Combating Childhood Obesity
by Dr. Ooi Hooi Leng
Consultant Paediatrician and Paediatric Endocrinologist
MBBS (Malaya), MRCPCH (UK), AM (Mal), Fellowship in Paediatric Endocrinology and Diabetes (Malaysia and Australia)
KPJ Klang Specialist Hospital
How do I know if my child is obese?
Calculating the body mass index (BMI) is one way to determine if a child is underweight, normal, overweight or obese. It compares a child’s body weight in relation to his or her height using the formula below:
BMI = Weight (kg)
Height2 (m2)
BMI increases as a child grows. Therefore, the BMI calculation for children or adolescents must be compared against age and gender specific charts. The current BMI charts have been developed by the United States Centre for Disease Control. They are useful to assess if children aged over two are overweight or obese.
BMI-for-age ≥ 85th percentile suggests that a child is overweight whereas a BMI-for-age ≥ 95th percentile indicates obesity.
The BMI calculation should be used as a guide only. Your paediatrician can help to assess whether your child’s weight is a reason for concern.
How common is childhood obesity?
Changing lifestyle and dietary patterns have contributed to increasing obesity rates in children. Childhood obesity is a major public health problem in many developed and developing countries. In theUnited States, approximately 24 per cent of children and adolescents are overweight and another 18 per cent are obese. InMalaysia, data from various researches have estimated that as many as 15 per cent of toddlers and 30 per cent of primary school children are overweight or obese.
Will children outgrow obesity?
Not really. Obese children tend to become obese adults, especially if they have the following features:
a) Become obese after the age of three. 55 per cent of obese children between six to nine years old become obese adults and the risk increases to 75 per cent for those between 10 to14 years old.
b) The more severe the degree of obesity, the higher the likelihood of persistence.
c) Obesity in one or both parents.
What are the complications of obesity in children?
Obesity can result in serious health problems in childhood and later life. It predisposes them to:
a) Insulin resistance and type 2 diabetes especially if there are family members with diabetes.
b) High blood pressure and elevated bad cholesterol. This will cause narrowing or blockage of arteries by the cholesterol plaque, thus predisposing them to early heart attack or stroke.
c) Sleep apnea, which is breathing difficulty during sleep. It also causes snoring, frequent wakening and poor sleep, resulting in tiredness and contributing to poor concentration during the day.
d) Liver problems including fatty liver.
e) Increased body weight results in excess load to the bones and joints causing early wear and tear especially to the lower limbs and feet, resulting in bone pain and deformities.
f) Most obese children will experience psychological problems including low self- esteem, teasing by friends in school, social isolation, anxiety or depression.
What are the strategies for combating childhood obesity?
a) Preventing our child from becoming obese is far easier and less painful than asking them to lose the excess weight. In growing children, it is important to at least maintain current weight so that the BMI decreases as the child grows taller.
b) Promote breastfeeding. Exclusive breastfeeding from birth until six months and continued breastfeeding up to two years should be encouraged. Various studies have shown a weak but consistent protective effect of breastfeeding on preventing the development of obesity.
c) Adopt a healthy lifestyle for the whole family. Be a good role model by keeping your own BMI within the normal range. Implement a healthy diet and active lifestyle for the whole family and not just for the children.
d) Avoid crash diets, appetite suppressants or humiliating or teasing an overweight child as it does not help them in losing weight.
How can I ensure a healthy diet for my child?
e) Avoid fast food, deep fried food, junk food, sugary food and food cooked with coconut milk. Use less oil, and cook more grilled or steamed dishes. Eat more vegetables and fruits. Limit takeaway and fast food.
f) Make water the main drink. Avoid sugary soft drinks, processed fruit juices or cordial. Have low fat or skim milk.
g) Eat breakfast to prevent them from consuming too much snacks or large meals during lunch.
h) Provide healthy snacks that are low in calories. Fruits and vegetables make excellent choices.
i) Offer smaller portions. Serving 10 or 20 per cent less over time can make a significant difference.
j) Have meals as a family at least once a day. Make mealtime a happy time.
k) Avoid rushing to finish meals. Eating too quickly does not allow time for digestion or feeling a sense of fullness.
l) Avoid eating while watching TV.
m) Encourage babysitters/maids and grandparents not to give children unhealthy foods.
n) Educate your child to make healthier choices at the school canteen.
What is an active lifestyle?
a) Be active for at least one hour a day. Encourage lots of opportunities for active play for pre-school children and toddlers. For kids, exercise is about having fun. The activity can also be incorporated into their daily routines and carried out in small amounts throughout the day, e.g., using the staircase instead of the lift, helping with the household chores or playing with friends in the evening. Be active as a family and plan family outings together.
b) Limit total screen time to two hours a day. This includes the TV, computer, iPad and playing electronic games.
