Overweight Children in The Gambia

Prevention and Treatment Help Keep Your Kids from Becoming Overweight

Obesity is an increasing problem for children worldwide, Gambia not exception

Childhood Obesity Facts

· Childhood obesity has more than doubled in children and quadrupled in adolescents in the past 30 years.

· The percentage of children aged 6–11 years in the United States who were obese increased from 7% in 1980 to nearly 18% in 2012. Similarly, the percentage of adolescents aged 12–19 years who were obese increased from 5% to nearly 21% over the same period.

· In 2012, more than one third of children and adolescents were overweight or obese.

· Overweight is defined as having excess body weight for a particular height from fat, muscle, bone, water, or a combination of these factors. Obesity is defined as having excess body fat.

· Overweight and obesity are the result of “caloric imbalance”—too few calories expended for the amount of calories consumed—and are affected by various genetic, behavioural, and environmental factors.

Health Effects of Childhood Obesity

Childhood obesity has both immediate and long-term effects on health and well-being.

Immediate health effects:

· Obese youth are more likely to have risk factors for cardiovascular disease, such as high cholesterol or high blood pressure. In a population-based sample of 5 - to 17-year-old, 70% of obese youth had at least one risk factor for cardiovascular disease.7

· Obese adolescents are more likely to have prediabetes, a condition in which blood glucose levels indicate a high risk for development of diabetes.8,9

·Children and adolescents who are obese are at greater risk for bone and joint problems, sleep apnoea, and social and psychological problems such as stigmatization and poor self-esteem.5,6,10

Long-term health effects

· Children and adolescents who are obese are likely to be obese as adults 11-14 and are therefore more at risk for adult health problems such as heart disease, type 2 diabetes, stroke, several types of cancer, and osteoarthritis. 6 One study showed that children who became obese as early as age 2 were more likely to be obese as adults.12

· Overweight and obesity are associated with increased risk for many types of cancer, including cancer of the breast, colon, kidney, pancreas, gall bladder, thyroid, ovary, cervix, and prostate, as well as multiple myeloma and Hodgkin’s lymphoma.15

Now, in addition to educational efforts to get parents to teach their children to eat well and exercise more, kids are turning to adult obesity treatments. These include the use of weight control drugs, like Meridia, and gastric bypass surgery.

As in adults, there is no quick and easy way for kids to lose weight. Instead, many overweight kids end up becoming overweight adults.

Weight Loss Goals

The first goal in getting kids to a more healthy weight should actually not be weight loss. Instead, the usual recommendation is for kids to just stop gaining weight, and then, as they get taller, they can ‘grow into’ their weight.

An even more realistic goal might be to just not gain weight so fast though. For example, a 12 year old boy should usually gain about 10 pounds a year during the early teen years. If he gains much more, say 15-20 pounds, then he will quickly become overweight. If he limits himself to the usual healthy weight gain for a teenager, then he might become less overweight and will at the very least, not become more overweight. Although that doesn’t sound like much, it is an important accomplishment and first goal.

If your child is very overweight, then the next goal should usually be to stop gaining weight or gain less weight each year, say perhaps only 3-5 pounds a year. If necessary, your child could then move towards losing weight, especially if he is very overweight, in which case he may need to restrict his calories somewhat under the guidance of a Registered Dietitian or your Paediatrician.

Parents, and many weight loss centres, like Weight Watchers, often ask what weight a child should be to be healthier. This is a tricky question, as a child’s BMI and healthy weight changes each year as he gets taller. It can be important to figure out what a healthy weight would be though, as it can be an important concrete goal to reach for.

Although the body mass index calculation is usually used to figure out if a person is at a healthy weight, you can also use it to find a target healthy weight for your child. For example, a 12 year old boy who is 4’11” and 150 pounds has a BMI of 28 and would be considered overweight. A healthier BMI would be about 24, which would put his weight at only 119 pounds. But it is very unreasonable (and unhealthy) to expect a child to lose 31 pounds.

You should instead look at what his height and weight should be in a year or two to reach a healthy BMI. For example, for this child, in a year you can expect him to grow about 3 inches. And at age 13, a more healthy BMI for a boy would be 25 (which is about a 10% loss in a year). If you enter those numbers in this reverse BMI calculator, you will calculate a target weight of 137, which is a little more reasonable and about a 1 pound loss a month.

What if you use more modest goals, perhaps getting to a healthy BMI over two years? You will expect this child to be 5’4” at age 14, with a more healthy BMI of 26, which gives you a target weight of 151 pounds. So now, instead of losing weight, this child actually gained a pound, but because he grew 5 inches, he is now at a more healthy weight!

To use the Healthy Weight Calculator, you will have to have your child’s growth chart and body mass index chart handy. You can view and print them out from our Children’s Growth Chart subject area. Once you have the charts, mark your child’s current height, weight and body mass index. See our guide to Understanding Growth Charts and ourBMI Calculator if you need help with this. Next, follow your child’s growth curve to see what his height will be in a year or two. And then find the BMI that would be at the 95th percentile when he is a year or two older. You can then plug these numbers into the Healthy Weight Calculator to find your child’s target weight.

Why the 95th percentile for BMI? Well, over that number, your child is considered overweight. Since children with a BMI between the 85th and 95th percentile are considered at risk of becoming overweight, you could also use the 85th percentile BMI if you like.

Adults can also use this Healthy Weight Calculator. Just use your current height and a target BMI of 18.5 to 25 (an adult with a BMI over 25 is considered to be overweight).

See our Weight Management Guide for tips on helping your child get to a more healthy weight.

Losing Weight

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 behaviors 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.

Get Help

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 azadehhassan@yahoo.co.uk, Text only to 2207774469/3774469.

Author DR AZADEH Senior Lecturer at the University of the Gambia, Senior Consultant in Obstetrics & Gynaecology, Clinical Director of Medicare health services