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The prevalence of overweight and obesity among children and adolescents aged 6-17 in mainland China is close to 20%, and 10% of children under 6 years old. This means that for every 10 minors, there is at least one "little chubby".
Written by | Yan Xiaoliu
In the first week of July, the "Weight Loss Summer Camp" of Beijing Children's Hospital affiliated to Capital Medical University will be held again. This is the 9th weight-loss summer camp held by the hospital in 8 years.
Yan Jie, one of the planners of the event and chief physician of the Department of Clinical Nutrition, said frankly that she started late this year, but she was not worried that no one would sign up. "We have a pediatric obesity and bariatric clinic, and there are more and more children, and there is a great and urgent need for weight loss."
On June 26, the National Health Commission and other 16 departments jointly issued the "Weight Management Year" Activity Implementation Plan (hereinafter referred to as the "Plan") and held a press conference, Guo Yanhong, director of the Medical Emergency Department of the National Health Commission, said at the meeting that overweight and obesity are major public health problems, and it is urgent to strengthen intervention and improve them.
According to the Report on Nutrition and Chronic Diseases of Chinese Residents (2020) released by the National Health Commission, the overweight and obesity rate among children and adolescents aged 6-17 in mainland China is close to 20%, and 10% of children under 6 years old. This means that for every 10 minors, there is at least one "little chubby". The Plan provides specific guidance and requirements for the weight management of infants, toddlers and pre-school children, as well as students.
Since May, the official account of the National Bureau of Disease Control and Prevention has released 6 articles in the series of articles "Don't be a "little chubby dun"". A "tough battle" for the weight of children and adolescents has begun.
Beijing Children's Hospital Affiliated to Capital Medical University "Bariatric Summer Camp" live. Image source/interviewee
The sooner you get fat, the bigger the problem
High blood pressure, high uric acid, fatty liver ...... These chronic diseases, which used to be susceptible to the elderly, are also showing a trend of younger and younger age.
In January this year, the School of Public Health of Peking University and others held a seminar. Mi Jie, a professor at the Children's Chronic Disease Management Center of Beijing Children's Hospital and chairman of the Pediatric and Adult Disease Prevention and Control Committee of the Chinese Preventive Medicine Association, said that obesity will bring damage to almost all tissues and organs in the body. "In obese children, there is already an increase in blood pressure, high uric acid...... A growing body of research data shows that obesity in childhood continues into adulthood, increasing the risk of developing various chronic diseases. ”
"Almost every day, the child care clinic can screen for overweight or obese children, and some of them are visibly fat." Dr. Huo Yanyan from the Department of Children's Health Care of the Children's Hospital of Shanghai Jiao Tong University School of Medicine said worriedly that he saw a four or five-year-old child in the outpatient clinic with round cheeks on both sides, a fat belly, and a neck as black as the bottom of a pot. Further examination revealed that the child had developed fatty liver and insulin resistance.
Yan Jie told the "medical community" that if fatty liver is allowed to develop, histological abnormalities such as liver fibrosis will occur, and it may even progress to liver cirrhosis. "The longer and more severe the fat, the more irreversible the liver fibrosis. Especially at the age of five or six, you will enter the quiescent period of fat cells, when you overeat and lead to obesity, and the long-term harm is even deeper. ”
Yan Jie said frankly that the harm of obesity to young children is all-round. She often encounters boys transferred from the urology department and is found to have small genitals. "In fact, one of the root causes is that obesity affects sexual development."
Being overweight can also reduce self-esteem and self-confidence in children and adolescents. Ma Jun, director of the Institute of Child and Adolescent Health at Peking University, once told the media that judging from the data, there are more and more overweight and obese children, but in real life, they seem to be "invisible". On the one hand, obese children don't like outdoor activities. On the other hand, due to the fear of others judging their body shape, they are more likely to be introverted, have low self-esteem, and have a low sense of presence.
"People will think they always smell of sweat." Yan Jie often encounters young children who are so fat that they are worrying.
As early as 2014, the World Health Organization (WHO) proposed to "end obesity in children under 5 years old" as an important goal. However, according to the February Lancet article, in 2022, China's obesity rates among girls and boys ranked 102nd and 70th respectively among more than 190 countries and regions around the world. Among them, the obesity rate among girls increased from 0.6% in 1990 to 7.7% in 2022, and from 1.3% to 15.2% for boys.
Joep Perk, a former spokesman for cardiovascular disease prevention and treatment at the European Society of Cardiology, once pointed out that "this is the most dramatic increase in the number of obese children and adolescents I have ever seen. ”
Poster of "Weight Loss Summer Camp" at Beijing Children's Hospital Affiliated to Capital Medical University. Image source/interviewee
If you are tall and don't weigh much, you are successful
In October 2020, six ministries and commissions issued the "Implementation Plan for the Prevention and Control of Obesity in Children and Adolescents" (hereinafter referred to as the "Implementation Plan"), which put forward a clear goal: by 2030, the annual growth rate of overweight and obesity among children and adolescents aged 0-18 years old will be reduced by 70%, and the reduction rate in high-epidemic areas will reach 80%.
The Implementation Plan encourages medical and health institutions to provide individualized nutrition and exercise prescriptions for overweight and obese children according to their needs.
In the face of the increasingly serious problem of childhood obesity, Huo Yanyan has a set of scientific evaluation methods. She said: "Whenever you encounter an overweight and obese child, you should combine various data for a comprehensive assessment, including height, weight, waist circumference, hip circumference, body composition, etc. ”
According to the Chinese Expert Consensus on the Diagnosis, Evaluation and Management of Childhood Obesity, it is recommended that infants and young children aged <2 years be diagnosed by "body weight", and children aged ≥ 2 years can be diagnosed by body mass index (BMI).
Waist circumference and waist-to-height ratio can be used to determine central obesity and predict the risk of cardiovascular disease and diabetes. According to Chinese children's data, the waist-to-height ratio of boys aged 6-15 is >.48, girls aged 6-9 > 0.48, and girls aged 10-15 > 0.46, and the risk of metabolic diseases increases.
Yan Jie said that most children are simply obese, which stems from unreasonable diet and living habits. The first principle to help them control their weight is the same as that of adults, and children should be encouraged to "keep their mouths shut" and "open their legs" under the guidance of their parents.
"The difference is that children aged 0-6 cannot be hungry and given no meat. The fast dieting diet that is popular online is not suitable for children and teenagers. Huo Yanyan reminded that diet and exercise are the first-line treatment methods for children to control their weight, and they must also ensure the normal growth and development of children. Otherwise, the child may develop "hidden hunger", which can lead to an imbalance in nutrients.
She also doesn't advise parents to just increase their children's physical activity. If the consumption is too high, the child is hungry quickly, and may secretly drink energy drinks and eat biscuits, and the energy intake is excessive.
"Doctors should conduct an individualized assessment, customize daily nutrition and exercise prescriptions, and control total calories while ensuring balanced nutrition." Yan Jie introduced that this is roughly divided into two steps.
First, control high-oil, high-sugar and high-calorie snacks. Second, balance the ingredients and improve the cooking method. The same is to love meat, to choose less fat varieties, less or no braised or fried. By doing these two things, your child's weight will gradually improve. Moreover, the establishment of good eating habits at the age of 0-6 can benefit you for a lifetime.
However, in practice, there are many obstacles. "We need parents to recall what and how much their children eat each day to calculate calories and evaluate the effectiveness of treatment. If the child goes to kindergarten, or is raised by grandparents, parents can only make a rough estimate, and there will be deviations. Sometimes, grandparents would secretly stuff food for their children. Huo Yanyan said.
Moreover, the weight management of "keeping your mouth shut" and "opening your legs" needs to be adhered to for a long time, otherwise it is easy to rebound. Huo Yanyan said that after engaging in children's weight management, the most common thing he said was "take it slowly, and be long-lasting".
Some parents can't wait. They will offer to give their child weight loss pills in the outpatient clinic in order to get off the scale quickly. Neither Yan Jie nor Huo Yanyan supported this idea. Previous studies have shown that some diet drugs can inhibit the nerve center, which may cause blood pressure to rise and heart rate to increase. Improper medication can easily cause endocrine disorders in children, and even liver and kidney function are impaired.
On June 18, local time, the U.S. Preventive Clinical Services Guidelines Task Force (USPSTF) issued the latest recommendations, saying that for weight management in children and adolescents, doctors need to provide and recommend a comprehensive intensive behavioral intervention program. However, there is a lack of evidence to support the use of weight loss drugs in this population. Only short-term studies have shown rebound after discontinuation, and there are no long-term efficacy and safety studies.
In general, children with moderate to severe obesity need to be followed up once in about 2-3 months. In Huo Yanyan's outpatient clinic, as long as the follow-up can be insisted on, the child's body shape is developing for the better.
Yan Jie believes that compared with adults, children aged 0-6 have an innate advantage in controlling their weight. "The child's height grows fast, according to the calculation formula, as long as the weight is controlled, that is, the numerator remains the same, and the height is growing, that is, the denominator is large, the BMI will fall."
Dr. Huo Yanyan from the Department of Child Health Medicine of the Children's Hospital of Shanghai Jiao Tong University School of Medicine is conducting a physical growth and development consultation. Image source/interviewee
Don't expect the child to be thin on his own
Huo Yanyan feels that the whole society is now paying significantly more attention to children's body shape. In clinical work, more and more parents will take the initiative to take their children for physical examination, and other departments will actively transfer children who are overweight, obese or have abnormal blood sugar and blood lipids to the pediatric care department for weight management.
"Many schools actively invite hospitals and departments to come to the school to carry out weight prevention and control lectures. We doctors are talking at the top, and the teachers, parents and children are sitting below. Yan Jie said.
Huo Yanyan noticed that when children show signs of early development, the rate of active medical treatment will increase. At this time, parents are not only concerned about weight, but also about whether their children can grow taller. "But if it weren't for moderate to severe obesity with related complications, the child might not come after two visits."
Among infants and toddlers under the age of 2, many people still hope that their children will gain weight, thinking that this is a good way to raise them. Concepts such as "cramming" are still common in intergenerational rearing.
At present, the weight management of children in mainland China has been advanced to 0 years old. The plan proposes to strengthen maternal weight management and nutritional evaluation to reduce the intergenerational transmission of obesity.
In addition, physical growth monitoring is an important part of the child's first health check-up. Huo Yanyan said that from this time on, doctors should guide parents to scientifically evaluate the growth and development of their children.
Yan Jie reminded that don't expect children to automatically lose weight as they grow and develop. "Affected by the hormone secretion during puberty, some children have a greater appetite and are especially able to eat. At this time, there is a lot of academic pressure, and it may not be possible to ensure the amount of exercise, and it is difficult to control the weight. ”
"Some school-age children may be busy with schoolwork, and we would advise them to improve their learning efficiency, squeeze out fragmented time for sports, and do some housework within their means." Huo Yanyan said.
Yan Jie admits that she often has to take on the role of "psychiatrist", and every time she has a consultation, she spends time chatting with her parents, listening to the grievances of her grandparents, and guiding them to form a family supervision mechanism. "The child itself is a blank slate, and the key depends on how the parents teach. Parents teach well, and children's weight improves quickly; Parents can't lead by example and don't supervise in place, and it is difficult for children to lose weight smoothly. ”
参考文献：[1]. Guansheng Ma, et al. The return on investment for the prevention and treatment of childhood and adolescent overweight and obesity in China: a modelling study. The Lancet Regional Health Western Pacific. VOLUME 43, 100977, FEBRUARY 2024. doi.org/10.1016/j.lanwpc.2023.100977[2]. Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults. The Lancet. VOLUME 403, ISSUE 10431, P1027-1050, MARCH 16, 2024. doi.org/10.1016/S0140-6736(23)02750-2[3]. Qiang Zeng, et al. Clinical management and treatment of obesity in China. Lancet Diabetes Endocrinol, 2021 Jun; 9(6):393-405. [4].中华医学会儿科学分会内分泌遗传代谢学组,等. 中国儿童肥胖诊断评估与管理专家共识. 中华儿科杂志. 2022,60(6) : 507-515[5].李辉, 等. 中国0~18岁儿童、青少年体块指数的生长曲线. 中华儿科杂志. 2009,47(07) : 493-498. DOI:10.3760/cma.j.issn.0578-1310.2009.07.004[6].关于印发儿童青少年肥胖防控实施方案的通知. 国卫办疾控发〔2020〕16号[7]. To treat obesity in children, task force favors behavioral therapy over drugs like Wegovy. STAT
Source of this article: Responsible editor of the medical community: Moon
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