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Obesity Liza Chan, APD

 Content

❖ What is obesity - health problems

❖ Epidemic of obesity for children
❖ Reasons for obesity
❖ Possible solutions to obesity
❖ Conclusion
What is overweight and obesity
 Childhood obesity and
overweight

❖ Obesity tend to run in families

❖ Children with 2 obese parents have about 80% chance of
becoming obese themselves
❖ Studies have shown that in babies and very young
children, parental obesity is stronger predictor of adult
weight than the weight of the child itself
Childhood Obesity epidemic
 Childhood obesity Epidemic

❖ Key facts from WHO:

❖ The number of overweight and obese infants and
young children (aged 0-5 years) increased from 32
million globally in 1990 to 41 million in 2016
❖ In the WHO African Region alone the number of
overweight or obese children increased from 4-9
million over the same period
 Childhood obesity Epidemic

❖ According to WHO:
❖ In 2016, the number of overweight children under the
age of 5, is estimated over 41 million
❖ Almost half of all overweight children under 5 lived
in Asia AND 1/4 lived in Africa
❖ The problem is global and is steadily affecting many
low and middle income countries
 Childhood obesity epidemic

❖ The vast majority of overweight or obese children live

in developing countries, where the rate of increase has
been more than 30% higher than that of developed
countries
 Childhood obesity
❖ Childhood unhealthy weights may result in medical
problems in childhood such as:
❖ Type 2 diabetes
❖ High blood pressure and high blood cholesterol
❖ Liver disease
❖ Bone and joint problems
❖ Respiratory problems such as asthma
 Childhood obesity
❖ Childhood medical problems:
❖ Sleep apnea
❖ Earlier than normal puberty or menstruation
❖ Eating disorders such as anorexia or bulimia
❖ Skin infections due to moisture from sweat being
trapped in skin folds
❖ Fatigue
 Childhood obesity
❖ Childhood obesity is a serious medical condition that
affects children and adolescents
❖ It may lead to adult health problems such as:
❖ Diabetes
❖ High blood pressure
❖ High cholesterol
❖ Childhood obesity may lead to low self esteem and
depression
 Childhood obesity
❖ Overweight or obese children can also have serious
psychological issues such as:
❖ Are more likely to be teased and bullied
❖ Are more likely to bully others
❖ May have poor self-esteem
❖ Feel socially isolated
❖ May be at increased risk for depression
 Childhood obesity

❖ May have poorer social skills

❖ May have high stress and anxiety
❖ May have behaviour and/or learning problems as a
result of psychological difficulties related to childhood
obesity
 Childhood obesity
❖ There are studies that said higher BMI is also associated
with poorer educational outcomes
❖ Obese children are more likely to:
❖ Take absence from school
❖ Have school problems
❖ Repeat a grade
❖ Lower school engagement
 Childhood obesity

❖ Facts:
❖ Without intervention, obese infants and young
children will likely to continue to be obese during
childhood, adolescence and adulthood
❖ As mentioned previously, obesity in childhood is
associated with a wide range of serious health
complications and an increased risk of premature
onset of illnesses, including diabetes and heart disease
 Childhood obesity

❖ Fact:
❖ An adult who is obese at age 40 years can expect to
die 3-6 years earlier than someone who was of normal
weight at the same age
❖ It is important that families do all they can to prevent
obesity in children and to treat it properly
 Overweight and Obesity

❖ Hong Kong children obesity epidemic:

❖ https://www.chp.gov.hk/en/statistics/data/10/757/5513.h
tml
Diagnosis
 Childhood obesity

❖ How to diagnose a child is overweight/obese:

❖ Using the growth chart and the child’s percentile,
children are identified as:
❖ Overweight - BMI between 85th and 94th percentiles
❖ Obese - BMI 95th percentile or above
❖ BMI = kg / m^2
 Childhood Obesity

❖ According to CDC,
❖ Body Mass Index (BMI) is a measure used to
determine childhood obesity and overweight
❖ BMI is simply dividing a person’s weight in kg by
the square of height in meters
❖ BMI does not measure body fat directly but can be
considered an alternative to direct measurement
 Childhood obesity

❖ Using BMI to determine obesity/ overweight in children

is different to using BMI for adults
❖ For adults, it is not gender nor age specific
❖ For children, we need to plot the BMI number back to
their corresponding growth chart with specific age and
gender
 Childhood obesity

❖ The CDC had made the BMI recommendations for

children:
Weight Status Category Percentile Range (growth chart)

< 5th percentile

Underweight

Normal of healthy weight 5th percentile to < 85th percentile

Overweight 85th percentile to <95th percentile

Obese >= 95th percentile

 Childhood obesity

❖ There are different types of growth charts and for

different gender
❖ To determine overweight/ obesity, can use the BMI
chart
❖ https://www.rcpch.ac.uk/sites/default/files/2018-
03/boys_and_girls_bmi_chart.pdf
 Diagnosis
❖ If the child is overweight or obese, in addition to the
BMI and growth charts, it is good to also take notes of
the following:
❖ Family history - obesity and weight-related health
problems (diabetes, heart concerns, fatty liver etc)
❖ Child’s eating habits and activity level
❖ Other health conditions that the child has eg allergy
❖ Other psychological issues?
 Diagnosis

❖ Medically, doctors may also take blood samples for:

❖ Cholesterol
❖ Blood sugar
❖ Hormones imbalance, Vit D deficiency or other
conditions associated with obesity
Causes for childhood obesity
 Causes for obesity
❖ Lifestyle issues - too little activity and too much calories
from foods and drinks
❖ Regularly consuming high calories foods and drinks
and also snacks that are high in sugar and fat e.g.
sweets/ fast foods/ chips/ sugary drinks
❖ Lack of exercise would mean there is less chance to
expand more calories. This is quite common because
of increase of screen time and too high focus in the
academic area
 Causes for obesity

❖ Family factors - when children come from an

overweight people family, they are likely to put on
weight. Since their family may have a culture of eating
high calories foods and seldom to do any physical
activities
❖ Psychological factors - personal, parental and family
stress can increase a child’s risk of obesity. Children
may overeat to cope with the problems or deal with
their negative emotions
 Causes for obesity

❖ Socioeconomic factors - lower income families may not

be able to afford good quality foods, and may just buy
whatever is the cheapest instead of being balanced. Also
lower income people may live in a neighbourhood that
is not safe or convenient for children to play outside all
the time
 Formula and obesity

❖ From a survey conducted by the Family Health Service of

the Department of Health 2010 on infant and young child
feeding in HK, they had discovered:
❖ More than 80% of children consumed follow-up formula
beyond 12 months old
❖ Among 12 months old children who drank milk other
than breast milk, about 70% of them consumed more than
480ml of milk per day, which exceeded the recommended
intake of milk per day for children over the age of one
 Formula and obesity

❖ Excessive milk consumption in children is associated

with obesity
❖ Parents have the belief that follow-up formula milk
contains nutrients that promote children’s brain
development and cannot be provided by other foods
❖ It is more beneficial and better weight control by eating
a balanced diet than drinking too much milk
 Sleep and obesity
❖ According to Department of Health (HK):
❖ Local studies have shown relationships between sleep
pattern and risk of childhood obesity. A study of over
5100 primary school children (mean age 9.25 years)
had shown that shorter sleeping time had a higher BMI
❖ Another school-based study of 327 adolescents (mean
age 14.5 years) also found shorter mean time in bed
and greater weekend delay in bedtime were associated
with higher BMI
 Sleep and obesity

❖ Overseas studies have showed that people who were

deprived of sleep had a higher levels of appetite-
stimulating hormones and a lower level of the satiety-
inducing hormone, also there is an increase in hunger
and appetite for high carbohydrates and fats foods
❖ Also lack of sleep will mean the children more tired
during the day and hence too tired for more physical
activities
 Sleep and obesity
❖ There are other healths benefits associating with enough
sleep with school-aged children:
❖ Better physical growth
❖ Better mental health
❖ Better emotion regulation
❖ Better academic performance
❖ Bette quality of life
 Sleep and obesity
❖ Solutions for a better sleep: (DOH, HK)
❖ Reduce the screen time before bedtime
❖ Avoid big meal 2-3 hours before bed
❖ Set an age-appropriate bedtime and wake up time for
children and stick to the schedule most of the days
❖ Provide a good sleeping environment, minimal light
and noise and comfortable temperature and
ventilation
 Sugar sweetened beverage and
obesity

❖ Sugar-sweetened beverage consumption is high in

many parts of the world
❖ This practice contributes to the overall energy to diets
without providing good nutrient nor provide fullness
❖ Current evidence suggests that increasing consumption
of sugar-sweetened beverages is associated with
overweight and obesity in children
 Sugar sweetened beverages

❖ WHO recommends a reduced intake of free sugars

throughout the life course
❖ In both children and adults, WHO recommends
reducing the intake of free sugars to less than 5-10% of
total energy intake
 Lack of education

❖ Lack of education/ information on healthy eating for the

parents
❖ Often parents have misconceptions on foods, with more
is better approach and will cause too much calories
❖ Not many parents will look at the food pyramid and try
to work out the portion for their children
 Marketing

❖ The aggressive marketing of energy-dense foods and

beverages to children and families
❖ A lot of baby formula baby models are abit more
chubbier, and there is a misconception that chubby
babies mean they are healthy and growing
❖ Nutritional label claims on food that are misleading
 Food industries

❖ Food industries need to ensure healthy and nutritious

choices more affordable
❖ Do not add too much colourings or sweeteners or
sugars in children foods
❖ Try to have more honest marketing claims labels
❖ More promotion pamphlets on their products to
honestly discuss the pros and cons
Possible solutions to obesity
 Solutions to obesity

❖ In order to gain weight, it is just the simple equation of

energy in >> Energy out
❖ Here are some tips for parents to help children and
adolescents to achieve a healthy weight:
❖ Consider exclusively breastfeeding your baby for the
first 6 months, then with the introduction of solids to
continue to breastfeed until 2 years or above
 Solutions to obesity
❖ Infants diet is high in fat to support growth, however if
baby becomes overweight, they may get too heavy and
delay crawling and walking and also they may remain
obese as an adult
❖ It is not recommended to restrict calories for babies
under 2 years old aimed at reducing weight
❖ Should feed the babies with the right portion, play with
them, take them outdoors, not constraining their
movements and allow more tummy time
 Solutions to obesity

❖ How to keep babies at healthy weight:

❖ Monitor weight gain during pregnancy - excessive
weight gain during pregnancy can increase a baby’s
birth weight. Some studies say if birth weight
increases, so does the risk of childhood obesity
❖ Breast-feeding: Some studies say breastfeeding
reduces the risk of childhood obesity
 Solutions to obesity
❖ How to keep babies at healthy weight:
❖ Limit sugar-sweetened drinks/foods - when babies start
weaning diets, do not add any sugar into their food. Also juice
isn’t necessary to be in baby’s diet
❖ Try other methods to soothe your baby - parents often
automatically turn to breast milk or formula to soothe babies
when they cry. This may cause overfeeding - gain weight
❖ Limit media use - The American Academy of Pediatrics
discourages media use for children younger than 2. The more
TV children watch, the greater their chance of being overweight
 Solutions to obesity
❖ How to keep babies at healthy weight:
❖ Sleeping - studies suggest that short sleep duration may
be a risk factor for childhood obesity. Parents should
consider a consistent sleep-wake schedules and routines
and reduce too much sensory stimulation (food, light,
noise, activity) in the bedroom near bedtimes
❖ Parents should be more strict with their household
policies and practices about how their infants eat, play
and sleep
 Solutions to obesity

❖ Ensure portion size is correct and offer the child 3

regular main meals and snacks in between
❖ Follow the Healthy Eating Food pyramid for portion
sizes and also for the variety of health foods
❖ Snacks should be low in fat, salt and sugar and avoid
high sugary drinks. Plain water is the best hydration
option
❖ Do not use foods as rewards
 Solutions to obesity

❖ Limit eating out if possible. Home cooked meals are

usually more nutritious, low in sugar, fat and salt
❖ When eat out, try to choose dishes that are low in sugar,
fat and salt and high in fibre
❖ Educate children of food choices since young, educate
that what are better choices and suggest what a
balanced meal looks like
 Solutions to obesity

❖ Increase fibre so that they can be fuller

❖ Do not restrict too much and name foods - “good” or
“bad”
❖ Ensure hydration
❖ Be more sensitive to the child’s emotion to avoid
emotional eating or use food as an outlet to stress
 Solutions to obesity
❖ Physical activities:
❖ Make physical activity part of the family’s daily
routine
❖ Encourage kids to do more outdoor activities
❖ Join some sports teams at school
❖ Offer kids rewards that promote physical activity
❖ Limit screen time
 Solution to obesity

❖ Physical activities:
❖ Increase incidental activities, walking up the stairs in
train stations or walking to school or walking to
activity classes
❖ Go grocery shopping with them where they will need
to carry some of the shopping
❖ Take more public transportations where they require
to walk further to the stops
 Solutions to obesity

❖ The American Academy of Family Physicians (AAFP)

recommends that all children participate in physical
activity for at least an average of 30-60 minutes/day
❖ AAFP encourages parents and schools to make physical
activity a priority
❖ Prolonged periods of physical inactivity should be
discourage in both at home and school
 Solutions to obesity

❖ From the American Academy of Pediatrics, they

recommend that children older than 2 and adolescents
whose weight falls in the overweight category be put on
a weight-maintenance program to slow the progress of
weight gain
❖ This strategy allows the child to add inches in height
but not pounds, causing the BMI to drop over time
 Solutions to obesity

❖ For children who are 6-11 who are obese:

❖ Encourage to change eating habits to gradually lose
weight for no more than 1 pounds a month
❖ Older children and adolescents who are obese or
severely obese:
❖ Encourage to modify their eating habits to aim for
weight loss up to 2 pounds a week
 Solutions to obesity

❖ The method for maintaining child’s current weight or

losing weight are the same:
❖ Eat a healthy balanced diet according to the food
pyramid
❖ Increase physical activities
❖ It is not easy to make changes, need to persist and be
consistent
 Solutions to obesity

❖ From Childhood obesity Foundation,Canada

❖ They have a LIVE 5-2-1-0! :
❖ 5 or more veggie and fruit per day
❖ 2 no more than 2 hours of screen time a day
❖ 1 hour of physical activity or more per day
❖ 0 no sugary drinks
Meal Plan
 Meal Plan
❖ In order to give a good meal plan, we must follow the food
pyramids for their age group
❖ We must assess their current meal plan, modify what is not
as good and keep the good habits
❖ Alway encourage home cooked meals if possible and do
more physical activities
❖ Do not try to reduce too much calories even they are
overweight, since they still need to calories and nutrients to
grow
 Meal Plan
❖ Red flags to current meal plan:
❖ Irregular timing and portion of meals
❖ Eat too regularly
❖ Large portions
❖ Not balanced meals
❖ Too much junk foods such as biscuits, chips, lollies, fast
foods etc.
❖ Too much sugary drinks
 Meal Plan

❖ Red flags to meal plans:

❖ Always eating out
❖ Eat too close to bed time
❖ Drink too much formula
❖ Eat too much of one food group/ fussy eating
❖ Lack of fruits, vegetables and calcium
 Meal Plan

❖ Other Red flags that may cause childhood obesity:

❖ Are their parents overweight/ obese
❖ Were they breastfed?
❖ Do they sleep enough? Or is the quality of sleep
good?
❖ Do they have emotional issues? Stress issues? Family
issues?
 Meal Plan
❖ Other red flags to childhood obesity:
❖ Who takes care of them? Are parents always working?
Grandparents vs. Helper vs. Parent
❖ Is their family culture like to have lots of socialising
❖ Do they eat a lot of home cooked meal or eating out
meals
❖ What about their food preferences? Like tasty foods/
sauces/ deep fried foods/ sugary foods and drinks
 Meal Plan
❖ Other red flags to childhood obesity:
❖ Do they have a lot of screen time?
❖ Do they have a favourite sport or favourite outdoor
activity
❖ What do they do at their free time?
❖ Are they the only child?
❖ Are they high achievers academically?
 Meal Plan

❖ Red flags to childhood obesity:

❖ Do the family like to do outdoor activities
❖ Does the child like to move around
❖ Does the child’s friends like to play outside or play
online
❖ How do they get to school?
Practical tips
 Meal Plan

❖ Follow the Food pyramid portion for its corresponding

age
❖ Try to eat every 2-3 hours, older children >1 year old
can have 3 main meals and 1-2 snacks in between
❖ Encourage more physical activities instead of reducing
the portion
 Meal Plan

❖ Need to educate the parents what to do:

❖ Encourage daily physical activities for 1 hour
❖ Discourage screen time to max 1 hour/ day
❖ Do some simple healthy recipes
❖ Food pyramid and portion sizes
❖ Note the nutrition focus for the child’s stage of life
 Meal Plan
❖ Need to educate the child (age appropriate):
❖ Food pyramid
❖ Better food choices vs. Not as good choices when
eating out
❖ How to eat balancedly
❖ How to increase physical activities
❖ How to handle negative emotions
Meal planning for this age group [DOH] - portion size
https://www.change4health.gov.hk/en/healthy_diet/guidelines/food_pyramid/index.html

Food Pyramid/ day 2-5 years old 6-11 years old 12-17 years old
(same as adults)
3 mains + 2 snacks
Grains 1.5-3 bowls 3-4 bowls 3-6 bowls

Vegetables and Fruits 3/4 bowl cooked veg 1 bowl cooked veg 1 1/2 - 2 bowl cooked veg
+ + +
1 medium sized fruit 2 medium sized fruits 2 medium sized fruits

Meat/protein 1.5-3 Taels meat (or 3-5 Taels meat (or 5-6 Taels meat (or
equivalent) equivalent) equivalent)

Milk ~480ml cow’s milk or ~480ml cow’s milk or ~480ml cow’s milk or
calcium fortified milk calcium fortified milk calcium fortified milk

Remarks 4-5 gl fluid 6-8 gl fluid 6-8 gl fluid

Conclusion
 Conclusion

❖ Overweight and obesity are preventable

❖ Supportive policies, environments, schools and
communities are important to support the parents’ and
children’s choices
❖ Increasing physical activities is very important
❖ Do not reduce too much calories for children because
they still need enough calories and nutrients to grow
 Conclusion

❖ Establishing healthy eating habits since young is

important for prevention of obesity
❖ Parents play an active role in children lifestyle and
nutrition - should do a good role model
❖ Monitor regularly the child’s growth progress and
intervene as early as possible
❖ Take note of the food pyramid and encouraged a varied
balanced diet
Assignment 2