CN: Childhood Obesity

BMI-for-age percentile <5th indicates

Underweight

BMI-for-age percentile 5th–85th indicates

Healthy weight

BMI-for-age percentile 85th–95th indicates

Overweight

BMI-for-age percentile >95th indicates

Obese

Key child factors influencing obesity include

Gender, birth weight, temperament, feeding style, flavour experience, complementary feeding, experiential learning, health status, BMI, self-regulation, biological predispositions

Food factors influencing obesity include

Energy density, palatability, flavour, colour

Community factors influencing obesity include

Economic status, parent income, ethnicity, sociocultural education, media exposure, neighbourhood environment, recreation access, school lunch program

Parent and family factors influencing obesity include

Parent BMI, education, nutritional knowledge, food preferences, physical activity, parenting style, feeding practices, portion size, accessibility, family structure, mealtime frequency, environment

Authoritative parenting style is

Demanding + responsive, high control + warmth, associated with lower obesity risk

Authoritarian parenting style is

Demanding + directive, low responsiveness, high control, low warmth

Permissive parenting style is

Lenient, low demanding, high responsiveness, avoid confrontation

Neglectful parenting style is

Neither demanding nor responsive

Restrictive feeding practice effect

Increases intake of restricted foods, risk of weight gain

Pressure to eat effect

Higher food avoidance, lower core food consumption

Monitoring feeding practice effect

Lower food avoidance, lower non-core food consumption

More family meals are associated with

Greater fruit, vegetable, whole grain, calcium intake, healthier habits

Less family meals are associated with

More fast food, snacks, fizzy drinks, unhealthy habits (alcohol, drugs)

Maternal education in developed countries (low)

Higher sugar, fat, protein intake, ↑ BMI in child

Maternal education in developed countries (high)

More fruits, vegetables, daily breakfast

Parental education in developing countries (high)

Children more prone to obesity due to fast food, processed foods, less supervision

Socioeconomic status in developed countries

Obesity linked to low SES

Socioeconomic status in developing countries

Obesity linked to high SES/family affluence

Child eating behaviour in lighter children

Parents pressure to eat

Child eating behaviour in heavier children

Parents restrict intake

Food as reward effect

Overeating during negative emotions at 5–7 years

Food preference definition

Evaluative attitude of like/dislike towards food

Innate food preference in children

Preference for sweetness, rejection of bitterness

Biological factors influencing food preference

Taste preference, taste sensitivity

Environmental/social factors influencing food preference

Food accessibility, advertisement, parental feeding behaviour

Sociocultural factors influencing food preference

Culture, religion, ethnicity

Obesogenic environment definition

Easy access to calorie-dense foods + sedentary lifestyle + electronic recreation

Obesogenic feeding practices include

Emotional feeding, encouragement to eat, fat restriction

Media influence on obesity

Commercials shape food knowledge, attitudes, preferences, ↑ junk food intake

Watching TV while eating effect

↑ junk food, ↓ fruits/vegetables

Daily energy intake from food consumed in front of TV (USA)

20–25%

Multidisciplinary team for childhood obesity includes

Dietitian, paediatrician, family doctor, endocrinologist, behavioural therapist, psychologist, psychiatrist, speech therapist, physiotherapist, exercise therapist, occupational therapist, nurse, social worker

Nutrition assessment age range

2–18 years

Nutrition assessment includes

BMI percentile chart, age of onset, parental obesity, health problems, dietary intake, physical activity, family capacity for change

Covert control intervention

Purchase only healthy foods, avoid unhealthy stores/fast food

Avoid food rewards rationale

Food reinforces behaviour, maintains dependency

Authoritative parenting in intervention

Encourage new foods, model healthy eating, avoid showing dislike, moderate snack intake

Family meals intervention

Expose to variety, repeated exposure, child input, frequent shared meals, daily breakfast, socialization, TV off

Parent-focused intervention

Educational advice, feeding guidance, empower parents, social support

Family environment intervention

Early exposure to healthy flavours, parental role in shopping/preparation, healthy food availability, reduce screen time, adequate sleep

Promoting self-regulation in diet

Recognize fullness, moderate portions, organized feeding environment

Food preference intervention

General healthy diet, daily balance, food structure, nutritional education

Physical activity intervention

Age-appropriate games, indoor/outdoor, muscle/bone strengthening, personal fitness, manage screen time

Behavioural intervention

Stimulus control, sustainable change, contingency management, identify triggers, positive reinforcement

Monitoring & evaluation includes

Growth pattern, food/fluid intake, mealtime behaviour, eating environment, beliefs/attitudes, nutrition knowledge/skills, physical activity duration/frequency/screen time/sedentary activity

Weight reduction consideration

Post-pubertal adolescents with severe obesity + comorbidities (CPG 2013)

Intensive interventions may be considered when

Severe obesity with comorbidities beyond lifestyle modification

Family environment definition

Shared perceptions and cognition concerning healthy lifestyle within family

Positive family system promotes

Role modelling, provision of healthy foods, support for healthy behaviours

Authoritative parenting outcomes

Higher self-efficacy, self-discipline, emotional maturity, improved eating behaviours, lower obesity risk

Family meals linked to

Weight status, eating patterns, nutrient intake, psychosocial effects

Developed country SES determinant

Low SES strongly linked to obesity

Developing country SES determinant

High SES strongly linked to obesity

Child feeding practice pressure to eat associated with

Higher food avoidance, lower core food consumption

Restrictive feeding practice associated with

Excessive weight gain risk

Monitoring feeding practice associated with

Lower non-core food consumption

Food preference develops during

Early years of life, persists into adulthood

Obesogenic behaviours promoted by

Easy access to calorie-dense foods, sedentary lifestyle, electronic recreation

Media commercials causal link

Advertising directly influences children’s diets

Watching TV during meals effect

Fewer healthy foods, more red/processed meat, junk food

Average media exposure in USA children

7+ hours/day

Food consumed in front of TV proportion

20–25% of daily energy intake

Nutrition intervention goal

Promote healthy eating, physical activity, behaviour change, family support

Parental role in intervention

Model healthy eating, provide healthy food, empower child choices

Behavioural therapist role

Address problematic behaviours, triggers, reinforcement

Physiotherapist/exercise therapist role

Promote physical activity, muscle/bone strengthening

Social worker role

Support family environment, reduce barriers

Endocrinologist role

Manage comorbidities in obese child

Dietitian role

Assess diet, plan interventions, monitor progress

Paediatrician role

Medical assessment, growth monitoring, comorbidity management

Nutrition assessment includes evaluating

Snack/food choices, physical activity, family capacity for change

Early responsive parenting intervention

Encourage healthy eating habits from early life

Repeated exposure to foods effect

Promotes acceptance and preference

Turning off TV at meals effect

Improves socialization, reduces unhealthy intake

Daily shared breakfast effect

Promotes healthier eating habits

Healthy food availability effect

Encourages healthy eating patterns

Adequate sleep effect

Reduces obesity risk

Stimulus control in behaviour

Remove triggers for overeating

Contingency management in behaviour

Reward positive behaviours, discourage negative ones

Positive reinforcement in behaviour

Encourages sustainable change

Growth pattern monitoring importance

Detect abnormal weight gain/loss early

Food & fluid intake monitoring importance

Ensure balanced nutrition

Mealtime behaviour monitoring importance

Identify unhealthy eating practices

Eating environment monitoring importance

Reduce distractions, promote healthy habits

Beliefs & attitudes monitoring importance

Identify misconceptions, promote positive attitudes

Nutrition knowledge/skills monitoring importance

Empower child and family for healthy choices

Physical activity monitoring importance

Track duration, frequency, screen time, sedentary activity