Melomed Articles

13 February 2019 - Dr. Mardeyah  Bassier

Obesity in Children

If obesity in South African children continues to increase at the current rate, 3.91 million school children will be overweight or obese by 2025. - The Heart and Stroke Foundation South Africa (Oct 2016)

Obesity in children is a serious epidemic that has gripped South Africa and the world and has negative long-term health implications if not addressed early.

What is the definition of obesity?
Obesity is defined as excessive fat accumulation in the body. The standard measurement of body fat is determined by the body mass index (BMI). This measures the relationship between weight and height and is used in children aged 2 years and older. Weight status is categorised by BMI percentile curves (graphs) as:
a) Overweight if plotted between the 85th and 95th centile and
b) Obese if above the 95th centile for age and gender

What are the risk factors for the development of obesity in children?
The most common causes of childhood obesity are related to environmental factors with a small number linked to genetic diseases or hormonal disorders. 
Environmental influences include:
1) High caloric intake: these include sugar-sweetened beverages (including fruit juice), high-fat foods and high-salt foods. 
  • Families are increasingly being exposed to the aggressive marketing of the afore-mentioned foods and beverages, and together with reduced exposure to sound infant and child feeding practices are engaging in unhealthy eating trends.

  • 2) Sedentary lifestyle: television viewing and video games. 
  • Watching television displaces physical activity, lowers the metabolic rate and may encourage unhealthy eating practices through food advertisements and the like.

  • 3) Shortened sleep: mounting evidence points to an association between shortened sleep duration and obesity through possible alterations in the hormones which are involved in the regulation of appetite. There is also a longer time period in which to ingest food if sleep duration is curtailed.

    Genetic factors and hormonal disorders account for <1% of all cases of obesity.

    What are the complications associated with childhood obesity?
    There are many adverse outcomes related to childhood obesity, but a few of the more important ones are as follows:
    1) Cardiovascular disease
    a. Atherosclerosis - this is the hardening and narrowing of arteries from plaque build-up. It ultimately increases the risk of adult coronary artery disease.
    b. Hypertension - the risk of high blood pressure is 3 times higher in children with a BMI above the 95th centile compared to those below the 95th centile.
    c. Hyperlipidemia - this is manifested by an elevation of LDL cholesterol and triglycerides, and a decrease in HDL cholesterol. 

    2) Gastro-intestinal
    a. Gallstones - gallbladder disease should be considered in any obese child who complains of persistent abdominal pain and non-specific symptoms such as nausea and vomiting
    b. Non-alcoholic fatty liver disease (NAFLD) -  most children are asymptomatic, but there may be non-specific complaints such as fatigue and abdominal discomfort

    3) Endocrine: 
    a. Prediabetes and Type 2 Diabetes Mellitus are common comorbidities of childhood obesity. It is thus imperative to screen for these conditions in overweight and obese children.

    4) Orthopedic:
    a. Blount disease - progressive bowing of the legs (angling of lower leg inward) which is secondary to the excessive weight load on the growth plate of the tibia
    b. Slipped upper femoral epiphysis (SUFE) - obesity is a key risk factor for the development of SUFE and is characterised by the head of the femur slipping off the femoral neck.

    What measures can parents take to prevent childhood obesity ?
  • Exclusive breastfeeding for the first 6months of life, followed by the introduction of complementary foods at 6months
  • Reduce intake of energy-dense foods (foods with a high calorie content)
  • Increase consumption of fruits and vegetables
  • Decrease sugar-sweetened beverages and increase water intake
  • Maintain appropriate portion sizes and avoid adult plates when serving meals
  • Encourage regular physical activity / active play which will increase energy expenditure
  • Limit screen time (less than 2 hours of TV per day): no TV while eating and no televisions in the bedrooms
  • Ensure a good night's sleep

  • Conclusion:
    Childhood obesity is a serious condition and has detrimental effects on health if not addressed early. If you are concerned that your child may be overweight or obese, contact your healthcare provider for an assessment.


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