As school started, 10-year-old Beibei found his school uniform had “shrunk”. Upon weighing himself, he discovered he had gained 10 kilograms during the summer break. “If a child is too fat, it will not only affect their height and development, but also lay down health risks for adulthood,” said Professor Luo Feihong, head of the Endocrinology and Metabolism Department at the Children’s Hospital affiliated to Fudan University.
Recently, the National Health Commission and 16 other departments jointly issued the “Year of Weight Management” activity implementation plan, making weight management a hot topic. This summer, the number of obese and overweight children at Fudan Children’s Hospital has increased sharply, with the heaviest child nearing a BMI index of 50!
Photo caption: Dr. Pei examining obese children. Source/Wang Juliang, photo by the author
Observation: More chubby kids nowadays
14-year-old Niuniu revisited the MDT Obesity Clinic at Fudan University affiliated Children’s Hospital. Dr. Pei Zhou, the Deputy Chief Physician of the Endocrinology and Metabolism Department, happily informed Niuniu’s parents that their child had shed the label of “obesity” after a thorough inquiry and physical examination.
During her first visit last year, Niuniu was found to have complications like type 2 diabetes, fatty liver, and hyperuricemia. Her weight exceeded 140 pounds, her neck was darkened, she was out of breath when walking, and lacked the energy of a teenage girl. “If not addressed, the child will face more severe health issues,” Dr. Pei said.
After interdisciplinary consultations, a nutritionist devised a dietary plan for Niuniu, the Endocrinology Department adjusted her medication for blood sugar, and the Traditional Chinese Medicine Department adopted external treatment to assist in weight loss. “Niuniu’s family cooperated very well. Her mother prepares a weekly menu strictly following the nutritionist’s recommendations, providing a rich and varied diet while strictly limiting calorie intake, and her father ensures daily exercise with the child,” Dr. Pei commended Niuniu’s parents’ actions. In a year, she lost 20 kilograms, and in this check-up, she had completely moved out of the obesity range, with her blood sugar in the normal range without medication.
Dr. Pei has seen too many obese children. By observing the children around her, she also clearly feels that there are more and more “chubby kids”. A set of data confirms her feelings: the “Report on the Nutritional Status and Chronic Diseases of Chinese Residents (2020)” shows that the overweight and obesity rate among Chinese adults exceeds 50%, while the rate among children and adolescents aged 6 to 17 is close to 20%, and among children under 6 years old, the rate is 10%.
Currently, Fudan Children’s Hospital has established an Obesity MDT Clinic every Saturday, the Endocrinology Department has a specialized clinic for obesity, the Traditional Chinese Medicine Department has a pediatric obesity clinic, and the Nutrition Department has an obesity nutrition clinic, providing personalized weight loss plans including nutritional diet adjustments and exercise suggestions for the “chubby kids”.
Hazards: Obesity affects overall health
However, not all parents cooperate in helping their children lose weight. Some parents believe that since their child is not experiencing the complications of obesity and all check-ups appear normal, weight control is unnecessary. Some parents think that since the child is still growing, restricting their diet may affect their growth… “Being a bit fat is fine, as long as it doesn’t affect health,” is a phrase Dr. Pei hears most often, but obesity is a disease, and there is no such thing as “healthy fat”.
Childhood obesity not only affects organ function, physical activity, and learning ability, but also leads to other chronic diseases such as hypertension, dyslipidemia, diabetes, precocious puberty, sleep apnea, asthma, etc. Some obese children may have acanthosis nigricans in skin folds such as the neck and armpits, indicating possible insulin resistance, which can eventually lead to diabetes. Obesity also reduces the self-esteem and confidence of children and adolescents, leading to emotional issues.
Among obese patients, 95% have simple obesity, mainly related to genetics and environmental factors; 5% have secondary obesity, related to endocrine and metabolic diseases and genetic syndromes. Apart from genetics, the main problem faced by obese children currently lies in poor lifestyle habits, including an unreasonable diet structure and lack of physical activity, such as frequent consumption of high-fat, high-sugar, high-calorie foods, over-reliance on fast food delivery, love for carbonated drinks, skipping breakfast often or overeating.
Challenge: The success of weight loss depends on parents
Nowadays, most parents have realized the seriousness of obesity and actively bring their children to the hospital for treatment, which is a very positive trend. However, the key to a child’s successful weight loss lies in the determination of the parents,” she said, if parents can lead by example, maintain healthy eating habits and an active lifestyle, children will inadvertently mimic these behaviors. Furthermore, parents need to play the role of supervisors in their children’s weight loss process. Weight loss is a long process and may encounter various setbacks and difficulties, requiring the parents’ company and encouragement to overcome these challenges together.
“Through our observations in the obesity clinic, we have developed a keen eye. Through initial communication, we can roughly determine whether a child can successfully lose weight.” Dr. Pei mentioned that there was a girl with a BMI of 35, indicating severe obesity, and some complications. The doctors advised the mother with great concern that if the weight is not controlled, the situation will only worsen. However, when the doctor emphasized the need to “control diet and exercise,” the mother started to make pessimistic remarks, believing that the daughter would not be able to do it, and that she was too busy at work to monitor her weight daily, conveying negative thoughts to the child, implying that success was impossible in this family environment.
The parents Dr. Pei encountered were diverse. For example, some parents refuse any treatment, including traditional Chinese medicine and Western medicine; some parents are very radical, demanding the doctors to be more stringent with their dietary restrictions. “But Rome was not built in a day. Weight loss is not an overnight task. At the start of a weight loss journey, one can gradually adapt to the prescribed diet and exercise plan, achieve it, then set the next small goal,” said Dr. Pei.
Last week, a mother came in and asked if her child could undergo weight loss surgery directly? This astonished the doctors. “Have you tried any weight loss treatments before?” the doctors asked. The mother said no and had only seen many people losing weight through surgery online. In her understanding, weight loss surgery was a quick and permanent solution. “We explained to her that weight loss surgery is only considered in cases of severe obesity where other methods have failed to control weight, and post-surgery, if diet is not controlled and exercise is not maintained, the weight will rebound. Finally, through patient education, the mother accepted the advice and opted for dietary and exercise interventions.”
Method: Child weight loss is completely different from adults
According to Professor Luo Feihong, Director of the Endocrinology and Metabolism Department at Fudan Children’s Hospital, the prevalence of obesity is increasing year by year and showing a trend towards younger ages. This is related to individual health and also affects the socio-economic burden. The proposal of the “Year of Weight Management” is to advocate and promote a healthy lifestyle, enhance public awareness of weight management, and prevent and control overweight and obesity.
Parents are gradually realizing the dangers of childhood obesity, but when faced with overweight and obesity issues in children and adolescents, parents may still lack sufficient knowledge. Professor Luo Feihong reminds that due to the growth and development characteristics of children and adolescents, it is best for parents of obese children to have personalized weight loss plans formulated by professional doctors in medical institutions. Applying some weight loss methods found online directly on children is very dangerous. Weight loss in children differs greatly from adults, as children are in the growth and development stage and require adequate nutrition to support normal growth, while weight reduction in adults is mainly achieved by limiting calorie intake. While reducing weight in children, it must not affect normal growth and development, and a balanced diet must be ensured to provide sufficient nutrition.
However, when lifestyle interventions fail to improve weight, combined drug therapy can also be considered. Currently, no drugs have been approved for weight loss in children domestically, but for obese children aged 10 and above with clinical diagnosis of insulin resistance or abnormal glucose tolerance, metformin can be used as an auxiliary treatment.
New Min Evening News reporter Zuo Yan
