PARENTAL GUIDELINES FOR

OVERWEIGHT & OBESITY IN CHILDREN & TEENS

Overweight and obesity are a significant public health concern even for children and teenagers.  The prevalence of obesity for children and adolescents aged 2-19 years is 18.5% and affects about 13.7 million children and adolescents in USA, whereas in India it is about 14%  and growing . With the COVID lockdown, the incidence has further increased.

Overweight is defined as increased weight for age, height and gender of child. Standard charts like IAP, WHO , NCHS, UNICEF ,CDC which have  weight and height for age and gender, are used to identify overweight and obesity in children and teenagers .  WHO has declared Obesity as a disease process in 1998, requiring treatment.

Overweight & obesity in children & teenagers is associated with multiple health problems.

 Physical health problems include early onset high blood pressure, pre diabetes high serum insulin levels , high lipids (total cholesterol and  triglycerides) , acne , hair loss , irregular menses , PCOS ,fungal infections , joint problems and respiratory infections.

Pre diabetes is increased, especially if family history is present. 

Emotional health problems may arise as many children & teenagers are subjected to vicious attacks of peer pressure and bullying due to their weight. They may face isolation due to a lack of friends in the real world. As a result, loneliness creeps in and they spend long hours on media with more “cyber friends” than real friends, and may indulge in compensatory overeating as a “feel good factor”. Eventually they develop body image issues

All this would finally leads to low self esteem, lack of self confidence, anxiety, depression, lack of focus, aggression and/or passive aggressive behavior.

This can present with scholastic backwardness in form of poor academic achievement. Metabolic consequences of obesity and psychological impact are higher in girls. 

Causes of overweight & obesity are multi-factorial, commonest being lack of physical activity, over eating (large portion size), eating high caloric diet, long hours spent on media (TV, Internet, social media, gaming), hormonal problems, medical problems like thyroid abnormalities, anemia and other genetic problems, and family history of obesity .

Whatever is the cause of overweight & obesity, it is essential that child be diagnosed, investigated and treated accordingly. 

Parents must watch for certain physical signs and symptoms:

Lethargy , fatigue , joint pains , breathlessness , lack of interest and focus , easy crying ,  sudden bouts of anger and temper , prolonged periods of locking themselves up in room , asking meals to be served in room instead of having meals with family , self abuse in terms of over eating , physical hurt to self , wearing very loose clothes , not responding to spoken words .

Evaluation of overweight or obese child/teenager include :

• Medical evaluation  and diagnostic tests including blood evaluation , ECG , lung function tests , Ambulatory BP if required ( in teenager )
• Nutritional assessment of eating habits in form of frequency of eating out , intake of calories , frequency and portion size of energy rich foods, intake of fruits and vegetables, number of meals /day and skipped meals if any .
• Identify media addiction
• Exercise protocols to be customized per child/teenager as per their requirement
• Counseling including cognitive behavior counseling , dietary & lifestyle modification counseling , which will include child/teenager as well as parents ( entire family )

Parental Tips :

• Spend adequate time with your child /teen . Be present for your child.
• Communicate with your child
• Meal times should be happy time with all family members.
• Meals should not be eaten in front of TV or in bedroom.
• Breakfast must be the most important meal of the day .
• Small 5-6 meals / day should be taken which consists of 3 main meals and 2-3 small snacks which are balanced with right proportion of carbohydrates, proteins, fat and adequate amount of water .
• Starchy food with high glycemic index should be reduced, increase intake of high fibred diet.
• Force feeding should not be done. It is ok to leave some food on plate
• Holiday times should be used for cleaning house or community activity which allows the child to have some form of activity instead of waking up late and sitting in front of TV
• Child should accompany parents at times for food shopping and learn to read food labels before buying processed food
• Dieting in children and adolescents is not healthy as this is the  growth phase
• Healthy eating behavioral practice should be encouraged for the whole family

Prevention forms the key and can be achieved by

• Increase activity ,
• Reduce time on TV, media .
• Family activities like meal planning and physical activity together goes a long way to motivate children.
• Parents should set an example and avoid junk food themselves.
•  Food should not be used as a motivator to motivate child to perform well on any activity
• Parents should keep watch, as it does not take time for overweight children and teens to become obese . 
• Weight maintenance over a period of time (maybe 2 years) without weight gain, in the right zone for age will lead to balancing of weight for height and allow the body to grow without micronutrient deficiency.

 Pediatric & Adolescent Medicine Unit of Fayth Clinic  ensures that  Overweight & Obesity in Children and teenagers  are treated under the  National Guidelines laid down by the Indian Academy of Pediatrics which leads to healthy weight loss and prevents the complications of obesity.  This enables the child /teenager to adopt healthy lifestyle changes leading to healthy eating practices, coping skills, develop healthy body image and to deal with peer pressure in the most effective way.

Other Services include: vaccinations, Pediatric & adolescent OPD, treatment of PCOS, Acne, thyroid, short stature, poor academic performance, counseling etc

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