Pediatric Endocrinology and Metabolic Diseases Specialist Prof. Dr. Cengiz Kara explained the causes and treatment of obesity that increased during the pandemic period.

WEIGHT INCREASED IN OUTSTANDING CHILDREN

The coronavirus epidemic that affected the whole world and the lifestyle it brought deeply affected everyone, and children were more severely affected, as in all kinds of social disasters. During the COVID-19 epidemic, children remained motionless at home. The fact that the schools were closed and the education life continued on the computer / television remotely strengthened this still life even more. The eating habits of children who spent long hours in front of the screen at home also changed, especially the consumption of ready-made food and junk food increased. Unfortunately, the effects of this negative lifestyle on children were soon observed. During this period, some children had weight gain of up to 5-10 kilograms. In addition, we observed that breast development and puberty symptoms appeared early, especially in girls, with the increase in consumption of ready-made foods containing additives and rapid weight gain. This process has also increased parents’ concerns about their children’s health.

RECOMMENDATIONS TO PROTECT YOUR CHILD FROM OBESITY IN PANDEMIA

• During the epidemic and distance education process we are in, families have duties to prevent growth problems such as obesity and early adolescence in children. First of all, it is necessary to increase all kinds of movements of children.

• Recess breaks in distance education generally range between 15-20 minutes; During these breaks, as in school, children can be made to go out to the garden, breathe, run and play. If the environment is not suitable for this, opportunities should be created for play activities in the house.

• In the evening hours after the completion of the training, 30-60 minutes of brisk walking with the children will be effective in breaking the inactivity.

• Screen hours spent for lessons and homework in distance education are long enough, so screen hours for entertainment (computer-video games, tablet, phone, social media, internet, etc.) must be restricted; This period should not exceed 1 hour on weekdays and 2 hours on holidays.

• For normal growth, schoolchildren need at least 10 hours and adolescents need at least 9 hours of sleep. Accordingly, the time of going to bed should not exceed 10-11 at night and the connection with the screen should be disconnected at least 2 hours before that. The blue light of the screen and stress-filled video games can cause the cortisol hormone to go low at night and the growth hormone to stay low at night. These hormone irregularities can also lead to obesity and growth retardation. It will be very important for healthy growth that children who are exposed to screen light in distance education throughout the day are kept away from the screen at least in the evening.

• Children should eat breakfast, lunch and dinner regularly, without skipping meals. They can take fruit and similar snacks in between. However, unnecessary calorie intake should not be allowed with the consumption of packaged ready-made products (chocolate, wafers, chips, etc.) and sugary drinks. High-calorie ready-to-eat foods such as hamburgers and pizza should not be ordered, and special attention should be paid to consuming pot dishes at home. In addition, the portions of high carbohydrate meals, including pasta, potatoes, rice, bread and sweets, should be kept small.

What causes obesity?

There are basically two types of obesity: Simple obesity caused by lifestyle. Obesity caused by endocrine and genetic disorders. Obesity is a rare condition due to an endocrine or genetic disease in the body. In 95 percent of children, obesity occurs due to the energy imbalance between calories taken and calories expended.

Our body spends energy to perform daily activities such as walking, running, talking, digesting the food we eat, breathing and maintaining body temperature. In addition, children need energy to grow. This energy, which is used for daily activities and used for growth, is obtained from food.

If the energy (calories) taken with food is high, but the energy consumed by the body to do daily tasks is low, then the increased energy is stored in the body as a fat mass. Thus, depending on the increased fat mass, weight increases and obesity occurs. Every extra 7000 calories taken into the body is stored as approximately 1 kilogram of fat. Calories are easy to take and hard to burn. Unfortunately, in addition to faulty parental attitudes and wrong eating habits, today’s living conditions are also favorable for children to get fat.

What are the health problems caused by obesity?

Obesity causes various health problems and diseases starting from childhood. Obesity shortens the life expectancy of non-smoking adults around the age of 40 by 7-8 years and by 13-14 years in smokers. It is estimated that obesity that starts in childhood will shorten the life span by 15-20 years.

Insulin resistance syndrome (metabolic syndrome)
Type 2 diabetes (diabetes)
Hypertension (high blood pressure)
Dyslipidemia (high in blood lipids)
Atherosclerosis and coronary heart diseases (congestion in the vessels)
Kidney diseases
Early puberty
• Menstrual irregularities and hair growth problems in girls
Gallstones and inflammation
Fatty liver and hepatitis
Breathing disorder during sleep, short breathing pauses, snoring
Respiratory infections and asthma
Skeletal problems, hip joint slippage, leg curvature
Skin problems, inflammations, darkening of the skin color in the fold areas
• Increased cancer risk
Mental problems, depression

How is obesity treated in children?

• If there is an underlying disease, it should be investigated: First of all, a specialist physician should evaluate the child and investigate whether there is a disease that causes obesity and the health problems caused by obesity. If a hormonal-metabolic problem is detected, its treatment is a priority. In children with simple obesity, nutrition and lifestyle should be rearranged (balanced diet, regular sports and increasing mobility in daily life).

• Nutrition plan should be revised: Since the growth of children continues, diet models in adults and excessive restriction of calorie intake are not suitable in childhood. Limiting calorie intake impairs the growth of the child. It is important that the nutrition plan is absolutely appropriate for the age and gender of the child under the supervision of a specialist physician and that the growth and development of the child is monitored regularly.

• Activity should be increased: Another important issue in treatment is increasing the activity. In addition to the usual daily activities for obese children, at least half an hour of moderate activity (can be in the form of a tool or a game), regular sports activities and walking are recommended on weekends.

• Lifelong behavioral change should be provided: Necessary psychological support should be provided for the child to adapt to the nutritional plan and lead a more active lifestyle, and to stop seeing food as a reward and target.

• Families should cooperate and support the child: The cooperation of the whole family is very important. The purpose of obesity treatment in children is not only to reduce weight in a certain period of time; Stopping weight gain is sufficient for many children with mild to moderate weight. The main purpose is to prevent adult obesity by providing lifelong healthy nutrition and lifestyle changes.

Postpartum recommendations for obesity prevention

Studies reveal that eating ready-to-eat foods is a special risk factor. Breast milk is the ideal food source for babies and protects against obesity. Obesity develops less in children who are breastfed for a longer period of time. Therefore, breast milk should be given alone for the first 4-6 months and together with supplementary foods until the age of 1-2. Additional foods should not be passed early and unnecessarily and excessive feeding should not be done with ready-made foods.

On the other hand, it is observed that some babies gain weight rapidly in the first 6 months of their life when they are only fed with breast milk. Two features stand out in these babies: Mothers are overweight and breastfeed their babies numerous times a day and for long periods of time, or every time they cry. The growth of babies of obese mothers should be closely monitored.

If there is rapid weight gain, breastfeeding should be controlled. During the transition period to supplementary food, foods with low energy density should be selected. Formulas with low protein content should be preferred in babies who cannot receive breast milk. In summary, below are our recommendations for preventing obesity in infancy:

• Babies should be fed only breast milk for 4-6 months.
• The introduction of solid foods and sugary drinks should be delayed.
• Solid foods should not be started early, especially in those who are fed with formula.
• After the baby is full, it should not be forced to finish the meal.




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