A fat child is not a healthy child!

  Dr. R. Prem Sekar

The theme of this year’s  World Heart Day, ‘ Cardiovascular disease prevention  among women and children ,     indicates a  paradigm shift in the focus  from adults to children. This is a result of the global realisation  that the war against the leading killer, artherosclerosis and coronary artery disease, can be won only if remedial measures  are initiated  from childhood.

Obesity is a result of energy intake exceeding energy expenditure, leading to excessive  fat deposition  in the body. The excess fat and cholesterol  commonly get deposited  inside the arteries, resulting in a hardening of the arterial vessel wall. This is called artherosclerosis. The fat deposits inside  the vessel are called plaques and the increase  in size over a period of time, causing a progressive blockage to blood flow. When the blockage is significant, it will lead to a heart attack.

Recent data from the centres for Disease Control and Prevention  in the United States of America have established  that 35.7% of adults  and 16.9% of children are obese. Other studies show that at least 70% of these obese adolescents grow up to be obese. Once obesity is established in adulthood, it will be extremely difficult to reverse it. This is the rationale for shifting the focus on controlling obesity in children as well as  inculcating lifestyle modifications, which in turn will produce a generation of adults  free of the early  onset of cardiovascular disease and contribute to a healthy society.

Childhood obesity is caused by multiple factors . The predominant cause is an unhealthy dietary habit compounded  by a sedentary life style. Other causes include intake of medications such as steroids, some medical conditions such as hypothyroidism and genetic factors. It has been found that if one parent is obese, the chances of obesity in the child are 50% whereas if both parents are obese, it is nearly 80%. Children whose family members are overweight or have hypercholesterolaemia or a history of cardiovascular disease under  55 years are considered high risk for the early onset of coronary artery disease and should be screened periodically beyond two years of age with a fasting lipid profile.

The lipid profile values for children are :

Total  cholesterol >170mg/dl  (Borderline).

                                 >200mg/dl (Elevated).

LDL                           > 110mg/dl (Borderline)

      >130mg/dl (Elevated)

 

HDL< 35mg/dl

TGL  >150 mg/dl (Elevated)

If the average results of three lipid profile results  are above the cut-off values, then intervention will be required  in the form  of dietary and lifestyle  modifications. Medications to reduce cholesterol is indicated when the LDL exceeds 160mg/dl with associated high risks or when it is >190mg/dl.

In the absence of a medical cause, childhood obesity can be managed only by a strict diet  and exercise regimen. This includes avoiding fatty foods and snacks, binge eating, watching television while eating; eating slowly, increasing outdoor physical activities and, if necessary, taking the help of a dietician or psychiatric counselor.

The Writer is interventional Paediatric Cardiologist, Frontier lifeline Hospital, Chennai.

Thanks,

The Hindu- 11/11/2012