Dr Hudson Q&A on Obesity
General Paediatrician and Consultant at Great Ormond Street Hospital Dr Lee Hudson discusses children’s weight and obesity in a question and answer session for parents interested keeping their children healthy this World Anti-Obesity Day.
What does ‘overweight’ and ‘obese’ mean?
Overweight means that someone’s weight – but more specifically their body fat – is above what is conventionally thought to be healthy. If someone is overweight it means that their body fat is higher than would be advised, and it may have impact on their health (both right now and in the future). Obesity is a level of overweight that is considered to be quite severe and it is thought to mean even greater risk for current and future problems. In an adult, the definition of overweight is having a body mass index (calculated by weight divided by the square of height) of over 25, and obesity over 30. In children this is different because children are still growing and developing and so doctors use something called ‘percentiles’ which tracks children’s height and weight against an average. A child over the 85th-90th centile are usually considered overweight, but a child over the 95-98th centile are considered obese.
World obesity is climbing, with more than 1.4 million adults classified as ‘overweight’, which is why understanding about the risks relating to obesity is important. 44% of the diabetes burden, 23% of the ischaemic heart disease burden and between 7% and 41% of certain cancer burdens are attributable to being overweight or obese. More than 40 million children under the age of five were classified as overweight in 2011.
What are the medical concerns for obese children?
They are very similar to adults. We know that adults with obesity have a greater risk of heart disease (such as heart attacks or strokes) and diabetes. It is currently felt that children with obesity will be at greater risk of these diseases in the future. We also know that children and young people with obesity have current problems – in particular issues with self-esteem and other mental health problems – as well as problems with diabetes. As it was revealed by the Dasman Centre in Kuwait, 37% of children in Kuwait are diabetic, so it is important to be aware of the health risks associated with obesity. Some children with obesity will develop disordered eating and have difficult and unhappy relationships with food because of their obesity.
What can be done to help children who are overweight or obese?
In regards to being overweight and obese the answer is always prevention through the education of children and parents to stop the problem ever occurring. However, if a child is already overweight than the main thing is to try and prevent them gaining any more weight and then to try and reduce their weight. Things like keeping children physically active, limiting their time watching TV (especially when eating as they tend to not sense how much they are eating), being careful about portion sizes are all important ways of preventing further increase in weight. When possible make sure children do not skip meals as this will make them eat more at any given meal. Children are also really interested in, and tend to copy, what we as parents and adults do – so parents and relatives can try and demonstrate healthy eating to set a good example.
There is no single method that works to reduce the weight of an obese child. It needs efforts in different zones of a child and young person’s life. One way of thinking about risk in children and young people is to find evidence of other risk factors that go along with obesity – like high blood pressure. Finding high blood pressure can help children understand how big a problem being overweight is to their health and to help motivate changes for the future. For some young people who have a significant level of obesity, bariatric surgery might also be helpful.
Why is prevention so important?
Attempting to lose weight, which is often accompanied by a change in habits, is hard. It is easier to prevent the problem than try and solve it, especially as the treatment for being overweight is usually the same as the way to prevent it: eating well and exercising regularly. Trying not to get into the problem in the first place is therefore important. Prevention is always better than a cure.
What would you recommend for parents who are worried about their children’s weight?
Setting good examples for their around food is important, but also understanding why many children tend to become overweight is essential. Problems with weight tend to build up slowly over time and many families do not notice until problems are established. It always better to share a healthy lifestyle with your children even if weight is not a problem to ensure that children are given the best chance at a healthy and long life. Telling children off and punishing them for being overweight is unlikely to help, and the best approach is for the whole family to take part in healthy lifestyle changes, like eating better and doing more exercise. If you are worried about your child’s weight, then seeking advice and support from a health professional like a doctor or a dietician can be helpful.
Obesity is often referred to as an ‘epidemic’. What does this mean?
Obesity is often called the new “epidemic” because most countries around the world have seen a quick risk in the amounts of children and adults with obesity. This rise will mean an increased rate of illnesses that accompany obesity – such as high blood pressure, strokes and diabetes. This has very big implications for the health of all people within countries, regions and the world from now and into the future. In order to prevent a strain on healthcare systems around the world and an increase in preventable illnesses and death it is important to maintain a healthy lifestyle at whatever age.
Tips for parents
Top tips from Lee Hudson, Consultant General Paediatrician, and Bahee Van de Bor, Specialist Paediatric Dietitian, at GOSH to help get kids and families healthy and active.
- Get active! Exercising is important for preventing weight problems.
Kids need about 60 minutes a day and they need help achieving this both in school and at home. Encourage them to join a school sports team or take part in school activities. After school, look into local after school clubs or sports teams; there are lots of fun ways for kids to do 60 minutes without making it a chore. Activities such as cycling, walking, playing tag, jumping rope or swimming and dancing are great activities to encourage your child to do exercise.
- Join in as a family
Exercise is more fun as a family! It should be encouraged and integrated in everyday family life. This can be small, incremental changes (e.g. deciding to walk to school rather than taking the car), to bigger changes (e.g. family trips to the swimming pool or going on a family bike ride).
- Reducing screen time
Reducing the amount of time kids spend in front of a screen, such as a computer, television or video game consoles is also beneficial.
- Be a good role model
All the family need to be on board with a healthy ‘get fit, get active’ attitude so the child doesn’t feel odd or singled out. This will soon make this healthy attitude a normal, everyday part of family life.
- Eat well
It’s important that the body is fuelled correctly to feel the benefits of doing exercise. Make sure the family are eating regular, healthy and properly portioned meals every day. Watch out of sugary snacks and drinks in between meals and instead snack on fruit or nuts and drink water where necessary.