Major childhood

morbidities in a
modernised society:
childhood obesity and
hypertension
By Oliver Ki Kek Yee
0321435
 Learning Outcomes

1. Define the body mass index (BMI) and various weight categories according to the BMI.
2. Describe the epidemiology of childhood obesity worldwide and in Malaysia.
3. Describe the short and long term health effects of childhood obesity.
 Defining Body Mass Index (BMI)

● Body Mass Index (BMI) is a value of which is derived from the Mass (in terms of weight) and the Height of a
person.
● Calculated by using a person’s weight in kilograms divided by the square of height in meters.
● Acts as an inexpensive, and easy to perform method of screening for weight categories that may lead to health
problems.
● In children and teens, BMI is age- and sex specific and is often referred to as BMI-for-age.
● In children, a high amount of body fat can lead to weight-related diseases and other health issues.
● Being underweight can also put one at risk for other health issues.
 How to measure?
Measuring height accurately :
1. Remove the child or teen’s shoes, bulky clothing, and hair ornaments, and unbraid hair that
interferes with the measurement.
2. Take the height measurement on flooring that is not carpeted and against a flat surface such as
a wall with no molding.
3. Have the child or teen stand with feet flat, together, and against the wall. Make sure legs are
straight, arms are at sides, and shoulders are level.
4. Make sure the child or teen is looking straight ahead and that the line of sight is parallel with
the floor.
5. Take the measurement while the child or teen stands with head, shoulders, buttocks, and heels
touching the flat surface (wall). Depending on the overall body shape of the child or teen, all
points may not touch the wall.
6. Use a flat headpiece to form a right angle with the wall and lower the headpiece until it firmly
touches the crown of the head.
7. Make sure the measurer’s eyes are at the same level as the headpiece.
8. Lightly mark where the bottom of the headpiece meets the wall. Then, use a metal tape to
measure from the base on the floor to the marked measurement on the wall to get the height
measurement.
9. Accurately record the height to the nearest 1/8th inch or 0.1 centimeter.
 How to measure?

Measuring weight:
1. Use a digital scale. Avoid using bathroom scales that are spring-loaded. Place the scale on firm flooring (such as tile
or wood) rather than carpet.
2. Have the child or teen remove shoes and heavy clothing, such as sweaters.
3. Have the child or teen stand with both feet in the center of the scale.
4. Record the weight to the nearest decimal fraction (for example, 55.5 pounds or 25.1 kilograms)
 Weight Categories

The parameters are actually age and gender specific, hence the categories are divided based on percentiles, rather than a
static range as used in adults.
In Malaysia, we use the CDC BMI-for-age growth chart.
There are 4 categories in general; in order of percentile range; underweight, normal/healthy weight, overweight, obese.
 Childhood obesity
Worldwide:
1. In 2016, the WHO found that over 41 million children under the age of five were overweight, and almost half are
from Asia, and one quarter from Africa.
2. Within the past 40 years, the number of school-aged children and adolescents with obesity has risen more than 10-
fold; from 11 million to 124 million (2016 numbers); the total number of overweight but not obese children in 2016
was 216 million.
3. Children aged 5-19 were overweight or obese totalled to 340 million.
4. 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.
5. In 2019, 38 million children under the age of five were overweight or obese.
a. Once considered a high-income country problem, overweight and obesity are now on the rise in low- and middle-income countries, particularly
in urban settings.
6. Prevalence of overweight and obese children and adolescents aged 5-19 has risen from 4% (1975) to 18% (2016).
a. The rise is similar among boys and girls (19% and 18% respectively).
7. While just under 1% of children and adolescents aged 5-19 were obese in 1975, more 124 million children and
adolescents (6% girls, 85% boys) were obese in 2016.
8. Overweight and obesity are linked to more deaths than underweight.
a. Globally, there are more people who are obese than underweight - everywhere except sub-saharan Africa and Asia.
 Childhood obesity

Malaysia:
● In 2004, a study reported that the prevalence of overweight and obesity among school children and adolescents to
be 7.3% which rose to 19.2% (overweight) and 15.2% (obese) in the mid 2010’s.
For ages 5 years or under:
● In 1980, among south asia, Malaysia is ranked the highest in obesity prevalence in girls. (boys = Taiwan)
● In 2015, among south asia, Malaysia won BOTH genders this time. (Girls runner ups - Thailand and China; Boys
runner ups - Taiwan and Thailand).
For ages 5 -19 years:
● South Asia had extremely low levels in 1975; estimated at 0.0% for both girls and boys.
● Southeast Asia had less than 2% across the board.
● 2016, highest level of obesity in girls was in Malaysia, boys - Brunei Darussalam.
 Consequences

Childhood obesity is associated with a higher chance of premature death and disability in adulthood.
Overweight and obese children are more likely to stay obese into adulthood and to develop noncommunicable diseases
(NCDs) like diabetes and cardiovascular diseases at a younger age. For most NCDs resulting from obesity, the risks
depend partly on the age of onset and on the duration of obesity.

According to CDC; the more immediate effects are as follows:

1. High blood pressure an dyslipidaemia, which are risk factors for cardiovascular disease.
2. Increased risk of impaired glucose tolerance, insulin resistance and type 2 diabetes.
3. Breathing problems, such as sleep apnea, and asthma.
4. Joint problems and musculoskeletal discomfort.
5. Fatty liver disease, gallstones, and gastro-esophageal reflux (i.e., heartburn).
6. Psychological stress such as anxiety and depression, behavioral problems, and issues in school.
7. Low self-esteem and low self-reported quality of life.
8. Impaired social, physical, and emotional functioning.
 Consequences
Long term effects:
1. Adulthood obesity.
2. Cardiovascular diseases - mainly ischaemic heart disease and stroke.
3. Diabetes.
4. Musculoskeletal disorders - Osteoarthritis.
5. Cancers - Endometrial, breast, and colon cancer.

Double burden
● Low and middle-income countries are currently facing a “double burden” of disease, as they continue to struggle
with the problems of infectious diseases and under-nutrition; at the same time they are experiencing a rapid
increase in risk factors of noncommunicable diseases, such as overweight and obesity, particularly in their urban
settings.
● It is not uncommon to find under-nutrition and obesity co-existing side-by-side within the same country,
community and even within the same household.
● This double burden is caused by inadequate pre-natal, infant and child nutrition which is then followed by exposure
to high-fat, energy-dense, micronutrient-poor foods and a lack of physical activity as the child grows older.
 References
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