is also a trend towards decreased physical activity levels due to the increasingly sedentary nature of many forms of recreation time, changing modes of transportation and increasing urbanization.

The problem is societal and therefore it demands a population-based multisectoral, multidisciplinary and culturally relevant approach.

• Unlike most adults, children and adolescents cannot choose the environment in which they live or the food they eat. They also have a limited ability to understand the long-term consequences of their behaviour. They therefore require special attention when fighting the obesity epidemic.

Fighting the Epidemic

WHO recommends the following to reduce and prevent childhood overweight and obesity:

1. Increase consumption of fruit and vegetables, as well as legumes, whole grains and nuts
2. Limit energy intake from total fats and shift fat consumption away from saturated fats to unsaturated fats
3. Limit the intake of sugars
4. Be physically active and accumulate at least 60 minutes of regular, moderate- to vigorous-intensity activity each day that is developmentally appropriate.

Image 3: Eat well guide for parental guidance .

The Benefits Of Physical Activity

Physical activity and inactivity can have a big effect on a child's health and development in many ways. It is important to know and understand the benefits of regular activity and the risk of inactivity for a child between the ages of 5 - 12 years old.

Regular Activity

Encouraging a child participate in regular physical activity between the ages of 5 - 12 years old will benefit their body and mind health in a variety of ways including mentally, physically and academically . These benefits are detailed below:

The video below provides more details of the top 5 benefits of physical activity for children.

 

Inactivity

It is common to find children playing video games and watching television, however, this leads to a lot of sitting and therefore to an inactive lifestyle which can have a detrimental effect on on children's future health. These effects may not show until later life. It is important to be aware of the higher risk of developing non communicable diseases due to childhood inactivity and encourage regular physical activity to help reduce and prevent a child developing them in adulthood.

• Obesity
• Heart disease eg coronary arterial disease
• Stroke
• Diabetes
• Cancer
• Mental health disease eg anxiety, depression and dementia
• Earlier death

Physical Activity Guidelines for Children (Age 5-12)

Children (aged 5-12) should partake in at least 60 minutes of physical activity a day - this should range from moderate activity to vigorous activity. Amounts of physical activity greater than 60 minutes, provides additional heath benefits to your child.

Moderate Activity

Moderate activity raises the heart rate and can make a person sweat. Examples of activities which involve moderate exertion for children include:

• Cycling on flat ground
• Walking to school
• Playing in the playground
• Walking the dog
• Riding a scooter
• Rollerblading

Vigorous Activity

Vigorous activity is known to improve general health, bone and muscle strength and self-esteem. Vigorous activity can bring health benefits over and above that of moderate activity. Every one-minute of vigorous activity provides the same health benefits as two-minutes of moderate activity . Examples of activities which involve vigorous exercise for children include:

• Swimming
• Running
• Gymnastics
• Football
• Karate
• Rugby

Bone Strengthening Activities

Children should include bone and muscle strengthening exercises at least 3 days a week. Many vigorous activities can help to build strong muscles and bones in children. This can include anything involving running and jumping, such as football or gymnastics. Examples of suitable bone strengthening activities for children:

• Body weight lifting exercises
• Jumping and climbing activites
• Hopscotch
• Rope Skipping

Examples of suitable muscle-strengthening activities for children:

• Sit-ups and Press-ups
• Gymnastics
• Resistance band exercises
• Rock Climbing

Click here to download a helpful fact sheet on physical activity guidelines for children .

Managing Childhood Obesity

See Management of Obesity

It is important to encourage parents to take proactive steps in managing their child's weight. Once they have identified problems it is important to take steps to effect change.

Remind parents they are not alone, they can consult their General Practitioner and other health professionals for advice .

Apps

We are in the age of technology and it may be easier to encourage children to get active by the use of free online Apps. Below is a list of free apps online that may help parents to engage their child in physical activity and also provide ideas of activities. This is not an exhaustive list and there is a wide variety and many more apps available.

1. HOOP: Find and book fun things to do in your local area for children aged 0-11 years old. (iOS & Android)
2. Kiddy Keep Fit by Scotty & Lulu: Uses music and games to get children moving and exercising. (iOS)
3. 7-minute workout for kids: High intensity workouts with rests to develop strength, stability and balance. (iOS)
4. Habitz: Set up by Health Professionals to help parents to inspire their children to develop healthy habits and lifestyles. (iOS)
5. Sworkit Kids – Fitness Meets Fun (7-14 year olds): Wide variety and duration of fun exercises to develop and enhance strength, agility and flexibility. (iOS & Android)
6. Appu’s Yoga for Kids: Easy yoga poses for children to enhance and refresh your child's body and mind. (iOS & Android)
7. Wuf Shanti Yoga Fun Machine: Yoga app using games and music to promote health and happiness for your child through yoga, meditation and mindfulness. (iOS)

Conclusion

Childhood obesity between the ages of 5-12 years old is rising and is a current global concern and challenge. Unfortunately, in this present age the growing popularity in the daily use of technology in children, among the many other barriers mentioned above, is enhancing an inactive lifestyle. It is important to recognise and understand childhood obesity and how to encourage children to become more active and make changes to help manage a child’s weight and maintain a healthy lifestyle.

Useful Links

• NHS Choices: What can I do if my child is very overweight?
• Article: TV in bedroom 'risk factor' for child obesity
• BBC: What to do if your child is overweight
• NHS: Change 4 Life

• NHS Livewell: advice for children health ages 6-15
• Families online: child-wellbeing
• CDC Government: Obesity causes
• MEND Foundation
• More Life
• Childhood Obesity and Weight Problems Help Guide
• Kids eat right: How to Talk to Kids about Weight and Obesity
• Tips for Parents – Ideas to Help Children and Maintain a Healthy Weight: Centers for Disease Control and Prevention
• Healthy Kids' Lunchbox Recipe Ideas