Annchen Weidemann | Dietician Western Cape

Childhood Obesity

Annchen Weidemann, Dietician, Western Cape

December 11 2017

In the December edition of the New England Journal of Medicine, associate Professor in Pediatrics, Dr. David Ludwig, wrote a very interesting perspective concerning CO. In the course of his work he met with a family with five children, each more obese than the next, with problems such as fatty liver, hypertension, GERD, orthopedic problems and marked dyslipidaemia and insulin resistance. “Sadly, this family might be a microcosm of 21st-century America: if we don’t take steps to reverse the course, the children of each successive generation seem destined to be fatter and sicker than their parents.” He views the obesity epidemic as consisting of four overlapping phases.

Phase 1 began in the early 1970’s and is ongoing: weight of children is escalating beyond control. Attracting much attention from medical profession and public, the obese child may remain relatively healthy for years.

Phase 2 which we are now entering, is characterized by the emergence or serious weight-related problems. Type 2 diabetes, fatty liver, orthopedic problems, sleep apnea and psychological problems are taking its toll. Obese children tend to be socially isolated and have high rates of disordered eating, anxiety and depression. They are less likely to complete college and are more likely to live in poverty.

Phase 3 is where medical problems of obesity reach life-threatening proportions. We’re talking seriously increased incidence of CHD, high risk of limb amputation, kidney failure requiring dialysis, and premature death. Fatty liver will progress to hepatitis and cirrhosis leading or irreversible organ damage. Poverty and isolation would compound the situation and the risk of dying in middle age will be three times as high as among normal weight adolescents.

Without effective intervention, phase 4 of the epidemic will entail an acceleration of the obesity rate through trans-generational mechanisms. Obese children tend to be obese adults because their habits persist. Irreversible biologic changes in hormonal pathways, fat cells and the brain occur, that increase hunger and adversely affect metabolism. Through perinatal programming, adult obesity and its complications appear to increase the risk of the same in offspring through non-genetic influences. Like global warming, this epidemic is a looming crisis. Although expert forecasts have been skeptic, doubting the far-reaching effects of CO, this is gradually being overcome by accumulating data. Hope is placed on the development of new drugs or surgical procedures that might offer a painless quick-fix.

Certainly, dietary intervention is curcial. Family involvement and treatment of carbohydrate-overloading appear to be effective on the short term. Parents must take responsibility for their children’s welfare by providing improvement in food quality, restricting television viewing, and setting the example to a healthful lifestyle. But why should these efforts be undermined by massive marketing campaigns from the manufacturers of junk food? Why are children subjected to the temptation of such food in the school cafeteria and vending machines? Why don’t they have the opportunity to exercise their bodies during the school day? And why must we fight with medical aids about reimbursement to cover the costs of the inputs of the expert Dietician, to prevent the unavoidable health consequences through practical guidance in changing eating habits? Hear, hear. But childhood obesity remains a field fraught with non-coverage by medical aids and non-compliance by responsible parents. Rest assured – I will not stop at these hurdles to help these promising young children improve their lives and help their parents make better choices on their behalf, based on improved knowledge and better understanding of nutrition. Children don’t have to “diet” or starve to lose or control weight. They need at least one motivated parent…

Although broad consensus exists regarding the dietary and lifestyle habits needed to prevent and treat CO, we lack anything resembling a comprehensive strategy for encouraging children to eat a healthful diet and engage in physical activity. Slice the pizza in four pieces, not eight – I’m not hungry enough to eat eight. Yogi Berra

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