rates are rapidly increasing in the African Region, as in most parts of the
world. Overweight and obesity, particularly in urban settings, are major risk
factors for type 2 diabetes, high blood pressure, heart attacks and a variety
There is a common misconception that obesity and other no communicable diseases (NCDs) only occur among the wealthy. Poorer populations are experiencing high double-burdens of infectious and chronic diseases. Additionally, sub-Saharan women are far more likely to be obese than men affecting women’s health issues, pregnancy, maternal and infant health.
The greatest risk factors for dying of NCDs are complications with infectious diseases such as HIV, tuberculosis, streptococcus, human papillomavirus, viral hepatitis, rubella and parasitic diseases such as malaria.
Obesity is affected by many factors including food choices, sedentary lifestyles, genetics and cultural beliefs. Counterproductively, many countries in the Region view obesity as a sign of prosperity. Sedentary lifestyles are affected by changing modes of transportation, types of work and increasing rates of urbanization.
The upward shift in obesity is associated with:
increased consumption of high-fat and high-sugar foods;
increased consumption of highly-refined and processed foods;
decreased consumption of fruits, vegetables, nuts and legumes;
Increased sedentary lifestyles.
Facts and figures on childhood obesity
The number of overweight or obese infants and young children (aged 0 to 5 years) increased from 32 million globally in 1990 to 41 million in 2016. In the WHO African Region alone the number of overweight or obese children increased from 4 to 9 million over the same period.
The vast 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.
If current trends continue the number of overweight or obese infants and young children globally will increase to 70 million by 2025.
Without intervention, obese infants and young children will likely continue to be obese during childhood, adolescence and adulthood.
Obesity in childhood is associated with a wide range of serious health complications
An increased risk of premature onset of illnesses, including diabetes and heart disease.
Exclusive breastfeeding from birth to 6 months of age is an important way to help prevent infants from becoming overweight or obese.
Consequences of obesity in childhood
Obese children are more likely to develop a variety of health problems as adults. These include:
· cardiovascular disease
· insulin resistance (often an early sign of impending diabetes)
· musculoskeletal disorders (especially osteoarthritis - a highly disabling degenerative disease of the joints)
· some cancers (endometrial, breast and colon)
Contributors to obesity in infants and children
Every aspect of the environment in which children are conceived, born and raised can contribute to their risk of becoming overweight or obese. During pregnancy, gestational diabetes (a form of diabetes occurring during pregnancy) may result in increased birth weight and risk of obesity later in life.
Choosing healthy foods for infants and young children is critical because food preferences are established in early life. Feeding infants energy-dense, high-fat, high-sugar and high-salt foods is a key contributor to childhood obesity.
Lack of information about sound approaches to nutrition and poor availability and affordability of healthy foods contribute to the problem. The aggressive marketing of energy-dense foods and beverages to children and families further exacerbate it. In some societies, longstanding cultural norms (such as the widespread belief that a fat baby is a healthy baby) may encourage families to over-feed their children.
The increasingly urbanized and digitalized world offers fewer opportunities for physical activity through healthy play. Being overweight or obese further reduces children’s opportunities to participate in group physical activities. They then become even less physically active, which makes them likely to become more overweight over time.
Prevention of childhood obesity
Overweight and obesity are largely preventable. Supportive policies, environments, schools and communities are fundamental in shaping parents’ and children’s choices, making the healthier choice of foods and regular physical activity the easiest choice (accessible, available and affordable), and therefore preventing obesity.
For infants and young children, WHO recommends:
· early initiation of breastfeeding within one hour of birth;
· exclusive breastfeeding for the first 6 months of life; and
· The introduction of nutritionally-adequate and safe complementary (solid) foods at 6 months together with continued breastfeeding up to two years of age or beyond.
Complementary foods should be rich in nutrients and given in adequate amounts. At six months, caregivers should introduce foods in small amounts and gradually increase the quantity as the child gets older. Young children should receive a variety of foods including meat, poultry, fish or eggs as often as possible. Foods for the baby can be specially prepared or modified from family meals. Complementary foods high in fats, sugar and salt should be avoided.
School-aged children and adolescents should:
· limit energy intake from total fats and sugars;
· increase consumption of fruit and vegetables, as well as legumes, whole grains and nuts;
· Engage in regular physical activity (60 minutes a day)
Overweight and obesity are defined as abnormal or excessive fat accumulation that may impair health.
Body mass index (BMI) is a simple index of weight-for-height that is commonly used to classify overweight and obesity in adults. It is defined as a person’s weight in kilograms divided by the square of his height in meters (kg/m2).
BMI provides the most useful population-level measure of overweight and obesity as it is the same for both sexes and for all ages of adults. However, it should be considered a rough guide because it may not correspond to the same degree of fatness in different individuals.
For children, age needs to be considered when defining overweight and obesity.
Children under 5 years of age
For children under 5 years of age:
overweight is weight-for-height greater than 2 standard deviations above WHO Child Growth Standards median; and
Obesity is weight-for-height greater than 3 standard deviations above the WHO Child Growth Standards median.
Charts and tables: WHO child growth standards for children aged under 5 years
Children aged between 5–19 years
Overweight and obesity are defined as follows for children aged between 5–19 years:
overweight is BMI-for-age greater than 1 standard deviation above the WHO Growth Reference median; and
Obesity is greater than 2 standard deviations above the WHO Growth Reference median.
Charts and tables: WHO growth reference for children aged between 5–19 years
Facts about overweight and obesity
The fundamental cause of obesity and overweight is an energy imbalance between calories consumed and calories expended. Globally, there has been:
an increased intake of energy-dense foods that are high in fat; and
An increase in physical inactivity due to the increasingly sedentary nature of many forms of work, changing modes of transportation, and increasing urbanization.
Changes in dietary and physical activity patterns are often the result of environmental and societal changes associated with development and lack of supportive policies in sectors such as health, agriculture, transport, urban planning, environment, food processing, distribution, marketing, and education.
In general, to lose weight, you either have to decrease the amount of calories you are eating and drinking, exercise to burn more calories, or even better, do a combination of both. Remember that 1 pound is equal to about 3500 calories, so you have to burn 3500 calories to lose a pound or eat an extra 3500 calories to gain a pound.
For example, if you are child is at a steady weight, to lose 1 pound a week, you either have to eat 500 fewer calories a day (equal to 3500 calories a week) or burn 500 extra calories a day by exercising. Or eat 250 fewer calories and burn 250 calories exercising.
To lose 1 pound in two weeks, you can decrease your calories by 250 a day or burn 250 extra calories a day.
What is 250 calories? A piece of cake, 4 cookies, 2 sodas, an hour of light bicycling or walking, or 30 minutes of playing soccer, roller balding, or jogging at 5 MPH. 250 calories is also almost the difference between eating a regular McDonald’s cheeseburger (330 calories) and medium (450 calories) French fries instead of a Quarter Pounder (430 calories) and super-size (610 calories) French fries.
If your child is gaining 1/2 pound a week, then cutting his diet by 250 calories a day will lead to no weight gain. Once he stays at a steady weight, you can cut back by another 250 calories a day to lose 1/2 pound a week.
Although you don’t need to count calories each and every day, doing it for a week or so might help you find where excess calories are coming from. If your child is gaining a 1/2 pound a week, you might find that cutting out a bedtime snack of 250 calories might keep him from gaining more weight.
Prevention of Obesity
Although trying to help overweight children lose weight is important, even more important may be trying to prevent them from becoming overweight in the first place. This too is not easy, but something that needs to be started in early childhood, especially if your child is at risk for becoming obese, like if they have overweight parents.
Targeting the behaviours that lead children to become overweight can be helpful in preventing your child from becoming overweight. These include unhealthy eating habits and a lack of physical activity and exercise.
Tips, both to prevent obesity and help your child lose weight, include:
· limiting the number of calories that your child drinks. For example, many kids drink too much juice and soda each day. Sticking to the usual recommend limits of 4-6 ounces of 100% fruit juice for children under age 6 years and only 8-12 ounces for older children can help to limit excessive weight gain.
· limiting the amount of milk that younger children drink. Although drinking milk is important and it is a good source of calcium, too much milk can lead to your child becoming overweight. Obesity often starts in early childhood, with a common scenario being a child who drinks too much milk.
Children usually only need about 16-24 ounces of milk each day.
· avoiding frequent meals of fast food.
· don’t ‘super-size’ your child’s meals. A common problem that contributes to overweight children are meals with portions that are too large.
· don’t force younger children to ‘clean their plates.’ An important way to help children learn to eat healthy is for them to know that they can stop eating when they are full.
· encourage regular exercise and physical activity in your children each day. This may include going for walks as a family, playing outside, riding a bike, or participating in organized sports, like soccer and baseball.
· limit inactivity by setting strict limits on watching television and playing computer and video games.
· avoiding allowing your children eat while watching TV. Instead, limit meals to the dinner table.
· don’t put too much of a focus on what your child eats. Remember not too restrict calories and instead, offer a healthy diet with 3 healthy meals (don’t skip meals, especially breakfast) and a few snacks, and allow occasional treats. Talking to your child too much about calories, fat and dieting can actually cause more harm than good, leading to eating disorders.
· know what your child is eating and where his calories are coming from.
And also important, be a good role model for your children by eating a healthy diet and exercising regularly. Keep in mind that a healthy diet is usually low in saturated fat.
Losing weight is not easy and you may need to get extra help for your child. This will likely include your Paediatrician, who can monitor your child’s weight gain and loss every few months, but it might also include a Registered Dietitian, who can help you come up with a more healthy diet for your family.
If being overweight is affecting your child’s mood or self-esteem, then a Child Psychologist might also be helpful.
For further information Paediatric Department of EFSTH, number of NGO and private clinics, email to firstname.lastname@example.org, Text only to 2207774469/3774469 working days from 3-6 pm.
Author DR AZADEH Senior Lecturer at the University of the Gambia, Senior Consultant in Obstetrics & Gynaecology, Clinical Director of Medicare health services