Overweight and obesity in children may include cardiovascular system, endocrine system, digestive system, nervous system, skeletal system, respiratory system, skin and psychological abnormalities, resulting in serious short-term and long-term consequences, and will also lay a solid foundation for obesity in adulthood, increase the difficulty of weight loss in adulthood and the risk of various chronic metabolic diseases, cardiovascular and cerebrovascular diseases, and tumors in adulthood. Summer is an important period for many parents to urge overweight children to implement weight loss plans, and weight loss plans are likely to include dieting, but in fact, children and adolescents lose weight through dieting is harmful, parents need to pay attention.
While losing weight, pay attention to the normal growth and development of children's bodies
Body mass index (BMI) is the most commonly used method for diagnosing overweight and obesity. Referring to the "Classification Standards for Body Mass Index Values for Overweight and Obesity Screening in Chinese School-age Children and Adolescents", obesity in children and adolescents refers to the 95th percentile of BMI ≥ in children and adolescents of the same age and sex (that is, the position compared with the same age, the same below); Overweight is defined as a BMI between the 85th and 95th percentiles in children and adolescents of the same age and sex. You can also refer to the Health Industry Standards of the People's Republic of China (WS/T 58602018), BMI screening for overweight and obesity cut-off values for school-age children and adolescents aged 6-18 years.
For obese children, weight loss must be accompanied by consideration of the importance of maintaining their normal growth and development and the long-term nature of obesity treatment.
Children's growth and development is a phased and procedural continuous process, in the age of 6-10 years old, the height growth rate is 5-7 cm / year, usually girls (about 10 years old), boys (about 12 years old) into puberty, height fierce long-term generally can last 1-3 years, an average of about two years. Nutrition is an important factor affecting height growth, and a balanced diet is very necessary.
Excessive dieting is harmful
Some children use imitation of adult dieting on the Internet to lose weight, such as not eating staple food, not putting oil, drinking a lot of water, only eating boiled vegetables and other extreme ways to control weight, and even some girls use this way to lose weight, within a month of weight loss obviously, and then the weight no longer drops, come to the hospital to consult how to continue to lose weight. As everyone knows, she has developed symptoms such as hair loss, fatigue, palpitations, amenorrhea, etc., and her gastrointestinal function has also been affected, and she cannot tolerate normal diet.
Rapid weight loss in the short term, the human body relies on a large amount of consumption of body storage to support, may lead to hypoglycemia, electrolyte imbalance, vomiting, dizziness, fatigue, hair loss, amenorrhea, anemia, immunity decline, etc. Due to excessive dieting, it can also lead to "anorexia nervosa". This is an eating disorder caused by intentional dieting, which is more common in women aged 13-20 years and also occurs in adolescent boys. In addition to hunger strikes, some children will also induce vomiting, throat picking, taking laxatives, crazy exercise... They will never be satisfied with the degree of "dropping the scale", and if after a day, the weight is still the same as yesterday, it is simply a "disaster". What they see in the mirror about themselves is completely different from what others see – even though they are skinny, they still feel fat.
How children and adolescents lose weight scientifically
As the child's height increases, BMI decreases without changing weight. If it is a 6~11-year-old child, the BMI is in the 85~94th percentile, and the weight should be maintained or the weight gain rate should be controlled; BMI is in the 95th ~ 99th percentile, should maintain weight until BMI < 85th percentile, or slowly lose weight, but the weight loss rate does not exceed 0.5 kg/month; BMI > 99th percentile, weight loss is required, but the rate of weight loss does not exceed 1 kg/week.
If the child is 12 to 18 years old with a BMI in the 85th to 94th percentile, maintain weight until the BMI < the 85th percentile, or lose weight slowly; BMI in the 95th-99th percentile, lose weight until BMI < 85th percentile, but not more than 1 kg/week; BMI > 99th percentile, weight loss is required, but not more than 1 kg/week.
The methods of medical nutrition weight loss intervention include: energy-restricted diet, high-protein diet, low-carbohydrate diet, intermittent sexual energy restriction, low glycemic index diet, multiple dietary patterns, meal replacement food weight loss, and time-restricted eating method. Nutrition therapy is the preferred first-line treatment for overweight and obese children and adolescents, but the management mode is different from that of adults, and it should also ensure their normal growth and development needs while limiting energy.
Overweight and obese children and adolescents lose weight, the nutritional program of the diet should be individualized, the energy reaches the nutritional needs of the age corresponding to their height, to ensure the balance of the three major nutrients (protein energy supply accounts for 15%-20% of the total energy, carbohydrates account for 55%-65%, fat accounts for 20%-25%), to ensure high-quality protein, sufficient dietary fiber and healthy oil intake.
The "Guidelines for Physical Activity of Chinese Children and Adolescents" proposes that at least 60 minutes of moderate to high intensity exercise should be accumulated every day, including at least 3 days a week of high-intensity physical activity and resistance exercise to enhance muscle strength and bone health; Limit screen time to 120 minutes a day and avoid sedentary behavior; Exercise appropriately between classes.
Exercise is all about perseverance. The use of self-resistance exercise combined with aerobic exercise is more effective. Parents should help their children develop regular and scientific exercise habits, and it is best to carry out outdoor activities, which can appropriately increase the fun. When starting to exercise, the speed and amount of exercise should be appropriate, limited to tolerance, gradually increased, do not rush, and be relaxed and happy after exercise, without fatigue.
In addition, it is also necessary to pay attention to cultivating good sleep habits: avoid strenuous exercise before going to bed, avoid eating sweets, do not stay up late, and ensure sufficient sleep time. Help children establish good interpersonal relationships: enrich children's interests and hobbies, enhance children's self-confidence, and reduce the chance of emotional overeating. Cultivate correct cognition: Educate children more about the importance and benefits of weight management and scientific eating habits, and publicize the harm of obesity, children are more likely to use cognition to cool their desire to eat when facing "temptation".
Continuous diet management and effective exercise are long-term management models for obese children. Children are in the stage of growth and development, and the weight management model is different from that of adults, the management cycle is longer, and the participation of family, school and society is required.
(The author is the attending physician of the Department of Clinical Nutrition, Beijing Children's Hospital, Capital Medical University)