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THE ROLE OF DIETARY FACTORS AND FOOD HABITS IN THE DEVELOPMENT OF CHILDHOOD OBESITY

Introduction
Obesity is the most prevalent nutritional disorder among

children and adolescents throughout the world. The World Health Organization describes obesity as one of todays most blatantly visibleyet most neglectedpublic health problems and uses the term globesity to reflect an escalating global epidemic of overweight and obesity. The International Obesity Task Force (IOTF) terms obesity the millennium disease, highlighting the major international impact of this condition. More than 30% of children and adolescents in the Americas, and approximately 20% of those in Europe, are overweight or obese, with much lower prevalence rates being seen in sub-Saharan Africa and Asia, although in some of these regions rapid changes in prevalence values are being reported. This highlights the central role of recent important environmental trends in the development of the obesity

Childhood Obesity
Definition

o (CDC) recommends using the percentile BMI for

age and gender as the most appropriate method to screen for childhood overweight or at risk for overweight. o Because BMI norms for youth vary with age and gender, BMI percentiles rather than absolute BMI must be determined. o The 85th percentile roughly approximates a BMI of 25, which is the cutoff for overweight. The 95th percentile roughly approximates a BMI of 30, which is the cutoff for obesity.

Pathophysiology
total energy intake > total energy expenditure,

resulting from excessive energy intake and/or reduced energy expenditure fat accumulation dysfunction in the gut-brain-hypothalamic axis via the ghrelin/leptin hormonal pathway (abnormal appetite control and excess energy intake). genetic and environmental factors (familial food intake, exercise, activities)

Dietary factors
Carbohydrates and Fibre o High glycaemic index vs. low glycaemic index o Rapidly digested carbohydrates (HGI) produced

lower satiety o low-glycaemic index foods eaten at breakfast reduced food intake at lunch. o Research: neither dietary glycaemic index nor glycaemic load or added sugar intake appeared to significantly influence changes in body composition. o potential benefits in increasing fibre intake throughout childhood could be limited to toddlers with a lower meal frequency.

Fats o related to increased relative body weight, body fat o

o o o

mass , and body fat content Research: observational studies failed to find a relation between fat intake and the development of obesity. available study suggests that modification of fat intake may decrease the risk of obesity. It is likely that total fat intake and specific dietary lipids play a role in the development of obesity. However, the paucity of available data does not support recommendations on fat quantity and quality in relation to obesity prevention.

Proteins

- The evidence associating protein intake and obesity in children older than 2 years of age is inconsistent and does not allow firm conclusions and recommendations.

Vegetables

- Two recent reviews deal with the relation between

plant food and childhood obesity. - Research: concluded there was no relation between childhood obesity and fruit and vegetables

Food habits
Beverages

- A relation between sugar-sweetened beverage

consumption and development of obesity in children and adolescents has been reported in some studies, although conclusive evidence is not available. - plain water should be promoted as the main source of fluids for children.

Eating Frequency

o lower number of daily meals have a higher risk of

obesity. o eat more frequently, exercise more and make healthier food choices. o It is appropriate that children older than 2 years of age eat at least 4 meals per day.

Skipping Breakfast

o suggested to be a risk factor for obesity


o skipping breakfast cause increased appetite later

in the day, producing overeating.

Family dinner

o eating dinner with families all or most of the time

were less likely to be overweight. o Research: no findings of significant association between family dinner and obesity development.

Fast food consumptions

- research: reviewed studies it is concluded that

increasing consumption of food from fast food outlets is associated with excess weight gain.

Treatment and Prevention


Treatment

Under 7 years old - goal weight maintenance rather than weight loss Above 7 years old - weight loss is typically recommended

Healthy eating

Physical activity
Weight-loss medication - orlistat (Xenical). Weight-loss surgery

Prevention...

Conclusion
The current increase in childhood overweight and

obesity reflects the convergence of many biologic, economic and social factors. The solution for the current epidemic of overweight and obesity is prevention. Screening of children for overweight should begin in the first year of life, and primary care practitioners can monitor the nutritional status of children in their practice by calculating and plotting BMI once standing heights are obtained after 2 years of age. Advice should be offered to parents regarding the prevention of overweight Parental and childhood education is, therefore, essential. When the right family dynamics existsa motivated child with supportive parentssuccess is possible.

References
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Wang Y, Lobstein T. Worldwide trends in childhood overweight and obesity. Int J Pediatr Obes 2006;1:1125. Moreno LA, Pigeot I, AhrensW. Epidemiology of Obesity in Children and Adolescents: Prevalence and Etiology New York: Springer; 2011. Resnicow K. The relationship between breakfast habits and plasma cholesterol levels in schoolchildren. J Sch Health 1991;61:815. Wyatt HR, Grunwald GK, Mosca CL, et al. Long-term weight loss and breakfast in subjects in the NationalWeight Control Registry. Obes Res 2002;10:7882. Mayo clinic. Childhood obesity. Available at : http://www.mayoclinic.com/health/childhoodobesity/DS00698/DSECTION=treatments-and-drugs. Emedicine. Pediatric Obesity. Available at : http://emedicine.medscape.com/article/985333-overview#a0104. Niemeier HM, Raynor HA, Lloyd-Richardson EE, et al. Fast food consumption and breakfast skipping: predictors of weight gain from adolescence to adulthood in a nationally representative sample. J Adolesc Health 2006;39:8429.

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