Obesity at children – the chronic metabolic disorder which is followed by excess adjournment of fatty tissue in an organism. Obesity at children is shown by the increased body weight and contributes to development of locks, cholecystitis, arterial hypertension, a dislipidemiya, insulin resistance, dysfunction of gonads, arthrosis, flat-footedness, a dream, bulimia, anorexia, etc. The diagnosis of children's and teenage obesity is put on the basis of measurement of growth, body weight, IMT and excess of the actual indicators over forced (according to tsentilny tables). Treatment of obesity at children includes a dietotherapy, rational physical activity, psychotherapy.
Obesity at children
Obesity at children – a state at which the actual body weight of the child exceeds the age standard for 15% and more, and an index of body weight ≥30. Data of researches demonstrate that about 12% of the Russian children, and obesity - 8,5% of the children living in the cities and 5,5% - in rural areas have excess body weight. Epidemic growth of spread of obesity among children is around the world noted that demands the serious relation to this problem from pediatrics and children's endocrinology. Almost at 60% of the adults having obesity, problems with excess weight began at children's and teenage age. Progressing of obesity at children leads to development in the future of cardiovascular, endocrine, metabolic, reproductive violations, diseases of a digestive tract and the musculoskeletal device.
The obesity reasons at children
Obesity at children has the polietiologichesky nature; in its realization difficult interaction of genetic and environmental factors plays a role. In all cases at children the power imbalance caused by the increased consumption and the lowered energy expenditure is the cornerstone of obesity.
It is known that in the presence of obesity at both parents, the probability of emergence of similar violation at the child makes 80%; in the presence of obesity only at mother – 50%; only the father has 38%.
I make risk group on development of obesity the children having the increased body weight at the birth (more than 4 kg) and an excess monthly increase of body weight which are on artificial feeding. At babies obesity can develop against the background of the child's overfeeding high-calorific mixes, violations of the rules of introduction of a feeding up.
As show anamnestichesky data, development of obesity in most of children is connected with violation of a diet and decrease in level of physical activity. Usually in food of children with the excess body weight and obesity digestible carbohydrates (bakery products, sweet desserts) and solid fats (fast food), sweet drinks (juice, aerated water, teas) at the insufficient use of cellulose, protein, water prevail. At the same time most of children lead an inactive life (do not play outdoor games, do not play sports, do not visit physical education classes), spend at the TV or the computer much time, experience the intensive intellectual strain promoting a hypodynamia.
Obesity at children can be not only a consequence of constitutional predisposition and the alimentary reasons, but also serious pathological states. So, obesity quite often occurs at children with genetic syndromes (Down, Pradera-Neris, Lourensa-Muna-Bidl, Coen), endokrinopatiya (a congenital hypothyroidism, Itsenko-Cushing's syndrome, adipozo-genital dystrophy), defeat of TsNS (owing to ChMT, meningitis, encephalitis, neurosurgical operations, brain tumors and so forth).
Sometimes in the anamnesis of children communication of obesity with external emotional factors is traced: receipt in school, accident, the death of relatives, etc.
Classification of obesity at children
Thus, taking into account the causes distinguish two forms of obesity at children: primary and secondary. In turn, primary obesity at children is subdivided on exogenous and constitutional (connected with hereditary predisposition) and alimentary (connected with errors in food). At constitutional obesity children inherit not excess weight, but features of course of exchange processes in an organism. Alimentary obesity most often arises at children during the critical periods of development: early children's age (up to 3 years), preschool age (5-7 years) and the puberty period (from 12 to 16 years).
Secondary obesity at children is a consequence of various congenital and acquired diseases. As the most frequent type of secondary obesity serves the endocrine obesity accompanying diseases of ovaries at girls, a thyroid gland, adrenal glands at children.
Criteria of definition of obesity remain a subject of discussion with children so far. Gayvoronskaya A. A. on the basis of excess of body weight of the child normal for this age and growth of values allocates 4 degrees of obesity at children:
- Obesity of the I degree – the body weight of the child exceeds norm for 15-24%
- Obesity of the II degree – the body weight of the child exceeds norm for 25–49%
- Obesity of the III degree - the body weight of the child exceeds norm for 50–99%
- Obesity of the IV degree – body weight exceeds admissible age norm more than for 100%.
At 80% of children reveal primary obesity of the I-II degree.
Obesity symptoms at children
Increase in a layer of hypodermic and fatty cellulose is the main sign of obesity at children. At children of early age low-mobility, a delay of formation of movement skills, tendency to locks, allergic reactions, infectious incidence can be signs of primary obesity.
At alimentary obesity children have excess fatty deposits in a stomach, a basin, hips, a breast, a back, the person, the top extremities. At school age at such children short wind, decrease in tolerance to physical activity, the increased arterial pressure is noted. To pubertatny age the metabolic syndrome which is characterized by obesity, arterial hypertension, insulin resistance and a dislipidemiya is diagnosed for a quarter of children. Against the background of obesity at children violation of exchange of uric acid and a dismetabolichesky nephropathy quite often develops.
Secondary obesity at children proceeds against the background of the leading disease and is combined with typical symptoms of the last. So, at a congenital hypothyroidism children begin to hold late a head, to sit and go; they move up teething schedules. Acquired more often develops in the puberty period owing to iodic deficiency. In this case, except obesity, at children fatigue, weakness, drowsiness, decrease in progress at school, dryness of skin, violation of a menstrual cycle at girls is noted.
Fatty deposits in a stomach, the person and a neck are characteristic signs of kushingoidny obesity (at Itsenko-Cushing's syndrome at children); at the same time extremities remain thin. At girls in the pubertatny period also the girsutizm is observed .
If except excess weight the girl is disturbed by fat skin, acne rash, excess growth of hair, irregular periods, then with high degree of probability it is possible to assume at it a syndrome of polycystous ovaries. At boys with adipozogenitalny dystrophy obesity, a kriptorkhizm, a ginekomastiya, an underdevelopment of a penis and secondary sexual characteristics takes place; girls have a lack of periods.
Obesity complications at children
Presence of obesity at children is risk factor of early development of a number of diseases – atherosclerosis, a hypertension, stenocardia, diabetes 2 types. From a gastrointestinal tract formation of chronic cholecystitis and ZhKB, pancreatitis, locks, hemorrhoids, a fatty gepatoz, and further – cirrhosis can be noted. Children with an excess weight and obesity have frustration of food (anorexia, bulimia) and sleep disorders more often (snore and a syndrome sleepy ).
The raised load of bone and muscular system causes development in children with obesity of violations of a bearing, scoliosis, artralgiya, arthrosis, valgusny deformation of feet, flat-footedness. Obesity at teenagers serves frequent the reason of a depression, sneers from peers, social isolation, deviant behavior. The women and men having obesity since the childhood have an increased risk of development of infertility.
Diagnosis of obesity at children
Clinical assessment of obesity and degree of its expressiveness at children includes collecting the anamnesis, clarification of a way of feeding at chest age and features of food of the child now, specification of level of physical activity. At objective inspection the pediatrician makes anthropometry: registers indicators of growth, body weight, a circle of a waist, volume of hips, a body weight index. The obtained data are compared with special tsentilny tables on the basis of which the excess body weight or obesity is diagnosed for children. In certain cases, for example, at mass surveys, the technique of measurement of thickness of a skin fold, determination of relative mass of fatty tissue is used by method of bioelectric resistance.
For clarification of the reasons of obesity children with excess body weight have to be consulted by the children's endocrinologist, the children's neurologist, the children's gastroenterologist, the geneticist. Expediently additional research of biochemical blood test (glucose, glyukozo-tolerant test, cholesterol, lipoproteins, triglycerides, uric acid, protein, hepatic tests), hormonal profile (insulin, Prolactinum, TTG, T4 St., cortisol of blood and urine, estradiol). According to indications ultrasonography of a thyroid gland, hypophysis REG, EEG, MRT to the child is carried out.
Treatment of obesity at children
The volume of medical care to the children having obesity includes decrease in body weight, treatment of associated diseases, maintenance of the achieved result and prevention of set of excess weight.
First of all, to the child with obesity the individual diet assuming reduction of a daily kalorazh at the expense of animal fats and the refined carbohydrates is selected. It is recommended 5-times (sometimes 6-7-times) a diet, training of parents in calculation of norm of daily kilocalories is provided. Along with correction of food the organization of the rational motive mode is made: for children of younger age walks and outdoor games, and since preschool age – sports occupations are recommended (swimming, driving the bicycle and so forth). The dietotherapy is carried out under the leadership of the pediatrician or the nutritionist; control of food and physical activity of the children having obesity is assigned to parents.
At obesity to children acupuncture, LFK, hydrotherapy, psychotherapy can be carried out. In the presence of associated diseases the child needs the help of the children's endocrinologist, children's gastroenterologist, children's gynecologist, children's cardiologist, children's orthopedist, neurosurgeon, children's psychologist.
Prevention of obesity at children
The prevention of epidemic of obesity among children is the task demanding integration of efforts of parents, representatives of medical community and education. The understanding parents of importance of a balanced diet at children's age, education of the correct food addictions at children, the organization of a day regimen of the child with obligatory inclusion of walks in the fresh air has to become the first step on this way.
As other important point of prevention of obesity at children serves instilling of interest in physical culture, availability of sports activities in school and at the place of residence. It is important that parents were an example of a healthy lifestyle, but not authoritatively demanded its observance from the child. Development of screening programs for detection of obesity and its complications among children and teenagers is necessary.