Obesity is a disease of energy metabolism disorder that has been increasing not only in adults but also among children in recent years. Obesity, which occurs with excessive fat accumulation in the body and causes physical and mental problems; It is a problem that paves the way for various diseases, damages the child's self-confidence, and makes it difficult to make friends.
A healthy and fit body in adulthood can be achieved by providing the baby with adequate and balanced nutrition from birth. During this period, breast milk is the ideal food for the baby to provide the energy and nutrients appropriate for his age.
Problems underlying obesity in babies
> Mother's pregnancy history and genetics
> Large baby (high birth weight)
> Early weaning,
> Starting solid flour foods prematurely,
> Bottle feeding,
> Giving sugar and sugary foods.
Low-energy diet practices aimed at weakening the baby or stopping breast milk are extremely harmful. Daily energy should be given as much as the baby needs according to the month and the baby's growth should be monitored. Just correcting wrong eating habits is enough for weight control. Things to do for healthy weight gain in babies;
-Flour-sugar (pudding) should not be preferred as supplementary food.
-The amount of supplementary food should not be excessive and the child should not be forced to eat it.
-Ready baby food should be prepared according to the recipe and milk should not be used instead of water.
- Biscuits, bread, flour, sugar and oil should not be added to ready-made baby foods.
-The child should be fed with a spoon instead of a bottle.
According to research, an obese child;
- Large and early developing,
- Their height and bone maturation level before puberty are higher than their peers,
- Puberty symptoms appear early and they complete growth early,
- Their walking is delayed,
- Having problems with diaper rash and skin infections,.
- Striae observed with increased fatty tissue in the abdomen and hips,
- Boys These are also children with the appearance of gynecomastia.
The underlying problems of obesity in preschool children are;
> wrong eating habits of the family and the child,
> high-energy food consumption,
> heredity,
> hormonal status,
> lifestyle (technology addiction),
> lack of physical activity,
> psychological factors.
Chronic Developing a permanent, healthy eating habit, increasing daily activity, and behavioral change are the basic elements in protecting against childhood obesity, which is considered a disease. The family's eating habits and lifestyle should be reviewed. It is important for the success of the treatment that all family members be educated and help the child in this effort in the diet treatment to be applied after the detection of obesity.
What should be the general evaluation before obesity treatment?
1- Genetic and endocrine causes of obesity should be reviewed, and especially obesity cases with short stature should be carefully considered.
2- The energy spent for growth and development in children and young people should be taken into consideration.
3- Not all excess weight is obesity. Changes in body composition during the growth process should be evaluated correctly. The body fat percentage of children and teenagers whose weight is higher than their age or height should be calculated separately. Body fat percentage is an indicator of 12-13% normal weight in young men and 20% and above obesity, and 20-26% body fat percentage in young girls is an indicator of normal weight and 30% and above obesity.
4- Gender should be taken into consideration. The increase is parallel to the weight gain in boys, while the weight increase in girls is mostly in body fat mass. 5- It should be known which measurement values will be used as indicators of obesity in children. To clinically define obesity, body mass index, which is obtained by dividing weight to the square of height (kg/m2), is used. Accordingly, adults with a body mass index (BMI) over 25 are defined as overweight, and those with a body mass index (BMI) over 30 are defined as fat (obese). Identifying obesity in children BMI percentile curves prepared according to age and gender are used. Children with a BMI >85 percentile are classified as risky, and those with a BMI >90 percentile are classified as obese. In addition, body weight according to age, weight according to height, measurement of skinfold thickness and body composition in terms of fat content are other diagnostic methods used.
6- BMI (kg/m2) is another evaluation method and age is an important factor here.
br /> The presence of one or more of these factors together may cause obesity.
What Should the Treatment Plan Be?
-Whether obese children need weight loss programs? If necessary, it should be monitored for at least two years after the doctor and dietitian evaluate what kind of program it can be taken.
-It should be determined whether there is obesity in the family, and the detailed nutritional history of the child and the family should be evaluated.
-The child's age, gender, Since habits, biochemical findings, the presence or absence of a disease, and the degree of obesity affect the diet, the diet to be used in treatment should be personalized. -To reduce body weight to the desired level, weight should be lost slowly with the nutrition program to be applied. If the overweight is not much (if the weight is between 85-95 percentile), a program should be prepared to maintain the current weight in order to maintain height growth without gaining weight. If it is above the 95th percentile and there are increases in some blood values (cholesterol, etc.), weight loss should be taken as a basis. In obese children and young people, energy should be calculated according to their required weight.
-The nutrients that children should consume are the same as their mothers and fathers, but the amounts are different to ensure their growth and development. The amount of energy children need daily varies depending on the child's physical activity. The amount of energy that needs to be given, which is between 1800 and 2000 calories on average, should be calculated as (age*100) + 1000 for children between the ages of 2-5. It should never be applied because it is insufficient in nutrients such as iron.
-High protein crash diets should not be applied, and slimming practices with medication should never be done.
-Nutrient requirements should be met adequately and balanced in the nutrition program. General principles of healthy nutrition in children; It is based on the principles of providing diversity in foods, limiting fat and sugar, including whole grains with high fiber content, legumes, vegetables and fruits, adequate intake of vitamins and minerals and maintaining a healthy body weight.
-Regular and appropriate You should be accustomed to eating meals at regular hours. Saturation should be ensured after the meal, and the total calories should be divided into 5-8 meals.
-All food groups should be included in the daily diet, and foods should be offered in different taste, consistency, color and variety.
-Behavioral change should be adopted, wrong eating habits Instead, correct eating habits should be gained. The relationship between nutrition and health should be taught.
-The aim of behavioral approaches is to change eating habits, activities, and ways of thinking. The basis of behavioral approaches lies in the individual's self-discipline. Especially preschool children (1-6 years old) imitate their family members. Therefore, the nutritional habits of families of obese children should be examined. Games, fairy tales and rewards prevent the development of the child's eating habits. The child should be aware of what he eats. Another important factor affecting the child's eating habits is television. Preschoolers enjoy animated advertisements. Most advertisements for food and beverages are sugary and high-energy foods. On the other hand, television pushes the child into inactivity, and cake-type foods consumed while watching television also increase the risk of obesity.
-Parents and health professionals should frequently praise children and say that they appreciate their behavior.
-Food, reward. It should not be used as. The child and family can decide together what the rewards will be for achieving the goal; This reward should encourage positive behavior. For example, as a reward, equipment, clothes, balls, etc. that they will use while doing sports. gift, to help them be more physically active can provide. Do not show food, especially high-calorie ones, as a reward, otherwise the desire for them will increase even more. -In addition to the diet, an exercise program is essential for the success of the treatment. The mother or father should accompany the child. However, fat children are not agile and may get tired quickly and have difficulty adapting while doing sports. The motivation of the child who cannot match his friends' performance during group sports is impaired. For this reason, individual sports (cycling or family walks) may be recommended. -Exercise is an indispensable element in maintaining the weight lost in the long term. Calories are expended during exercise. It has positive effects on blood pressure, serum cholesterol, body composition, heart and respiratory system. Exercise improves the psychological state of the obese person. Prevents loss of lean body mass. Exercise should be done at least 3 times a week for 30 minutes to break a sweat. Exercise intensity and duration should be increased gradually.
-The habit of drinking water should be gained and soft drinks such as ready-made fruit juices or cola drinks should be kept away.
-The child should not be pressured to eat.
Obesity is a problem. caused by metabolic disorders; insulin resistance, type 2 diabetes, disorders in glucose metabolism, high blood pressure, cholesterol, high triglyceride etc. fat metabolism disorders.
Disorders related to puberty (such as menstrual irregularities, increased hair growth, acne), orthopedic disorders, gallbladder diseases, fatty liver, cirrhosis, predisposition to atherosclerotic heart diseases at an early age, sleep disorders, kidney diseases. may also develop.
Preventing obesity by taking measures against the risk factors that lead to obesity in childhood will both protect them from these complications and enable them to become healthy adults in the future.
It is easier to prevent obesity than to try to resolve it after it occurs. The child's bone age, physical examination, blood test, thyroid and growth hormones should also be determined, healthy nutrition education should be given, appropriate physical activity should be determined and behavior modification should be developed.
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