The pediatrician answers > Childhood Obesity: Prevention

Obesity is a chronic disease, with a multifactorial component that causes an increase in energy intake and decreased energy expenditure.

Apr 4, 2019


Obesity is defined as excess body fat. It is a chronic disease, with a multifactorial component in its cause that, in a unique or combined, results in an increase in energy intake and a decreased energy expenditure.

It is a disease that, in childhood and adolescence, is one of the most serious public health problems worldwide, whose prevalence is increasing alarmingly until it has been declared an epidemic of the 21st century. This increase has been influenced by environmental factors such as lifestyle, family behavior, physical activity, diet maintained, etc. As well as psychosocial factors, genetic and physiological factors.

The diagnosis of childhood obesity is not a clinical problem for physicians, who value the history of the disease, its form of presentation, possible influencing factors, as well as personal and family history. The physical examination of the patient helps to establish a more accurate diagnosis. In general, pediatricians use indicators adjusted to the reference population with which each individual is compared, taking into account the body mass index (BMI: quotient between the weight of the child in kilograms and its height squared, in meters) associated to percentiles and reference curves according to the reference population to which the patient belongs (ethnicity, nation…). In addition, these determinations are associated with the data provided by other anthropometric measurements (abdominal perimeter, measurement of the skin fold in the arm, etc.) and are accompanied by data obtained in the performance of a blood test, which discards the presence of Associated pathologies such as hypercholesterolemia, diabetes, etc.

The influence of obesity and overweight during childhood goes beyond the childhood stage, predisposing directly to the condition of obesity in adulthood. Thus, the possible chronification of obesity has been directly related to the development of other diseases that, in the case of children, are ahead of their presentation: increased cholesterol, diabetes mellitus type II, hypertension, metabolic syndrome, Polycystic ovarian syndrome, sleep apnea, etc. that has a direct relationship with the decrease in life expectancy of these patients.

sobrepeso infantil

Obesity is defined as excess body fat.

Prevention of obesity: strategies

Given the importance of the characteristics of this disease, there are many levels at which preventive action should be established as a primary objective: public bodies, health intervention, family action, school level, business contextualization, and community action, in short.

In recent years, public bodies have become aware of the importance of establishing prepared prevention plans. From the world health organization, intervention strategies have been developed in the diet, physical activity, and health. These types of strategies are adopted by different countries according to their social and cultural environment.

In Spain, since 2005, the NAOS strategy (Nutrition, Physical Activity, and Prevention of Obesity) has been developed, a health plan launched by the Ministry of Health, aimed at reversing the alarming data on the increase in the prevalence of obesity. obesity in our country, establishing strategies to stimulate physical activity and healthy eating, with greater emphasis on children.

Prevention of obesity at the family, school and community levels.

Within these public prevention strategies that cover broad fields (social, health, business, etc.) and through the endorsement of multiple published scientific studies, a series of measures can be established that, in the area closest to the child (the school and family), should be implemented regularly in order to achieve a primary prevention of effective obesity.

Thus, there are two basic fields of action: healthy eating and regular physical activity.

From pregnancy, the type of food that the mother carries can influence the development of the child, since overweight and maternal obesity have been associated with the appearance of overweight in the child’s age or obesity in the adulthood of the child. The advisable thing is that the mother performs a varied diet rich in fruits and vegetables, with an estimate of recommended weight gain of between 10 to 13 kg throughout the pregnancy. We have also seen the relationship that other factors such as smoking during pregnancy have on the overweight of children in the infant stage, which should always avoid tobacco in pregnancy for this and other health reasons for the fetus.

During the first year, feeding the baby is also important. Breastfeeding is the best food that can be offered to the child, as it acts as a protector of the risk of developing obesity in the child. When this lactation is not possible, it is essential the type of formulas of artificial feeding that are offered to the child, recommending an adequate protein intake in them (between 7 – 10% of the total caloric value of the formula) and correct composition of the fat of these with essential fatty acids. It should offer a diet on demand, introducing diversified complementary food, not before 4 – 6 months, with the introduction of different types of foods according to the guidelines recommended by pediatricians. It is advisable not to exceed the addition of cereals, avoid a high protein intake, prioritizing varied and healthy diet.

In preschool and school children, it is important to maintain that balanced diet, stimulating the taste for healthy food with repeated offerings of fruits and vegetables (3 servings of whole fruit and 2 servings of vegetables a day) and adjusting the energetic contribution of the same with the child’s activity rhythm.

Maintain a rhythm and feeding schedule established with 5 meals per day, ensuring that at least one of them is done as a family.

It is important that children have a good breakfast (dairy, cereal or bread, fruit, and natural juices). In the lunches and snacks industrial processes must be avoided (buns, non-natural juices, sweets, sweets, etc).

Water should be offered as a basic drink, and milk and occasionally fresh juices can also be offered. Avoid sodas and other sugary drinks.

As main courses, apart from the vegetables, which can also be offered as an accompaniment to meat and fish, you should not forget to include vegetables several times a week, pasta and rice some day of the same.

It is important the visual stimulation offered to children with food, combining colors and textures. Something fundamental is the example of parents in their diet. Foods should not be used as rewards or punishments, cooking without excess salt and using olive oil before butter or other types of oils.

Along with food, adequate rest (sleep from 9 to 11 hours) and the stimulation of physical activity are essential for the prevention of obesity.

Physical activity, both in normal activities (play, walks, rest time, etc.) and in structured physical exercise, must provide the child with adequate energy expenditure, in addition to stimulating lean mass (muscle) and decreasing the percentage of fat mass in your body composition. This physical activity should be promoted from the family, school and in the community, decreasing the time spent watching television and other screens.

In preschool children should be encouraged free and fun, that involves few instructions (running, swimming, short walks, etc.). From 6 to 9 years stimulate activities that increase motor skills and balance (games with flexible rules such as soccer, etc). From 10 years old they can play more complex games and sports, with more elaborate instructions (volleyball, basketball, etc.), and from adolescence you can do all kinds of sports, being able to train with weights once you have reached the maturity. This type of exercises is recommended to perform at least 3 or more hours per week.

In addition to structured sports, daily free play, active transfers, stair climbing, use of the bicycle, scooter or skates must be established as normal habits in the child’s day-to-day.

It is the implementation of all these measures that can really serve as prevention of one of the most widespread childhood diseases today, with which, their knowledge and commitment of all to achieve the development of a healthy childhood, should be allocated the efforts of all.