How is weight assessed in children?
The main tool is body mass index, calculated as weight in kilograms divided by the square of height in meters, and compared with standards for age and gender. Additionally, the doctor measures the waist circumference, assesses growth dynamics using curves and takes into account the stage of puberty. It is the trajectory that is important: the gradual upward deviation of the curve is noticeable long before the excess weight becomes obvious. Comparing a child with peers or with one’s own ideas about the norm is uninformative, so measurements are taken at the appointment and recorded.
- Body mass index adjusted for age and sex
- Waist circumference
- Dynamics of height and weight curves
- Assessing the stage of puberty
- Blood pressure measurement at every appointment
Reasons
Most often we are talking about a long-term slight excess of incoming energy over expended energy. The main contributors are sugary drinks and juices, large portions, frequent snacks, fast food, eating in front of a screen when satiety is not monitored. Inactivity and lack of sleep play a significant role: lack of sleep changes the hormones that regulate appetite. Heredity determines predisposition, but does not determine outcome. Endocrine causes—hypothyroidism, excess cortisol, genetic syndromes—are rare and are characterized by growth retardation, developmental delay, and other specific symptoms.
- Sweet drinks and juices
- Large portions and frequent snacking
- Eating in front of the screen and on the go
- Sedentary lifestyle
- Lack of sleep
- Hereditary predisposition
- Stress and emotional eating
- Rarely - endocrine and genetic causes
The dangers of being overweight in childhood
Complications develop earlier than is commonly thought. Already in adolescents, insulin resistance and prediabetes are detected, and sometimes type 2 diabetes mellitus, which until recently was considered a disease of adults. High blood pressure, lipid disorders, and nonalcoholic fatty liver disease are common. Excessive load harms the joints and spine, epiphysiolysis of the femoral head and flat feet are possible. Snoring and sleep apnea appear. The psychological side is no less important: ridicule from peers, decreased self-esteem, anxiety and depression, which additionally encourage overeating.
- Insulin resistance and type 2 diabetes
- High blood pressure
- Lipid disorders
- Fatty liver disease
- Problems with joints and spine
- Sleep apnea
- Low self-esteem, anxiety and depression
What examinations are needed
The scope of the examination is determined by the doctor based on age, degree of obesity and the presence of risk factors. Usually, fasting glucose is checked, if necessary, a glucose load test is performed, glycated hemoglobin and insulin are determined, the lipid profile and liver parameters are assessed. TSH helps rule out hypothyroidism, although it is rarely the only cause of excess weight. In case of dark velvety spots in the folds, insulin resistance is assessed. If a child is overweight and stunted, the examination is expanded to exclude endocrine and genetic causes.
- Blood glucose and exercise test
- Glycated hemoglobin and insulin
- Lipid spectrum
- Liver parameters and liver ultrasound
- TSH and free T4
- Dynamic pressure measurement
- Extended examination for growth retardation
What should the family do?
The main principle: the lifestyle of the whole family, not just the child, changes. You should start with something simple - remove sugary drinks and replace them with water, stop eating in front of a screen, introduce regular meals and a shared family dinner. Portions are reduced gradually, the plate is filled with vegetables, protein and whole grains are added. The movement is selected according to the child’s interests: regularity is important, not athletic achievements; The guideline is at least an hour of activity per day. Adequate sleep and limiting screen time are a must. Strict diets, counting calories and weighing yourself every day are not suitable for children and increase the risk of eating disorders.
- Avoid sugary drinks and drink water
- Regular meals without eating in front of a screen
- Vegetables, protein and whole grains in every meal
- At least an hour of movement per day
- Adequate sleep according to age
- Limiting screen time
- No strict diets or daily weighings
- Support and absence of accusations against the child