Is it easier to gain weight if you eat fast or slowly? Remember the three stages when the number of fat cells in the human body is most likely to increase. It is difficult to lose weight if you miss them.

Speakers: Ruan Xianli, Director of Pediatrics Department, Zhejiang Provincial Tongde Hospital, and Jin Weiwei, Director of Nutrition Department

Topic: Chubby is cute, but there are health risks behind it

In the eyes of many parents, chubby children are very cute and especially lovable. But in the eyes of doctors, chubby children hide many health risks.

So, what is childhood obesity? What are the criteria for determining childhood obesity? In what ways do parents need to intervene? Let’s talk about it today.

Energy intake > consumption, resulting in fat accumulation

Obesity is essentially a nutritional disorder

Director Ruan Xianli introduced that simple obesity in children is a nutritional disorder caused by long-term energy intake exceeding the body's consumption, resulting in excessive accumulation of fat in the body and body weight exceeding the reference value range.
At present, the incidence of overweight and obesity among children is continuing to rise not only in developed countries and cities, but also in some developing countries, including my country and rural areas. In some cities in my country, the incidence of overweight and obesity among school-age children has reached more than 10%.

The harm of obesity to children's health cannot be ignored. It can cause early sexual development and affect height growth ; it can cause inferiority complex due to poor image , which always brings negative mental effects, such as inferiority, timidity, anxiety, depression, impulsiveness, aggressiveness, etc. At the same time, childhood obesity is closely related to the occurrence of metabolic syndrome in adulthood , such as hyperlipidemia, fatty liver, type 2 diabetes, gout, etc.

Childhood obesity has become the root cause of most of today's public health problems. Families, schools, and society must jointly establish the concept that "obesity is a disease" and carry out multi-faceted and three-dimensional management.

First 3 months, 0-1 year, and puberty

These are the three stages in which the number of fat cells increases rapidly

Director Ruan Xianli said that from a physiological point of view, the mechanism of obesity is the increase in the number or size of fat cells. The three months before birth, the first year after birth and the 11-13 years old puberty are the three stages in which the number of fat cells in the human body increases rapidly.

If obesity occurs in these three stages, it will cause obesity due to increased number of fat cells, which is difficult to treat and prone to relapse; if obesity does not occur during this period of increased fat cells, the fat cells will increase in size but remain normal in number, and treatment will be easier to achieve.

Therefore, parents must pay attention to these three stages and control their children's weight.

1 in 5 children is overweight

If both parents are obese, the obesity rate of their offspring will reach 70-80%.

In the growth and development clinic of Director Ruan Xianli, 1 in 5 children is overweight, which is equivalent to the 10% rate mentioned above. The causes of childhood obesity include:

1. Excessive energy intake is the main cause of obesity. Increased intake of fast food, puffed food, fried food, barbecue food, and sugary drinks leads to unbalanced diet and excessive fat intake. In addition, excessive intake of pregnant mothers, the rise of knowledge of selective cesarean section, and the increase in the birth of giant babies have led to an increase in early overweight and obesity.

2. Lack of physical activity and exercise are important factors that cause obesity. Most obese children do not like to exercise, forming a vicious cycle.

3. Genetic factors. Current research suggests that human obesity is related to more than 600 genes, markers and chromosome regions. The familial nature of obesity is related to polygenic inheritance: 70%-80% of offspring with both parents being obese will become obese; if one of the parents is obese, the incidence of obesity in offspring is about 40%-50%; and only 10%-14% of offspring with normal parents will become obese.

4. Other factors such as eating too fast , or imbalance in the regulation of the satiety center and the hunger center leading to overeating; mental trauma and psychological abnormalities can also cause children to overeat.

5. Imbalance of intestinal flora.

6. Drug factors , such as taking hormones, anti-epileptic drugs, antidepressant drugs, etc.

7. Influence of diseases such as hypothyroidism and growth hormone deficiency.

How to determine whether children are overweight or obese?

What is considered obesity? Director Ruan Xianli said there are two diagnostic criteria for childhood obesity:

One method is to diagnose based on body mass index (BMI) of age, which is applicable to children over 3 years old. BMI = weight (kg) / height (m²).

Among them, children aged 2-5 years can refer to the BMI reference cutoff points for overweight and obesity in Chinese children aged 2-5 years in the "Growth Curve of Body Mass Index for Chinese Children and Adolescents Aged 0-18". Children aged 6-18 years can refer to the gender-specific BMI reference cutoff points for overweight and obesity screening in school-age children aged 6-18 in the "Screening for Overweight and Obesity in School-age Children and Adolescents".

The other method is to use "height weight" for diagnosis, which is suitable for infants and young children aged 0-2 years old. According to the 2006 Child Growth and Development Standards of the World Health Organization, the standard deviation score is calculated by referring to the average weight of the normal population of the same age, gender and height. If it is greater than 2 standard deviations of the average weight of the reference population, it is considered "overweight", and if it is greater than 3 standard deviations, it is considered "obese".

By referring to the corresponding table, once overweight or obesity is detected, comprehensive assessment and intervention can be carried out through a multidisciplinary team (MDT) approach.

What should parents of obese children do?

How to intervene in life?

Jin Weiwei, director of the Nutrition Department, pointed out that for children and adolescents (6-18 years old) who are already overweight or obese, the general treatment principle is to reduce the intake of heat-producing foods and increase the body's consumption of heat energy, so that body fat continues to decrease and weight gradually decreases. Therefore, the clinic advocates non-drug lifestyle intervention, and conducts personalized comprehensive prevention and control after a comprehensive assessment (medical history and physical examination, finding the cause, potential complication risk assessment, etc.) - **1. Diet and behavioral intervention. **Among the many modifiable obesity risk factors, dietary factors have an important impact on overweight or obesity in children and adolescents, and are also one of the important ways to prevent and control overweight and obesity.

For obese children, the main ways to improve the dietary structure and improve the overall quality of the diet include: calculating the basal metabolism, controlling the total energy intake on the basis of ensuring the energy required for growth and development; strictly controlling the intake of cooking oil and fat; appropriately controlling the amount of refined rice, flour and meat, and increasing potatoes; ensuring adequate intake of vegetables, fruits and milk; ensuring adequate supply of protein, vitamins and minerals; food should be based on the principle of diversity to avoid children being picky eaters.

The diet of preschool children should be low in salt, fat, and a combination of coarse and fine grains to develop healthy eating habits. Parents should pay attention to cultivating the ability of preschool children to eat independently and avoid overfeeding led by parents, which may lead to obesity in preschool children.

In addition, the nutrients provided by snacks are far less comprehensive than those provided by regular meals. When parents choose snacks for their children, they should not only pay attention to nutritional balance and reasonable matching, as well as the time of eating snacks, but also provide children with correct nutrition education and guidance. Snacks can be dairy products, fruits, and nuts, but the amount of milk should be controlled at 300-500 ml, and the amount of fruit should be diversified, with a total amount controlled at 200-400 grams.

2. Activity intervention.

From the perspective of energy metabolism, controlling energy intake and increasing energy expenditure are the two main ways to regulate energy balance. Therefore, increasing energy expenditure by increasing physical activity is also one of the effective intervention methods for preventing and controlling overweight and obesity in children and adolescents. For overweight or obese children, regardless of whether they are on a diet, exercise should be considered an integral part of weight control.

Accumulate at least 60 minutes of moderate to high intensity physical activity every day, mainly aerobic exercise, preferably more than 10 minutes each time. Perform at least 3 high intensity physical activities (such as long-distance running, swimming, playing basketball, etc.) and 3 anti-limit exercises (such as push-ups, sit-ups and pull-ups, etc.) per week. In addition to exercise, reducing sedentary and long-term screen time is also an effective way to prevent and control overweight and obesity.

3. Sleep intervention.

Lack of sleep is an important high-risk factor for childhood obesity and related metabolic diseases. Placing a TV or computer in the bedroom will increase children's screen time, thereby reducing their sleep time. Therefore, parents are advised not to place electronic products such as TVs and computers in children's bedrooms.

4. Psychological and behavioral intervention.

Studies have found that obese children have significantly lower mental health than normal children, and are more prone to low self-esteem and depression. Creating a supportive environment, maintaining the mental health of children and adolescents, cultivating health knowledge and skills, and taking comprehensive physiological, psychological and social intervention measures are one of the important means to effectively prevent and control the occurrence of obesity in children and adolescents.

Selected Questions

01

Q: What should I do if my child is too thin? A 9-year-old girl is 1.4 meters tall and weighs 52 kilograms.

Ruan Lixian: First, find out the reason for being thin, such as how the child usually eats, what are the eating habits, and whether the family members are thin. Second, whether there is a lack of trace elements or poor spleen and stomach function. The specific reasons should be analyzed. If the child is particularly thin, evaluate and exclude the history of related diseases. Second, use Chinese medicine, pediatric massage and other Chinese medicine methods to regulate the spleen and stomach, increase appetite, and increase weight. Overall, there will be no big problems. It is best to evaluate and help the child gain weight to a certain extent, and try to reach the average BMI of the same age.

02

Question: Do I need to go to the nutrition department if I have trouble sleeping?

Jin Weiwei: If you have poor sleep, you should first find the cause. Many children's poor sleep is related to their parents' living habits. For example, if parents like to stay up late and sleep late, their children will also be affected. It is worth noting that if a child's sleep quality is extremely poor for a long time, it should be ruled out whether there are psychological or mental problems. At the same time, develop healthy sleep hygiene habits, such as a good sleep pattern and avoid participating in exciting activities before going to bed.

03

Question: A boy, 11 years and 9 months old, 1.5 meters tall, weighing 96 kilograms, is he obese? He was always thin before he was 9 years old, but in the past two or three years he rarely eats breakfast and has no appetite, but has gained weight.

Ruan Lixian: The average BMI of a 12-year-old boy is 18.1, overweight is 20.8, and obesity is 24.2. This child's BMI is 21.3, which is overweight. Skipping breakfast has a great impact on children's health. Children will easily feel very hungry at noon, eat a lot of food without knowing it, and the excess energy is stored in the body in the form of fat. A 12-year-old boy has entered puberty and should have a good appetite. It is recommended that parents spend more time to make breakfast rich and varied, and cultivate good eating habits for their children, especially during holidays. Eat regularly and don't sleep in and skip breakfast. If you really can't adjust, it's best to go to the hospital for treatment. On the one hand, you can use traditional Chinese medicine to regulate your spleen and appetite, and on the other hand, you can conduct comprehensive intervention in the nutrition department.

04

Question: A 9-year-old girl, 1.56 meters tall and 62 kilograms in weight, has always liked to eat staple foods and has a large appetite. She also likes to eat snacks. A physical examination revealed moderate fatty liver. How can I intervene?

Jin Weiwei: The 9-year-old girl's BMI reached 25.5, which is considered obese. The child has already developed moderate fatty liver. If it is left unchecked, the chance of high blood sugar in the future will greatly increase. It is recommended that the child go to the hospital as soon as possible to find out the cause of obesity and intervene. After a comprehensive assessment, our nutrition department can provide comprehensive treatment through diet, behavior, physical activity, parental supervision and other aspects.

05

Question: My husband is obese. Is obesity hereditary? How can we avoid it?

Ruan Lixian: If one parent is obese, the obesity rate of the offspring will reach 40-50%. How to reduce the obesity rate of children? Three key points should be controlled: 1. Do not eat too much in the last three months of pregnancy; 2. After the child is born, measure the height and weight once every half a month to a month, and strictly check the height and weight table to see if it is in the normal growth curve. 3. Eat a balanced diet during adolescence and strictly control BMI. If these three key points are controlled, the probability of children becoming obese will be significantly reduced, and the troubles caused by obesity will also be reduced.

Reporter Zhang Jing

Correspondent Ying Xiaoyan

Editor Pan Lei

Deputy Editor-in-Chief Yu Qianqian Jin Jing

Producer Xu Fang Zhou Jieqiong