On July 22, the National Health Commission, Ministry of Education, National Health Commission, and State General Administration of Sports jointly issued the “Technical Guidelines for Comprehensive Public Health prevention and control of overweight and obesity among primary and secondary school students.” The guidelines explicitly put forward a three-tier prevention strategy of “prevention-oriented, early intervention, and disease warning,” aiming to effectively prevent and control the occurrence and development of overweight and obesity among Chinese primary and secondary students through scientific, systematic comprehensive prevention and control measures to safeguard students’ physical and mental health.
Obesity is related to health and appearance. In recent years, childhood obesity has become a global public health issue of concern, with an increasing trend and showing a younger age trend. Complications of obesity such as cardiovascular damage, abnormal lipid metabolism also show early signs (1-5 years). How to truly reduce “little plump”? Under the guidance principles of the “guidelines,” how can parents, schools, and society specifically help children control weight? Liu Yunman, Chief Nutritional Therapist of the Clinical Nutrition Department of Shanghai Children’s Medical Center affiliated with Shanghai Jiao Tong University School of Medicine, provides the answer.
Definition of childhood overweight and obesity differs slightly from adults. Promote healthy eating, reduce salt, oil, and added sugar; provide detailed scientific intervention methods, encourage schools to have qualified full-time and part-time nutrition guidance personnel; ensure physical activity, promote regular exercise, encourage schools to conduct 1 physical education class daily; screening and filing, establish students’ health records combined with health checkups and promptly provide feedback to parents on examination results; issue the “Risk Self-Assessment Form for overweight and obese primary and secondary school students,” deploy schools and families to carry out assessment warnings with the guidance of professional institutions through calculating the total score of the self-assessment form etc.
In the “guidelines,” a series of specific implementation measures were proposed to comprehensively and systematically promote the prevention and control work of overweight and obesity in Chinese primary and secondary school students. “This is the first time to emphasize the importance of prevention. It is too late to intervene until overweight and obesity occur,” said Liu Yunman.
She told reporters that according to multiple domestic and foreign research data, the overall rate of childhood overweight and obesity in China has reached one-fifth, and in economically developed areas such as Shanghai, this data has even reached one-fourth. How is childhood overweight and obesity judged? Liu Yunman said that in adults, overweight and obesity are generally judged based on BMI index, with most international standards being 25 overweight and 30 obese. In Asia, these thresholds are slightly lowered to 24 and 28, “because Chinese people are more prone to complications caused by obesity, numerical values alone are not sufficient.” Similarly, whether a child is obese is also closely related to factors such as age, height, gender, etc. “In infancy, if the weight at birth exceeds 4 kilograms, it is considered a large baby and faces a high risk of obesity; in school-age, if BMI exceeds 20, it can be basically determined as obesity. If parents do not continue to monitor height and weight, overweight and obesity may pose a health hazard during critical growth periods.”
Children with complications of obesity are not uncommon in outpatient clinics. Why is obesity often overlooked in childhood? “In younger age groups, parents are often unable to perceive obvious complications in children, and traditionally, being chubby or sturdy may be seen as a sign of health,” Liu Yunman admitted. “I just received a 4-year-old boy, who is visibly obese, and blood test results show indications of high LDL cholesterol. A 3-year-old child has abnormal glucose and lipid metabolism, postprandial insulin elevation in school-age children, fatty liver, hypertension. These seemingly unimaginable ‘middle-aged and elderly chronic diseases’ have already become common in outpatient clinics.”
Furthermore, another problem caused by obesity is psychological burden: many children may keenly discover in early childhood that being “obese” can lead to differential treatment in the environment, reduced social evaluation, or even stigmatization. As cognitive levels increase and self-esteem strengthens, they may face shock, avoid medical treatment and health management, with some obese children seeking security and venting emotions through binge eating, exacerbating obesity and generating related psychological disorders.
Long-term issues require long-term management, focusing on treatment as well as prevention, on physical well-being as well as mental health. In her view, this is the greatest significance of the introduction of this “guidelines.” As early as 2020, the National Health Commission issued the “Implementation Plan for Obesity Prevention and Control in Children and Adolescents,” which proposed to establish a “supportive environment for obesity prevention and control”; by 2023, as a project unit, the Children’s Medical Center undertook the scheme design and training guidance for the Shanghai “Guidelines for the Prevention of Obesity in 0-6 Year-Old Children,” with much data coming from the pediatric nutrition clinic jointly established by the Shanghai Children’s Medical Center and the Weifang Community Health Service Center in Pudong New Area since March 2018. Among the follow-up children with an average age of about 10 years, 71% have developed metabolic syndrome, 58.1% have insulin resistance, and 29% have abnormal blood lipids. The problem of overweight and obesity is urgent.
“Children’s weight management requires teamwork between hospitals, communities, and families, and it requires multiple forces to promote the implementation and persistence of the plan. For children themselves, the key lies in changing their lifestyles. However, if complications of obesity have already occurred, effective weight loss requires guidance from professional doctors,” she said.
Prevention and control of overweight and obesity need to start from pre-pregnancy. So, what are the key points to pay attention to in childhood obesity? Liu Yunman said that high-risk factors include parental obesity, excessive and rapid weight gain during pregnancy, gestational diabetes, intrauterine malnutrition and growth retardation, low birth weight, large baby, and excessive feeding in infancy.
Secondly, the fetal period, infancy, the adipose tissue recondensation period (5-7 years old), and puberty are the stages of the most active fat development, the fastest proliferation of fat cells in the entire growth and development process, and also the physiological sensitive periods easily developing obesity, making them key windows for preventing obesity. “Research shows that rapid increase in fat percentage before 6 months may increase the risk of obesity by the age of 2 for infants.”
Therefore, Liu Yunman proposed prevention recommendations for overweight and obesity in overlooked stages: in pre-pregnancy and pregnancy, prospective parents need to pay attention to pre-pregnancy and prenatal reports in a timely manner, receive face-to-face health counseling from professionals regularly (1 to 2 years), recommend monthly sessions, which are critical strategies for dealing with high-risk infants for obesity in the first 1,000 days of life. “Women planning pregnancy need to balance their diet under the guidance of doctors and nutritionists, reduce the intake of processed foods in the breastfeeding and complementary feeding stages, prioritize breastfeeding and gradual introduction of complementary foods, and avoid overfeeding.”
She also mentioned that communities and district-level health institutions should regularly screen high-risk families for childhood obesity, strengthen health education, and when necessary, refer them to tertiary medical institutions for further diagnosis and treatment. “In addition to primary and secondary schools, the dietary and activity environments of early childhood institutions also need more attention, recommending that registered nutritionists and other related professionals provide regular nutrition guidance to such institutions, optimizing dietary structures from an earlier stage to say no to overweight and obesity.”
