Overweight in children

Dampflock", «Rollmops» or worse - hardly a day goes by without Juri being teased by his classmates. Because the 11-year-old primary school pupil is obviously too fat. Even climbing the stairs to the classroom on the fourth floor is a real struggle for him: once he reaches the top, he regularly has beads of sweat on his forehead and breathes audibly to get enough air.

The excess kilos do not grow back, but remain untreated almost always into adulthood.

«Around 17 per cent of all Swiss children and adolescents are overweight, and a good 4 per cent are even obese,» says Dagmar l'Allemand-Jander, Co-President of the AKJ Childhood and Adolescent Obesity Association and Head of Paediatric Endocrinology/Diabetology at the Children's Hospital of Eastern Switzerland. «These are alarming figures, because overweight and obesity in childhood and adolescence have a lasting negative impact on the health of adolescents. Unfortunately, the excess kilos don't go away, but almost always remain untreated until adulthood. There they can then lead to a variety of serious secondary diseases such as diabetes, arteriosclerosis or high blood pressure, which are otherwise observed in much older people.»

When is a child considered overweight and when is a child considered obese?

«Doctors speak of obesity when the body mass index BMI, i.e. the ratio of body weight to height squared, is over 25,» explains l'Allemand-Jander. «A value over 30 is considered obesity or adiposity. A BMI of over 40 is considered extreme or morbid obesity.»

As children are still growing, they are usually categorised according to their position on the age-appropriate percentile curve. Parents can find this curve on the last pages of the health booklet. It shows the child's weight in comparison to the values of their peers. «A percentile of over 90 means overweight, obesity begins at 97 and extreme obesity at 99.5,» says the endocrinologist. It is even easier to determine overweight in children using the waist circumference in centimetres. «This should be less than half the child's height, otherwise they are overweight,» says l'Allemand-Jander.

Excess weight in children and adolescents has a negative impact on health in several areas. For example, the excessive body weight puts long-term strain on the joints. «Around 75 per cent of overweight and obese children and adolescents develop joint problems such as bow legs, flat or bow-legged feet and back pain,» says l'Allemand-Jander. «In adulthood, this is often compounded by premature joint wear and tear and slipped discs.»

Around 10 per cent of overweight children and adolescents suffer from sleep apnoea, i.e. short pauses in breathing during sleep. «Fatty tissue in the throat and chest literally cuts off the air and impedes breathing,» explains l'Allemand-Jander. «80 per cent are short of breath and have asthma-like symptoms.»

Restricted fertility

A high percentage of abdominal fat is considered particularly dangerous in the case of obesity. This is also referred to as the apple shape or apple type because the waist is the widest part of the torso. This so-called visceral fat is very metabolically active and also has a hormonal effect. «Girls reach puberty earlier as a result, but produce too many male hormones, which disrupts egg maturation and therefore menstruation, resulting in reduced fertility,» warns l'Allemand-Jander.

«In boys, testicular function is suppressed, which means that less testosterone is produced. This also limits fertility and can lead to breast enlargement.» In addition, the overall risk of serious illnesses such as diabetes, high blood pressure, lipometabolic disorders and arteriosclerosis, which often occur at a young age in overweight people, increases.

In addition to the physical complaints and limitations, there is also severe psychological stress caused by stigmatisation, bullying, exclusion and ridicule. «This happens through verbal attacks in the classroom, in the schoolyard or in the canteen, and often also through exposing pictures and films that are shown on mobile phones or spread via social media,» says l'Allemand-Jander. «The constant humiliation and exclusion leave their mark. They damage self-esteem and can even lead to depression.»

Bad genes are only about 50 per cent to blame

«Overweight children almost always have overweight parents,» explains the paediatric endocrinologist. «Predisposition is considered an important factor in the development of childhood obesity.» However, it only accounts for around 50 per cent of the causes. The other 50 per cent are environmental factors. These include, above all, lifestyle and eating behaviour within the family. «Children learn from models,» emphasises l'Allemand-Jander. «Unfavourable eating patterns of parents with too many fatty, sweet and sumptuous meals shape unhealthy eating behaviour. Inactivity and many hours in front of the TV, tablet or computer do the rest.» The duration of media use is closely linked to weight gain.

It is important to take small steps, to always emphasise the positive, the successes and what has been achieved and to keep encouraging people.

However, psychological factors such as stress, sadness, loneliness, boredom or neglect also encourage uncontrolled binge eating, comfort eating and withdrawal in front of a screen. «Medication such as cortisone or anti-epileptic drugs, on the other hand, play a minor role as a cause,» says the obesity expert.

A diet alone is not enough

As obesity in children and adolescents has a variety of causes, diets alone do not help in the long term," says l'Allemand-Jander. «Multi-professional therapy programmes consisting of nutritional advice, exercise therapy and medical and psychological support are more effective,» explains the obesity expert. «Above all, it is important that the entire family system is involved.»

The first point of contact for affected families is always the paediatrician or family doctor. They can start the therapy together with nutritional counselling and physiotherapy on an outpatient basis. «If this treatment does not lead to at least small successes after several months, specialised obesity centres are available throughout Switzerland, which look after the entire family with an interdisciplinary team for at least a year - the aim is to achieve a long-term change in lifestyle,» emphasises the Co-President of the AKJ.

However, the success of obesity therapy depends not only on a comprehensive programme, but above all on the confidence of those affected in the purpose of the measures and the will to implement them. «To achieve this, it is important to develop a «good relationship» with the affected families from the outset and to provide understanding support,» emphasises Anneco Dintheer-ter Velde, head nutritionist at the Eastern Switzerland Children's Hospital.

«Families all know that they need to do something - they often just don't know how.» It is therefore important to take small steps, to always emphasise the positive, the successes and what has been achieved and to keep encouraging people to stick to the newly learned dietary and behavioural patterns in the long term. According to nutritionist Dintheer-ter Velde, this includes above all

• Eat meals at the table at set times and also have breakfast.
• Make the plate as colourful as possible so that each meal always includes vegetables, fruit and salad.
• Avoid meat, sugar, carbohydrates and highly processed foods.
• Take a break of at least two to three hours between meals.
• Only drink unsweetened drinks.
• Calculate the portions of food according to the hand model (a child's hand holds less than an adult's hand).
• Scoop only once.
• Eat slowly to feel fuller.
• Enjoy a good atmosphere at the table and don't discuss food or other problems.

In addition to diet, regular exercise and sport also play an important role in effectively combating obesity. Specialist centres usually offer individual and group therapies, and sports and gymnastics clubs also offer children and young people many opportunities to exercise close to home.