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Endocrine, Family Medcine, Medical Oct 23, 2020 0

Dr. Adel Hamamsy

Specialist Pediatrician

Med care Medical center-Sharjah

Overweight and obesity are defined as abnormal or excessive fat accumulation that presents a risk to health. A body mass index (BMI) over 25 is considered overweight, and over 30 is obese. The issue has grown to epidemic proportions, with over 4 million people dying each year as a result of being overweight or obese in 2017 according to the global burden of disease.

Obesity is a complex health issue resulting from a combination of causes and individual factors such as behavior and genetics. Behaviors can include physical activity, inactivity, dietary patterns, medication use, and other exposures. Additional contributing factors include the food and physical activity environment, education and skills, and food marketing and promotion.

Obesity is serious because it is associated with poorer mental health outcomes and reduced quality of life. Obesity is also associated with the leading causes of death in the United States and worldwide, including diabetes, heart disease, stroke, and some types of cancer.

pathogenesis

These effects of obesity result from two factors: the increased mass of adipose tissue and the increased secretion of pathogenetic products from enlarged fat cells. This concept of the pathogenesis of obesity as a disease allows an easy division of disadvantages of obesity into those produced by the mass of fat and those produced by the metabolic effects of fat cells. In the former category are the social disabilities resulting from the stigma associated with obesity, sleep apnea that results in part from increased parapharyngeal fat deposits, and osteoarthritis resulting from the wear and tear on joints from carrying an increased mass of fat. The second category includes the metabolic factors associated with distant effects of products released from enlarged fat cells. The insulin-resistant state that is so common in obesity probably reflects the effects of increased release of fatty acids from fat cells that are then stored in the liver or muscle. When the secretory capacity of the pancreas is overwhelmed by battling insulin resistance, diabetes develops. The strong association of increased fat, especially visceral fat, with diabetes makes this consequence particularly ominous for health care costs. The release of cytokines, particularly IL-6, from the fat cell may stimulate the proinflammatory state that characterizes obesity. The increased secretion of prothrombin activator inhibitor-1 from fat cells may play a role in the procoagulant state of obesity and, along with changes in endothelial function, may be responsible for the increased risk of cardiovascular disease and hypertension. For cancer, the production of estrogens by the enlarged stromal mass plays a role in the risk for breast cancer. Increased cytokine release may play a role in other forms of proliferative growth. The combined effect of these pathogenetic consequences of increased fat stores is an increased risk of shortened life expectancy.

Childhood Obesity Causes & Consequences

Childhood obesity is a complex health issue. It occurs when a child is well above the normal or healthy weight for his or her age and height. The causes of excess weight gain in young people are similar to those in adults, including behavior and genetics. Obesity is also influenced by a person’s community as it can affect the ability to make healthy choices.

Behavior

Behaviors that influence excess weight gain include eating high-calorie, low-nutrient foods and beverages, medication use and sleep routines. Not getting enough physical activity and spending too much time on sedentary activities such as watching television or other screen devices can lead to weight gain.

In contrast, consuming healthy foods and being physically active can help children grow and maintain a healthy weight. Balancing energy or calories consumed from foods and beverages with the calories burned through activity plays a role in preventing excess weight gain. In addition, eating healthy foods and being physically active helps to prevent chronic diseases such as type 2 diabetes, some cancers, and heart disease.

Use these resources to eat well and be active!

A healthy diet;It emphasizes eating a variety of vegetables and fruits, whole grains, a variety of lean protein foods, and low-fat and fat-free dairy products. It also recommends limiting foods and beverages with added sugars, solid fats, or sodium.

The Physical Activity Guidelines for Americansexternal icon recommends children aged 6 – 17 years do at least 60 minutes of moderate to vigorous physical activity every day. Children aged 3 through 5 years should be physically active throughout the day for growth and development.

Community Environment

It can be difficult to make healthy food choices and get enough physical activity in environments that do not support healthy habits. Places such as childcare centers, schools, or communities can affect diet and activity through the foods and drinks they offer and the opportunities for physical activity they provide. Other community factors include the affordability of healthy food options, peer and social supports, marketing and promotion, and policies that determine how a community is designed.

Consequences of Obesity

More Immediate Health Risks

Obesity during childhood can harm the body in a variety of ways. Children who have obesity are more likely to have:
- High blood pressure and high cholesterol, which are risk factors for cardiovascular disease.
- Increased risk of impaired glucose tolerance, insulin resistance, and type 2 diabetes.
- Breathing problems, such as asthma and sleep apnea.
- Joint problems and musculoskeletal discomfort.
- Fatty liver disease, gallstones, and gastro-esophageal reflux (i.e., heartburn).

Childhood obesity is also related to

- Psychological problems such as anxiety and depression.
- Low self-esteem and lower self-reported quality of life.
- Social problems such as bullying and stigma.

Future Health Risks

Children who have obesity are more likely to become adults with obesity. Adult obesity is associated with increased risk of several serious health conditions including heart disease, type 2 diabetes, and cancer.
If children have obesity, their obesity and disease risk factors in adulthood are likely to be more severe.

Weight Loss Strategies

Weight loss and maintenance strategies include dietary therapy, physical activity, lifestyle modification, behaviour therapy, pharmacotherapy and occasionally surgery. Using these techniques the goals are, at least to prevent further weight gain, or achieve weight reduction and maintain the lower body weight over a long term

Several expert panels have suggested the best methods of assessing and treating obesity. Currently, weight loss therapy is recommended for patients with a BMI ≥ 30 kg/m² and those with a BMI between 25 and 29.9 kg/m² or a high-risk waist circumference who additionally have two or more cardiovascular risk factors. Treatment must be geared to a 10-percent body weight reduction over a 6-month period, at a rate of 0.5 to 1 kg per week (2 – 4 kg per month).

Dietary therapy should ensure an intake reduced by 500 to 1,000 kcal/day from the current level. Low calorie diets (LCDs) containing 1,000 to 1,200 kcal/day for most women and between 1,200 kcal/day and 1,600 kcal/day for men can result in sufficient weight reduction. Very low calorie diets (VLCDs) containing less than 800 kcal/day are no more effective than LCDs in producing weight loss and are to be discouraged.

Physical activity increases energy expenditure and also reduces the risk of heart disease more than that achieved by weight loss alone. Physical activity (walking, dancing, gardening, household chores and team or individual sports) should be increased slowly to a level that ensures at least 30 minutes or more of moderate-intensity physical activity on most, and preferably all, days of the week. Behavioural strategies including self-monitoring, stress management and social support can enhance the gains from dietary methods and physical activity.

Drug therapy should be used only in conjunction with diet, physical activity changes, and behaviour therapy and only when these measures have failed to promote weight loss after 6 months. Orlistat, an oral pancreatic lipase inhibitor which inhibits the absorption of 30% of ingested fat from the intestine, is currently the only drug approved by the Ghana Food and Drugs Board for long-term treatment of obesity. Its side-effects may include abdominal pain, flatulence and oily stools following a meal containing fat.

Weight loss surgery, using various techniques, is an option only for well-informed and motivated patients who have clinically severe obesity (BMI ≥ 40 kg/m²) or a BMI ≥ 35 kg/m² accompanied by serious co-morbid conditions.

Preventive Strategies

Prevention is the key to controlling the obesity epidemic. The various prevention strategies recommended by the WHO include; a universal or public health approach directed at all members of a community; a selective approach directed at high-risk individuals and groups; and a targeted approach directed at individuals with weight-related problems and those at high risk of diseases associated with overweight and obesity. Of these the population-wide obesity prevention programs have a greater potential of stemming the obesity epidemic and being more cost-effective than the clinic-based treatments. The WHO has further suggested the incorporation of the objectives of obesity prevention into the strategies and programmes for controlling other CVD-related non-communicable diseases (NCDs). since many of these conditions share common risk factors.

An overview of obesity in children