Childhood Obesity: An Increasing Concern

     Childhood obesity is a growing problem that can have long-term health impacts. The Pediatric Department and Healthy Child Clinic at Ramkhamhaeng 2 Hospital are dedicated to nurturing children's health through accurate diagnosis, treatment, and guidance. With proper nutrition and sufficient exercise, today's children can grow up strong and happy.

Factors Contributing to Childhood Obesity

• Maternal Obesity: Mothers who are overweight, especially those with gestational diabetes, can increase the risk of obesity in their children.
• High Birth Weight: Babies born with a high birth weight may have a greater likelihood of becoming overweight in early childhood.
• Rapid Weight Gain in Early Childhood: Children who gain weight quickly in their first two years are more prone to obesity due to changes in fat cell composition.
• Excess Fat by Age 5: Normally, children at this age should have the lowest body fat percentage, about 15% of their body weight. Those with higher fat levels may face obesity challenges later on.
• Adolescence: Around 80% of overweight adolescents continue to be obese into adulthood.
• Health Complications in Adulthood: Obese adults face numerous complications, such as diabetes, high blood pressure, and cardiovascular diseases, with a 20% higher risk of heart disease within 10 years if there are additional risk factors.

The Recommendations For Prevention

• Pre-Pregnancy Consultation: Overweight women should consult a doctor before pregnancy to manage weight gain during pregnancy.
• Breastfeeding: Infants should be breastfed for at least six months. Formula-fed infants are twice as likely to become obese.
• Introduction of Solid Foods: Solid foods should be introduced around 4-6 months of age, as starting too early increases obesity risk.
• Monitoring Growth: Parents should consult a doctor if an infant gains weight rapidly without proportional height growth, as excessive weight gain in the first two years can lead to fat tissue accumulation.
• Healthy Proportions by Age 5: By age 5, children should have a healthy weight to avoid easier fat accumulation in later years.
• Family Involvement: If weight issues persist into adolescence, family support is crucial, along with lifestyle changes to balance energy intake and expenditure.

Who Should Receive Care?

• All children experiencing rapid weight gain not proportional to height (ideal weight for height > 120%), especially those under 5 years old.
• Overweight children with mothers classified as obese (BMI > 30).
• Children with a family history of obesity.
• Children with overweight parents who have early-onset cardiovascular disease (father under 55, mother under 65) or have diabetes and hypertension.
• Children who are severely obese.
• Children with obesity-related complications, such as diabetes, high blood pressure, obstructive sleep apnea, hip pain, depression, and menstrual irregularities.

Visiting the Obesity Clinic

• Schedule an appointment at the Pediatric OPD.
• A parent or caregiver should accompany the child for direct consultation with the doctor.
• Keep a food diary for 5-7 days, noting all food and portion sizes, to aid in weight management discussions.

Assessments at the Obesity Clinic

• Body Composition Measurement: To evaluate muscle and fat levels, considering hydration status for accurate calculations.
• Blood Tests: To check necessary vitamins and minerals for growth.
• If complications arise, further specialist consultations may be needed.

Weight Management Goals

• For mild obesity, the goal is to stabilize weight while decreasing fat and increasing muscle mass over 1-2 years.
• For severe obesity or obesity with complications, a 10% weight reduction is targeted within one year for children over 7 years old.

Success Factors in Weight Management

• Family cooperation.
• Genetics and environmental influences.

References

• Suntharee Rattanachueak et al. Thai Pediatric Nutrition Society, Royal College of Pediatricians of Thailand. Clinical Practice Guidelines for the Prevention and Treatment of Childhood Obesity. Revised Edition, May 22, 2017.
• American Academy of Pediatrics. Pediatric Nutrition, 7th edition, 2014; chapter 34.
• Ross AC et al. Modern Nutrition in Health and Disease, 11th edition, 2014; chapters 48, 58, 65.

Effective weight loss requires family cooperation and daily lifestyle changes to maintain a balance between energy intake and expenditure.