Childhood obesity

Abstract

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  Approximately 10% of children are obese.

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  Twin and adoption studies demonstrate a large genetic component to obesity, especially in adults. However, the increasing prevalence of obesity over the last 20 years can only be explained by environmental factors.

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  In most obese individuals, no measurable differences in metabolism can be detected.

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  Few children engage in regular physical activity.

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  Obese children and adults uniformly underreport the amount of food they eat.

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  Obesity is particularly related to increased consumption of high-fat foods.

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  BMI is a quick and easy way to screen for childhood obesity.

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  Treating childhood obesity relies on positive family support and lifestyle changes involving the whole family. Food preferences are influenced early by parental eating habits, and when developed in childhood, they tend to remain fairly constant into adulthood.

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  Children learn to be active or inactive from their parents. In addition, physical activity (or more commonly, physical inactivity) habits that are established in childhood tend to persist into adulthood.

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  Weight loss is usually followed by changes in appetite and metabolism, predisposing individuals to regain their weight. However, when the right family dynamics exist—a motivated child with supportive parents—long-term success is possible.

The pediatrician's approach was best summarized by Hilde Bruch¹ 25 years ago:

The pediatrician plays an important role in the prevention of obesity. From birth on, feeding a child always involves a dual task—namely, offering food in appropriate amounts and gearing it to the child's expression of his needs. Only in this way can he develop discriminating awareness and become active in establishing self-regulation. … If a child is fed when he is hungry, played with when he needs attention, and encouraged to be active when he is restless, he is not likely to grow up inhibited and passive or overstuffed and helpless, unable to control his eating because every discomfort is misinterpreted as a need to eat.