Overweight - when food makes you ill

Why do children like ten-year-old Luca become overweight? What are the consequences of obesity? And what could help Luca?

Luca is 10 years old and overweight. He suffers from weight problems and has often tried to lose weight. So far without success. He is often teased by his classmates because of his weight problems. As a result, the boy often feels worthless and sad. Luca is not alone with his weight problems. Almost one in five children in Switzerland is overweight or has a weight that is significantly higher than their height, which experts classify as obesity.

Obese children often suffer from depressive moods and increased anxiety. Anxiety disorders such as social phobias, separation anxiety and depression are not uncommon. Experts assume that depression and anxiety problems can develop due to the increased psychological stress caused by obesity and the associated stigmatisation.

Obese children cope with negative feelings with emotional eating, which further exacerbates the problem.

The fullness of the body makes the weight problem visible to others. Teasing at school, ostracisation by classmates, exclusion from certain leisure activities such as sport, but also restrictions in everyday life lead to the child constantly having to deal with their weight problem. The seats on the bus are too small, the school desks too narrow.

Feeling like a failure

This confrontation is very stressful for an obese child. Compared to normal-weight children of the same age, such negative experiences are far more common in overweight children and the psychological burden is therefore higher. The consequences of this stress are low self-esteem and a negative image of themselves and their body. It is not uncommon for children to develop anxiety or depressive moods as a result. Children with weight problems often perceive themselves as failures. Diets usually involve rigid restrictions and are therefore rarely successful over a long period of time. Such repeated unsuccessful attempts at dieting often lead to obese children perceiving themselves as weak-willed and losing the courage to deal with their weight problems.

If parents do not exercise enough, they contribute to their child gaining weight.

As a result, obese children devalue themselves, become frustrated and are afraid to socialise with their peers. This withdrawal favours the «vicious circle» in which frustration and disappointment lead to emotional overeating. Emotional eating in obese children is a way of coping with stress or negative feelings through food, which further exacerbates the weight problem. Some obese children also tend to be more impulsive and hyperactive and have difficulty controlling what and how much they eat. This can result in excessive calorie intake. If such eating binges occur regularly and are accompanied by feelings of loss of control as well as strong feelings of guilt and shame, further indications of an additional eating disorder, binge eating disorder (BED), should be investigated. BES is an eating disorder in which binge eating attacks occur repeatedly.

What are the reasons for being overweight?

Overweight and obesity are caused by an increased energy intake compared to energy consumption. The excess energy supplied by food is converted into fat deposits in the body and stored. In addition to the genetic predisposition to store fat and an increased responsiveness to food stimuli, which are therefore perceived as particularly positive, learning mechanisms in the child's environment and family play an important role. From an early age, children learn from their caregivers which foods are favoured, which portion sizes are scooped or how quickly they eat. How parents deal with their own body and weight also plays a role in the development and maintenance of weight problems in children. Parents' constant weight worries can influence children's weight problems. The constant preoccupation with weight and dieting can lead to children losing their natural access to food.

Obese children have a higher risk of developing behavioural problems due to frequent exclusion.

Stress in the family, such as the illness of a parent or serious life events, as well as the parents' financial worries, also influence the child's approach to food, body and weight. In addition, limited physical activity plays an important role in the development of overweight and obesity. Few opportunities to move freely, a lack of access to a playground, sports field or open space and sedentary leisure activities on the part of the parents influence the child's weight problems. Frequent sedentary activities such as watching television, reading, playing computer games and so on also favour weight gain.

Untreated obesity has health consequences

If overweight or obesity is not treated, it can lead to psychological and physical impairments. Obese children have a higher risk of developing behavioural problems due to frequent exclusion. In addition, obese children are more likely to develop depression and anxiety disorders. The physical health risk also increases with the weight problem. Obese children are more likely to suffer from lipometabolic disorders, high blood pressure, type II diabetes or sleep apnoea syndrome (symptoms caused by apnoea during sleep). The serious psychological and physical consequences emphasise the importance of early detection and treatment. Previous studies have shown that established treatment programmes can bring about short-term and long-term weight reduction in the child and thus prevent health consequences.
Picture: iStockphoto

Which treatment programme is successful for children?

In Switzerland, the Swiss Association for Childhood and Adolescent Obesity offers information on treatment programmes for different age groups, www.akj-ch.ch. Another treatment programme, Training for Obese Children and their Parents (TAKE), which has been tested for its effectiveness over five years, is available from Roth and Munsch (2010). It is aimed at children aged eight to twelve and their parents.
The programme trains parents on various topics relating to weight problems. The aim is to provide parents with information and strategies to support their children in healthy eating and good eating behaviour as well as promoting physical activity. Furthermore, parents are to be trained as their children's most important coaches when it comes to reducing the child's psychological stress. Examples of topics include dealing with teasing, building self-esteem and better acceptance of one's own body. At the Centre for Psychotherapy at the University of Freiburg(www.unifr.ch/psychotherapie/de), TAKE is carried out with parents only or as a parent-child programme, depending on the age of the child. In the case of older children or adolescents, the relevant content is developed directly with the adolescent.

When is a child said to be overweight or obese?

The presence of overweight or obesity is determined by calculating the body mass index (body weight divided by height squared). For children and adolescents, age and gender are taken into account in the assessment. According to the Working Group on Obesity in Children and Adolescents, children are considered overweight from the 90th percentile (weight curve) and obese from the 97th percentile. BMI calculator: www.akj-ch.ch/de > Families > BMI calculator

The authors

Nadine Messerli-Bürgy, PD Dr. phil., Mutter von zwei Kindern, arbeitet seit 2014 als Senior Researcher in der Abteilung für Klinische Psychologie und Psychotherapie am Departement für Psychologie sowie am Institut für Familienforschung und -beratung der Universität Freiburg. Sie ist klinische Psychologin und wissenschaftliche Mitarbeiterin der Schweizer Kinderstudie «Swiss Preschooler’s Health Study» (SPLASHY).
Nadine Messerli-Bürgy, PD Dr phil., mother of two children, has been working as a senior researcher in the Department of Clinical Psychology and Psychotherapy at the Department of Psychology and the Institute for Family Research and Counselling at the University of Fribourg since 2014. She is a clinical psychologist and research associate of the Swiss Preschooler's Health Study (SPLASHY).
Simone Munsch, Prof. Dr. phil., Mutter von drei Kindern, ist seit 2011 Ordinaria für Klinische Psychologie und Psychotherapie am Departement für Psychologie der Universität Freiburg. Sie ist Präsidentin des Instituts für Familienforschung und -beratung und Co-Leiterin der Akademie für Verhaltenstherapie bei Kindern und Jugendlichen. Simone Munsch ist klinische Psychologin, Psychotherapeutin BAG und Supervisorin.
Simone Munsch, Prof. Dr phil., mother of three children, has been a full professor of clinical psychology and psychotherapy at the Department of Psychology at the University of Fribourg since 2011. She is President of the Institute for Family Research and Counselling and co-director of the Academy for Behavioural Therapy with Children and Adolescents. Simone Munsch is a clinical psychologist, psychotherapist BAG and supervisor.