Which of the following is not true about childhood obesity? Childhood obesity is undoubtedly one of the main health problems facing the developed world, having been identified by the World Health Organization as the twenty-first century nutritional epidemic.
which of the following is not true about childhood obesity?
Although the causes of this epidemic are multifactorial, including genetic and environmental causes, in general we can admit that the excess body fat that defines it is mainly due to an imbalance between intake and energy expenditure. There are numerous authors who highlight the existence of an obesogenic environment in our society,
characterized by the availability at all times of abundant foods rich in energy, refined sugars, saturated fats and salt, the development of a sedentary type of leisure that includes consumption of countless hours of television a day, video game consoles, smartphones, etc., and a significant decrease in the hours dedicated by children to the practice of physical activity, both in the form of sports and games.
Although the concept of obesity is clear to everyone, its proper diagnosis continues to be a source of discussion.
Obesity is equivalent to excess body fat, therefore, for a precise diagnosis, a marker or somatometric determination is needed that adequately measure this parameter and that is accessible to any pediatrician in their daily practice.
The determination of total body fat is possible quite accurately, but the methods used for its measurement are only available to a few research centers. That is why, despite its imperfection, the body mass index (BMI) has been adopted as the best method to define overweight and obesity.
If in adults the values of 25 and 30kg / m 2 are unanimously accepted as cut points, respectively, for overweight and obesity, in pediatrics the circumstance is remarkably different. The very nature of the child, as a growing being whose body composition changes over the years, prevents the existence of a single value for all age and sex ranges.
At this point discrepancies arise when assessing the appropriate standard to compare. However, in recent years the definition based on standardized values (“Z”) seems to have been imposed, so that values of BMI equal to or greater than +1 and obesity at values equal to or greater than +2 are considered overweight.
The importance of childhood obesity does not lie mainly in its more frequent association with the development of comorbidities (diabetes mellitus, hypertension, fatty liver …) in the pediatric age, but in the fact that an obese child has high probabilities of become an obese adult and this has a higher risk of mortality. A recent study shows that Jewish teenagers have a high BMI in adolescence was significantly associated with increased cardiovascular mortality and all – cause in adulthood 1 .
The growing trend of the prevalence of childhood obesity is widespread throughout the developed world, being especially striking in countries such as the United States of America, where this prevalence has tripled in recent decades. In Europe, childhood obesity is a particularly serious problem in the countries of the South, among which is Spain.
This trend, however, seems to have been corrected in recent years. The results of the ALADINO study, recently presented and pending publication, show a significant decrease in the figures of obesity and overweight in Spanish children. Similar results had been observed in Oviedo, in a study conducted in a sample of public schools in the city, followed over 20 years 2 .
The treatment of childhood obesity includes pharmacological measures, not pharmacological and even, in certain cases, in adolescents may even require surgical treatment. Among the non-pharmacological measures, changes in diet and lifestyle changes, with an increase in the hours devoted to physical activity and a decrease in the hours dedicated to sedentary activities, are fundamental.
In the present issue of Anales de Pediatría , Rajmil et al. present the results of a systematic review of the literature, which includes a total of 48 studies conducted in the pediatric population, with the aim of analyzing the efficacy of clinical interventions in childhood obesity 3.
In its review, intervention studies on obesity that include any type of pharmacological and / or surgical measures, as well as preventive strategies are excluded. They conclude that, in spite of the heterogeneity of the interventions analyzed, the most effective in reducing the BMI of the participants are those of a multicomponent type, in which changes are included in the diet, in the physical activity and in the lifestyle habits.
On the other hand, for these to be effective, they must incorporate the family and begin at an early age. These results are in line with that published in a recent Cochrane review in children up to 6 years of age, although it is true that the results obtained are of little magnitude 4 .
There are studies that demonstrate the effectiveness of these interventions when they are addressed from primary care applying the principles of motivational interviewing. The motivational interview is a patient-centered communication system that has been used extensively as a method of behavior modification. It aims to build a common field that involves the patient and the professional,
forming an active group where the patient is the most important member. In the specific case of childhood obesity, the motivational interview must obligatorily include families. The method is based on empathy, tries to avoid “labeling” the patient, to also avoid blaming the patient and accepting ambivalence,
A problem generally observed in the treatment of the obese pediatric patient is the difficulty in achieving adherence to it and the difficulty in maintaining its long-term effects. Therefore, it seems that prevention can be a more effective approach to the problem.
From the studies of Osmond and Barker 5 , the scientific community has been generating a huge body of evidence that shows the existence of a “fetal programming”, by which, certain physiological events that occur in the early stages of life from the conception until 2 years of age (the so-called first 1,000 days of life), generate permanent changes in metabolism that in some way favor the subsequent development of various diseases and cardiovascular risk factors.