Various somatic structures are involved in the feeling of hunger and food intake. The work and movement of muscles, heat exchange in the body and other forms of activity are carried out under the condition of energy balance, in this case food intake is mandatory. The feeling of hunger is regulated by the central nervous system through the cerebral cortex.

Also, the person’s personality and the surrounding situation also participate in these processes. Special studies were conducted in which animals took part. In order for the body to take food, a special atmosphere must be created.

You should make sure that there is no danger, you need to ensure comfort and good relationships with others. Even pets should feel safe while eating.

The act of eating involves biting and sucking, chewing and swallowing. All these processes occur together and are also quite stressful. From childhood, every living being feels joyful satisfaction from food. Eating behavior and various deviations are expressed in protests and rage, adoration and hatred.

When a baby touches his mother's breast for the first time, he feels unity with the person closest to him. After this, the child learns to eat socially, he needs to create a sincere and pleasant atmosphere at the table. For other people, eating may improve their appetite.

Eating directly depends on the emotional state of a person and the environment. Appetite is not just a feeling of hunger; food culture can easily be destroyed. When eating, a person’s values ​​and habits are of great importance. Different cultures are accustomed to different taste sensations and directions, which have a direct relationship with experience.

Psychophysiology also influences appetite. Some people view food as a gift from God, but sometimes people give up food completely to overcome themselves. There are individuals who perceive food as an animal and a base instinct, but a feast makes it more humane.

Some people also experience shame when eating, which is very similar to sexual shame. From childhood, a child feels the great importance of food in life, this can provoke internal conflicts.

It is quite possible that it was the parents who provoked obesity. In response to any children's hysterics or discontent, mom and dad offered the baby food, this is how they showed love for their child. As a result, the child did not feel his independence and his own needs; all he had to do was eat in time.

Eating disorders and obesity mostly occur in those people who have a strong attachment and dependence on their mother. The woman in the family takes a leading position and forces everyone to obey. The mother cares too much about her child, does not respond to the father’s comments, the baby becomes passive and apathetic.

In such cases, patients feel their imperfection and vulnerability; they prefer to lead a passive lifestyle and eat away all their problems. Also, obese people think that the more they weigh, the more protection they provide themselves from the outside world. The psychosomatics of obesity can be short-term and long-term.

A person uses food to try to protect himself from negative emotions, his state of mind is unstable, he cannot accept himself at his weight, thereby only worsening the situation.

There are several most common causes of obesity:

• Frustration when the object of adoration is lost. Typically, women begin to suffer from obesity after the death of a spouse or separation from a permanent partner, or when their parents leave home. Usually, when a divorce or loss of a loved one occurs, a person is depressed, so his appetite increases greatly. Many children begin to actively eat food when a brother or sister is born.
• A person feels depressed and afraid, is very afraid of being alone and worries about this, sometimes without any reason. That is why he begins to eat food in huge quantities. This can also occur during periods of intense brain activity and overstrain, preparing for exams or passing a project. People start eating or smoking too much.

All these situations reveal food as a substitute for satisfaction. It is nutrition that strengthens self-confidence and a sense of security, helps to ease mental and physical pain, and disappointment.

From childhood, children remember that during illnesses they were given the best and most delicious things. Many people who are obese were addicted to food as children and had poor eating habits. As a result, they developed psychomatic illness and unconscious reactions.

Most obese patients consider it an important fact that they have always been overweight; since childhood, food has replaced pleasure for them. Parents suffer from this no less than their child, so the problem of obesity becomes a problem for the whole family.

Psychological illness here implies only oral satisfaction of human needs. Food replaces the lack of attention from family and friends and protects the child from depression. Children perceive food as self-affirmation; it helps get rid of excess stress and provides support to the mother.

Many obese individuals are highly dependent on their mother and are afraid of losing her. It is worth considering that about 80% of parents are also obese, which is why you might think that they are predisposed to becoming obese. In these cases, there are no manifestations of love and care; they are simply replaced by oral satisfaction. Adopted children are less likely to be obese than their parents.

The causes of obesity according to somatic data in children can be an overly caring or indifferent mother. Some parents allow their child everything; the father cannot say anything. Mothers believe that they give too little to their children, are alienated from them on an emotional level, and are tormented by feelings of guilt. That is why feeding becomes exclusively an expression of love for your child.

Psychotherapy

Typically, weight loss courses do not have a positive effect if an obese patient is not able to change his own emotional behavior. He feels that excess weight is vital for him. Therapy often does not produce any results, because the patient experiences real pleasure from eating. He strives on a psychological level to maintain his own weight, because this is easier than getting rid of psychological problems. During the diet, patients show symptoms of nervousness and irritation, quickly get tired and become depressed.

Reasons for the lack of treatment results in psychotherapy:

• a person does not feel sick, he is satisfied with everything on a subconscious level;
• the specialist cannot carefully analyze the patient’s behavior and motivations when treating behavioral disorders;
• a person cannot overcome sociological factors, he is simply not able to refuse to eat fatty foods with his family;
• patients refuse to follow the specialist’s instructions during behavioral therapy;
• some patients cannot understand what the doctor suggests, but are embarrassed to ask again and ask for additional explanations.

It is necessary to take an active part in therapeutic treatment. The psychotherapist should establish contact with the person. He must understand him and his motives. The specialist is also obliged to determine how the loss of his usual way of life affects the patient, and whether he suffers greatly from this. After this, an individual treatment plan is drawn up. The patient must learn to control his behavior.

Eating disorders

Obesity, anorexia and bulimia occur due to eating disorders. They should be given special attention in psychosomatics. A person may not even realize that he is sick, so specialists cannot always call somatic causes a disease. It is imperative to identify the psychological causes of unhealthy eating behavior in order to eliminate the psychosomatic disease.

Anorexia and bulimia are very well-known diseases, but few people think about the fact that a huge number of people dream of getting them. Anorexia and bulimia are psychosomatic disorders in which people experience a strong fear of being fat. Their energy depot is greatly weakened; people believe that if the soul suffers, then the body should not feel good.

With anorexia, a woman always considers herself too fat and completely refuses to eat. She may be very thin, but she doesn’t consider herself that way. Usually young girls suffer from this disease. Some end up dying, others instinctively start eating a lot and become fat.

Then they look at themselves in the mirror and are horrified. They induce a gag reflex in themselves in order to get rid of food in the body and dream of becoming thin again. This provokes bulimia. Signs of bulimia are that a person constantly wants to eat, he cannot control it, he eats in incredible quantities, as if the last crumb is about to be taken away from him.

The personality picture of an anorexic patient shows that the person generally refuses to eat. The common feature of these diseases is that a person’s image of his body is subject to distortion. Even if a person is very thin, he still thinks he is fat. A huge number of women suffering from anorexia and bulimia categorically refuse to consider themselves sick; they are sure that everything is fine with them. This is why they are very difficult to treat.

Women have a strong degree of denial. They can persistently prove for several years that they are absolutely healthy and look great, they just need to lose a little weight. People begin to constantly keep their weight under control; this is their main goal in life. In some cases, death occurs, but still women believe that in this way they can get rid of their problems.

Model of behavior that provokes psychomatic illnesses:

• unresolved emotional and psychological problems, inability to get out of a stressful situation;
• dislike of parents in childhood provokes rejection and non-compliance with standards;
• a tragic situation or loss of a loved one.

A person perceives the world through his own beliefs and beliefs. This is what affects your emotional state and physical health. If a person experiences negative experiences and emotions, then he becomes unsure of himself, his energy field is destroyed. A person believes that there is nothing to love him for, he cannot open up.

Bulimia shows a person’s inner fears, because he is afraid that he will not be able to keep his own life under control. A person loses his purpose in life and completely switches to his own body. He experiences satisfaction from eating, but then begins to reject and vomit.

Each person independently sets the boundaries of his own reality and controls his health. His beliefs and views on life, awareness of spirituality, all this affects the state of the body. Such diseases must be eliminated and a person’s internal problems must be solved through long work.

Psychosomatics of anorexia and bulimia

When a person sees a girl who is too thin, he thinks that she doesn’t eat anything. However, this is absolutely not true in most cases. The girl can eat a lot more than people can imagine, she just induces a gag reflex and suffers from bulimia.

Difference between anorexia and bulimia

Bulimia and anorexia are psychosomatic disorders in which eating behavior is disrupted. With anorexia, a person loses appetite and completely refuses to eat. The consequences of this can be severe and almost irreversible. First, a person strives to lose weight, goes on a diet, then reduces food intake, and subsequently the appetite completely disappears. Such individuals can also cause themselves to vomit, despite eating a tiny amount of food.

With bulimia, a person is unable to control his gluttony, but then forcibly rids the body of food. Such people do not always suffer from being overweight or underweight. Gluttony occurs due to psychological reasons and emotional stress. Patients pounce on food, swallow large pieces, and then feel a strong sense of guilt.

Psychosomatics of bulimia

What causes bulimia? Some psychological problems contribute to this:

1. Violation of family relationships. The mother cannot find a common language with her child, as a result he develops gluttony. Children eat too much, if they lack maternal attention, they consider themselves abandoned and unnecessary.
2. Psychological isolation of the child. He was sent to a camp or boarding school, the only source of joy is eating in huge quantities.
3. An adult experiences dissatisfaction with life, he is haunted by failures, interest in life decreases, and he begins to eat to get pleasure.

Psychosomatics of anorexia

Anorexia is a female disease. Usually girls begin to give up food in order to become beautiful, attractive and slim. However, many on a subconscious level strive for exactly this. To be loved and worshiped by men.

Anorexia usually occurs in those who have many unresolved psychological problems. The person did not feel enough love in childhood, he has a difficult relationship with his mother, he felt betrayed and unnecessary, inferior in society.

As a result, the woman decides to change her own appearance in order to change her life. Eating is tightly controlled and anorexia occurs.

Suggestive therapy

It is imperative to help patients with anorexia and bulimia, because almost all patients, without exception, do not understand that they are seriously ill. Most girls believe that they are infinitely happy in the form of a skin-covered skeleton and do not want to change anything.

Patients cannot realistically look at the situation and begin a normal life again. It often happens that a person has bulimia and anorexia at the same time.

Positive therapy

Anorexia and bulimia nervosa are the ability to consume minimal amounts of food and maintain world hunger.

Conflict situation

With psychosomatic fasting, it is necessary to judge not only the individual, but also the situation of the family as a whole. The starving person carries a symptom within himself; through his behavior he expresses all the suffering of his family, but no one says this out loud. If you judge a person from this point of view, you might think that the patient is the strongest among his family and friends. He puts his own life at risk to show family problems and unfair treatment.

Only truly strong individuals are able to almost completely refuse to eat and protest against normal behavior. They are able to control their body much better than others and not succumb to provocations. However, control also plays a bad joke on them. They break down, consume countless amounts of food, and then throw it out of themselves, suffering from remorse.

Basic problems

Typically, families in which there is a hungry person have a stable financial situation. Parents are serious about raising their children, forcing them to be impeccably polite and neat, obedient and religious individuals. All this is aimed at being no worse than others, and possibly better. In such families there is no place for tenderness and sensuality, it is not customary to show one’s love, and as a result, children lack the attention of their parents. They begin to feel worthless.

Conflict concepts

When children grow up in such families and become independent, they leave their parents' home and find themselves in an unusual situation. After all, in the world around us, everything is far from being as calm and joyful as they are used to thinking. As a result, psychosomatic deviations occur, people begin to protest against generally accepted norms and rules.

Therapy is carried out together with the family of a starving person, so that all relatives and friends reconsider their attitudes, life principles and concepts. Only in this case will it be possible to see a positive result. After all, a person first of all seeks, through fasting, to attract attention to himself or to show the real surrounding reality.

Those people who suffer from psychosomatic anorexia show that it is quite possible to exist in complete solitude and get by with too little. They also enjoy cooking for others while sharing in world hunger.

Fight for justice

Justice is a person’s ability to equally distribute his own interests and the interests of others. Every person has these feelings.

In therapy, many questions are asked about a person’s perception of fairness, whether he believes that life is unfair to him and for what reason.

Typically, sick people feel disadvantaged and unsure of themselves. The roots of this come from deep childhood; often a person does not even realize it without the help of a specialist.

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Many of us remember our childhood, when our parents tried to stuff us with food in order to compensate for the calories spent after active walks and games. But times have changed, and modern children, who spend most of the day in a sitting position, should be raised and fed in a completely different way.

How common is this disease?

The problem of childhood obesity is relevant for many countries. In most cases, the occurrence of excess weight in children is associated with excessive consumption of fast food and various semi-finished products. Moreover, if you consider what statistics say on this matter: the bulk of potential patients are schoolchildren and teenage children.

And this can be fully explained. Children who start school spend a lot of time sitting at their desks. During breaks, in order to calm their appetite, they snack on sandwiches, chocolates and other similar food products, which contain many calories but few nutrients. Thus, with a passive rhythm of life, children begin to gain excess weight very quickly.

It is worth noting that the only country that was able to successfully get rid of the problem of childhood obesity was France. They conducted numerous studies and, having established the reasons for excess weight gain in children, were able to develop and launch a special program on nutritional culture. As a result, in just three years they were able to reduce obesity rates and prevent disaster.

How exactly? As part of a special government program, the French were able to remove vending machines with fast food, soda and chips from all educational institutions, and also began to regularly conduct classes on food culture with children. In addition, doctors and schoolchildren had conversations with nutritionists and endocrinologists, and even psychologists provided assistance in the fight against excess weight to children.

In order to reduce rates of childhood obesity in other European countries, not only doctors, representatives of WHO, departments of culture and education will have to become more attentive to the problem. The success of this enterprise will depend as much as 60-70% on the children themselves and their parents. But are they all ready to help the child get rid of extra pounds?

Factors causing obesity

As practice shows, the fight against such a problem as obesity in childhood will be effective only if parents recognize its presence. When they realize that their beloved child is overweight, they will already be halfway to success. In the future, they should stock up on patience and willpower, since eliminating obesity in a child is by no means an easy task.

In order to correct his weight in the present and prevent consequences in the form of further obesity in a child, it is first important to understand what factors provoked its appearance.

So, the most common reasons for the accumulation of extra pounds in children.

Incorrect, unbalanced diet

This is perhaps the most important reason why many children begin to suffer from obesity from childhood. Currently, not every family pays due attention to nutritional culture and teaches the child from an early age to eat only healthy foods. In addition, recently all sorts of semi-finished products have become very popular, which greatly simplify life, but at the same time have a negative impact on the health and weight of the child. And besides, now many children prefer to eat some sweets, chips, snacks, hamburgers, etc. instead of fruit for a snack.

If you notice that your child’s body shape has become noticeably rounded, take action. First, try adjusting your child’s diet, while talking about the benefits and harms of specific foods. It is also advisable to calculate the ratio of calories consumed to burned to prevent the accumulation of excess subcutaneous fat in the body.

Genetic predisposition

In some situations, genetics can take over. According to statistics, a child raised by obese parents has a more than 65% chance of gaining weight.

Hormonal imbalances

There is a very common opinion that excess weight in a child can accumulate due to dysfunction of the endocrine glands, in particular, diseases of the pancreas. In fact, such diseases can only partially influence weight gain.

Physical inactivity

Or, in simple terms, insufficient activity. A sedentary lifestyle, which we can observe recently among representatives of the younger generation, is another common reason why a child begins to develop a complication. And often the culprits for this are the parents themselves, who encourage the child for calm and sedentary behavior or themselves demonstrate a passive example of spending leisure time.

How do they treat such children in society?

It is worth noting that the problem of excess weight begins to seriously concern children when they turn 5-6 years old. And not only because a baby with rounder cheeks and plump legs begins to stand out from his peers. But also because by this age a child begins to form his own ideas about beauty and views on his body.

Please note that already in kindergarten, children are faced with the opinions of others. And adaptation to society, which takes place through direct contact with peers, often has negative consequences for a plump child. He may be awarded an offensive nickname, which may cause trauma to his psyche.

Moreover, a boy is no less susceptible to this than a girl. The child's sympathy that your child first encounters in kindergarten may turn out to be unrequited and hurt the child's delicate psyche.

The child will rush to protect himself from all these and other problems associated with obesity at an early age. So he may begin to develop not very good character traits:

• aggressiveness;
• constant anxiety;
• isolation, etc.

Feeling inferior, an overweight child begins to experience various psycho-emotional disorders. But they also have a far from comforting prognosis - consequences that will accompany the child throughout his life. So who is to blame for the fact that children have these kinds of problems? Let's watch a thematic video from Dr. Komarovsky, who knows the causes of children's suffering.

How to prevent and fix the problem?

According to most doctors, parents are interested in how to deal with child obesity already at the stage of making an actual diagnosis. And on the one hand, it is very good that parents notice their child’s excess weight and try to find a way to eliminate it. But on the other hand, usually in such situations obesity is already quite advanced. This means that you will have to get rid of not only excess weight, but also low self-esteem and other mental disorders.

In order to overcome obesity and correct a child’s weight, first of all, you should definitely consult a specialist. He will be able to determine the causes of the accumulation of subcutaneous fat and prescribe adequate treatment. What could it be?

Initially, in order to achieve the desired result, parents will have to reconsider their diet and begin to set a worthy example for their child. To do this, you can also contact specialists who will help develop a special comprehensive program for all family members.

It will consist of several components.

Balanced diet

Those who are overweight will have to follow a dietary diet. It is important to understand that fasting will not help restore slimness to the body. Only a special diet, including all the substances necessary for the growth and development of the body (proteins, carbohydrates, vitamins, etc.). Typically, such a diet involves eating fresh vegetables and fruits, low-fat fermented milk products, lean meat and fish, and cereals. As a snack you can use nuts, apples, carrots, low-fat kefir, etc. In addition, you will have to exclude from your diet all harmful and completely unhealthy foods: fast food, soda, high-calorie yoghurts, buns and pies, chips, chocolates, etc.

Strict diet

To prevent a child from suffering from excess weight, he should not only be fed healthy foods, but also on a strict schedule. In total, you need to divide your diet into six meals with approximately the same interval between meals. So, for example, a child needs to have breakfast at 8:00, and have a snack around 10:30. Then at 13:00 he should have lunch, and the next appointment is already at 15:30. This is followed by dinner at 18:00 and the last snack from 20:00 to 20:30. When organizing your child’s meals, remember that all portions should be small, low-calorie and light (for example, 1 apple or 1 carrot, 0.5 cups of low-fat kefir or yogurt, etc.).

Regular physical activity

Not all children are delighted when they are forced to do exercises. Therefore, parents who want to rid their children of obesity will have to perform a simple set of exercises with their children. In addition to exercise, you can introduce a great family tradition - walking or riding bicycles in the evenings, doing dancing or yoga, etc. The main thing is that the classes are regular and enjoyable. In this case, even the prevention of obesity will be successful.

In addition to all these components of the fight against excess weight in a child, psychological support should also be present. Typically, children who are obese find it very painful to give up their favorite treats. In addition, stress at school and quarrels with friends and family do not improve the situation. Therefore, a child who is struggling with obesity needs to be given more attention and help with overcoming difficulties. That is why the problem of childhood excess weight is a problem for the whole family, which can only be overcome together.

The increase in the prevalence of obesity in adults and children in many countries over the past 10 years has averaged 75% and has become a non-infectious epidemic. The results of sample studies conducted in Russia suggest that almost 40% of the country's working population is overweight. The number of obese children doubles every three decades. In the Russian Federation, 5.5% of children living in rural areas and 8.5% in urban areas are obese. In almost 60% of adults, obesity, having begun in childhood and adolescence, continues to progress and leads to the development of vascular complications.

With the spread of obesity, severe somatic diseases associated with it are increasing: type 2 diabetes mellitus (DM), arterial hypertension, coronary heart disease, atherosclerosis, cancer and others (Fig. 1). Obesity-related diseases kill 2.5 million people worldwide every year. Excess body weight in childhood often transforms into obesity in adults, which, in turn, poses a serious threat to health. Thus, the observed epidemic increase in the spread of overweight and obesity throughout the world requires serious attention from medical, public and political institutions.

Over the course of its centuries-old history, man has developed in a constant struggle for survival, in conditions of constant external danger, when the advantage was the ability to go without food for a long time, and therefore, at the slightest opportunity, to store energy in the body in the form of fat mass. It is this genetic predisposition to store fat with the help of insulin, combined with a sedentary lifestyle and consumption of high-calorie foods, that contribute significantly to the development of obesity. Obesity and its complications are associated with numerous genetic markers, but certain hormonal, syndromic or molecular genetic disorders can explain only less than 5% of all cases of obesity. It is most likely that childhood obesity is polyetiological and is realized through a complex interaction of genetic and environmental factors.

Unfortunately, the lack of targeted detection of obesity in children in Russia causes its late diagnosis by specialists. The majority of patients (up to 70%) come under observation only 5-10 years after the onset of excess fat mass. However, in these cases, parents seek medical help not because of the excess body weight itself, but because the child has complaints such as headache, dizziness, excess appetite, thirst, pain in the legs, discomfort in the heart, and the appearance of stripes. stretch marks on the skin, delayed sexual development in boys, menstrual irregularities in girls, which are actually symptoms of a complicated course of obesity.

Diagnostics

Clinical assessment

The accurate definition of overweight and obesity in children is still a matter of debate for two main reasons: 1) the lack of a simple, cheap, reliable and reproducible method for measuring fat mass in children and adolescents, and 2) the lack of critical fat mass values ​​in children for prognosis of moderate or high risk for cardiovascular or metabolic complications in children. Whitaker et al showed that the predictive value of childhood obesity depends on the presence or absence of obesity in one or both parents.

It is very important at the initial stage to differentiate primary or idiopathic obesity from rarer cases of secondary obesity as part of a genetic syndrome, endocrinopathies, damage to the central nervous system (CNS) or due to iatrogenicity (Table 1).

When collecting an anamnesis, it is necessary to find out the nutritional history, starting with feeding during the neonatal period and in infancy (breastfeeding or artificial feeding, timing of the introduction of complementary foods, etc.), an assessment of the calorie intake is extremely important. You should also clarify the level of physical activity, restrictions associated with excess weight; the presence of snoring and drowsiness as potential signs of sleep apnea.

During an objective examination, first of all, one should evaluate the proportions of the body, the presence or absence of dysmorphia, which may indicate a certain genetic syndrome. Registration and graphical recording of height, weight, body mass index (BMI) and waist circumference (WC) should be performed at every visit to the doctor.

Quantifying fat mass in children and adolescents

Because increased fat mass in adults is associated with increased morbidity, accurate diagnosis of overweight and obesity in children should be carried out to determine the risk of developing obesity-associated diseases. Because of the difficulties of directly measuring fat tissue, obesity can be diagnosed quite simply using BMI. BMI correlates with the amount of adipose tissue in both adults and children. According to the WHO definition, overweight in adults, associated with an increased risk of morbidity, is diagnosed at a BMI of 25 to 30 kg/m2, and obesity - at a BMI of 30 kg/m2 or more.

T. J. Cole et al developed age- and sex-specific cutoff scores based on data from a study of children's BMI in six countries on different continents. The risk of morbidity in adults is extrapolated from these maps (Table 2). BMI centile distribution maps were created in each country taking into account national characteristics; when used, values ​​from the 85th to 95th centile are taken as overweight, and with a BMI over the 95th centile, obesity is diagnosed.

Methods for assessing fat mass and its distribution

Determining BMI is not a direct method of assessing fat mass and is not always a reliable predictor of the persistence and progression of obesity in the future. BMI does not allow differentiating the amount of subcutaneous and visceral fat. Therefore, additional methods for measuring total fat mass and the amount of fat in individual depots are needed.

Measuring skinfold thickness is a simple, quick and inexpensive method, usually used during mass examinations, providing information about the distribution of adipose tissue in different areas of the body. However, the technique itself requires some experience from the person conducting the study to standardize the results, otherwise the data will be inaccurate, especially with high BMI values. The thickness of the skin fold over the triceps correlates well with fat mass and, in combination with BMI, increases the sensitivity of the method for determining the percentage of adipose tissue in the body.

Study of bioelectrical resistance (BER). The method is quite simple to perform, results can be obtained quickly, it is relatively cheap and non-invasive. However, to reduce the error in the result, it is necessary to take into account the factors of food intake, physical activity, changes in water and electrolyte balance due to menstruation, acute illness, renal dysfunction, etc. Therefore, to increase the accuracy of the measurement, it should be performed on the patient before meals, 1 hour or more after drinking liquid, at rest. According to a study conducted in our department, a relative fat mass of more than 32%, determined by the BES method, at the age of 9-15 years allows one to reliably diagnose obesity in girls; in the majority of boys (86.7%) with obesity, the mass of adipose tissue exceeded 28.6%.

Anthropometry: Measurement of waist circumference (WC), hip circumference (HC) and WC/HC ratio is used as a method of indirect assessment of intra-abdominal adipose tissue. As with BMI, there are differences in the definition of WC cutoffs in adults. WC values ​​greater than 95 cm indicate an increased risk of mortality. This indicator is also a predictor of cardiovascular and metabolic complications in children. Excessive accumulation of visceral or intra-abdominal fat (with a WC/TB ratio of more than 0.9 in men and more than 0.85 in women) is associated with the presence of metabolic syndrome in adults and children. Techniques such as measuring skinfold thickness and BES do not provide an indication of visceral fat mass. Therefore, WC testing should be included in clinical practice as the least invasive and cheapest way to identify children at increased risk of metabolic complications. Currently, there is practically no information about normal WC values ​​in children, but such standards must be created. According to the data we obtained from examining 75 children aged 9-14 years with obesity in comparison with 45 children without obesity, matched by age, 96% of obese boys had a WC of more than 74 cm, and all obese girls had a WC of more than 70 cm.

Laboratory research

At the first stage, additional studies include: assessment of the lipid profile, liver function, fasting plasma glucose and insulin testing, and thyroid function. A glucose tolerance test is performed to exclude impaired glucose tolerance (IGT), or type 2 diabetes, in children with a family history of type 2 diabetes or metabolic syndrome. If signs suspicious for the presence of Cushing's syndrome are detected, a study of cortisol levels in the blood serum or urine is performed.

Further in-depth examination, including genetic testing, is required for children from infancy and early childhood if they have hypoglycemia or require frequent feedings, as well as if characteristic stigmas are identified. Examples of such conditions may be: persistent hyperinsulinemia with hypoglycemia in infants, hypoglycemia in Beckwith-Wiedemann syndrome, dysmorphic manifestations in Prader-Willi or Lawrence-Bardet-Biedl syndromes.

Treatment

Even mildly overweight children (BMI between the 85th and 95th centiles) have an increased risk of dyslipidemia and insulin resistance. In contrast, the incidence of dyslipidemia, hypertension, and IGT is low in the group of children with a BMI less than the 85th centile for age. Thus, dietary intervention to increase physical activity should be recommended for children with a BMI between the 85th and 95th centiles, and for children and adolescents with a BMI greater than 95th centile or who have metabolic, orthopedic, or cardiopulmonary complications or who experience significant psychological distress, more should be used. intensive methods of therapy (Fig. 2).

Most metabolic complications of childhood obesity appear during adolescence. However, starting treatment is justified already in childhood. Firstly, severe obesity in young children and preschoolers may already be accompanied by sleep apnea syndrome or orthopedic pathology (for example, Blunt's disease). Secondly, in some children, impaired glucose tolerance, type 2 diabetes, dyslipidemia and arterial hypertension develop before puberty. Third, excess weight gain between 2 and 10 years of age increases the risk of adult obesity and impaired glucose tolerance, especially if the parents have obesity or diabetes. Fourthly, early vascular changes are detected in children aged 3-8 years, which indicates the onset of obesity-dependent atherosclerosis already in childhood. Finally, interventions to prevent and reverse obesity in its early stages may be more successful than treating established severe obesity in adolescents and adults.

Targets for the treatment of childhood obesity, given the continued linear growth of children, must be individualized. The initial goal should be to restore the balance between energy input and energy costs; in cases with a clearly excessive intake of calories, it is necessary to reduce their intake, while simultaneously increasing energy expenditure.

Stabilization of body weight in growing children gradually leads to a decrease in BMI. Studies conducted in adults suggest that reducing body weight by 5-10% at a rate of 0.5 kg/week and maintaining the achieved weight for 2-5 years can improve insulin sensitivity, normalize glucose tolerance, reduce blood pressure, concentrations of low-density lipoproteins (LDL) and triglycerides, correct sleep disorders. Thus, obese children and their healthcare providers should strive to achieve any reduction in BMI. Long-term goals for the treatment of childhood obesity should be reduction of BMI below the 95th centile, as well as reversal and prevention of comorbidities.

Desired lifestyle changes will be achieved more quickly when the efforts of the patient and his family are coordinated. Long-term success requires a long-term treatment program; Therapy experience in adults shows that cessation of therapeutic intervention again leads to weight gain in the vast majority of patients. Eating disorders and other psychological disorders are not uncommon in obese patients and require a separate approach, otherwise treatment will be ineffective.

Parents primarily form the child’s environment and, therefore, they play a key role in the prevention and elimination of problems associated with excess weight. The behavior of parents and the eating style in the family are decisive factors in the formation of a healthy lifestyle, correct awareness of hunger and satiety. In the program developed by the staff of our department for reducing body weight in children with behavioral changes with the participation of the family, the main object of influence, along with the child, is his parents, classes with whom are conducted separately on the same topics that are discussed with children.

General approaches to the treatment of obesity in children can be formulated as follows:

Start treatment as early as possible;

The family must be prepared for lifestyle changes;

Educating family members about the complications of obesity;

Involvement of family members in the treatment program;

Treatment programs should focus on gradual weight loss and should not use short-term diets or rapid weight loss programs;

Family members must learn to control nutrition and physical activity;

The program should help the family gradually make changes in diet or physical activity (2-3 changes at first). Evaluation of the effectiveness of the program and support from a doctor - at least once every 2 weeks;

There should be no criticism from the doctor, on the contrary - support and encouragement of the successes achieved;

Involvement of a team of specialists (nutritionist, psychologist, physical therapy specialist).

Advice for parents of obese children includes:

Find reasons to praise your child for his behavior.

Never use food as a reward.

Agree with the child about a “reward” on his part for changes in the behavior of the parents themselves (more time spent with the child, walks together, games, changes in their own diet, etc.).

Set daily meal times for the whole family.

Parents must decide what food to offer and at what time, and the child decides whether to eat it or not.

Offer your child a choice only between healthy foods (not “an apple or a cake”) and between physical activity options (but not “TV or a walk”).

Eliminate temptations (remove foods high in fat and sugar from the house).

Be an example yourself (in terms of nutrition, physical activity).

Be consistent.

Dietary approaches: Mild caloric restriction is safe and can be effective when obese children and their parents are motivated to make long-term changes in eating habits and receive ongoing support. An example of such a program aimed at working with a child’s family is the “traffic light diet”. Significant weight loss is rare and usually short-lived, as long as the reduction in caloric intake is accompanied by significant energy expenditure. However, diets with severe caloric restriction cannot be followed for a long time and are potentially dangerous, since significant caloric restriction leads to a deficiency of vitamins, minerals and micronutrients, slows down the growth and mineralization of bones, reduces the rate of linear growth and leads to menstrual irregularities. Prolonging severe calorie restriction leads to frustration and can lead to rapid cycles of fasting and bingeing in a futile attempt to lose weight.

The most rational way is to teach children and parents the principles of rational nutrition, which can be observed for as long as desired. A balanced diet should be: balanced in its main components (proteins 12-15%, fats less than 30%, carbohydrates 55% of the daily caloric intake); regular; fractional (3 main and 2 additional meals) with the correct distribution of calories during the day (breakfast - 25%, lunch - 30%, dinner - 25% and additional meals - 10%); varied, taking into account taste and culinary capabilities; including fresh fruits and fiber-rich vegetables (several times a day); limiting fats (especially animals); limiting quickly digestible carbohydrates and moderately limiting slowly digestible ones (potatoes, pasta, bread, mainly from wholemeal flour, porridge); maximally limiting the consumption of sausages, sausages, semi-finished products and confectionery products containing so-called “hidden” fats.

The use of diet in combination with regular exercise has proven effective in short-term treatment programs for childhood obesity. However, as the clinical experience of specialists from different countries shows, to maintain the effect of reducing BMI and reducing the risk of developing diseases associated with obesity, long-term changes in behavior style are required.

The World Health Organization launched the Global Strategy on Diet, Physical Activity and Health in 2004, a key element of which is primarily clinical programs supported by vocational and therapeutic training aimed at weight loss. Programs based on the recommendations of the Expert Committee on the Diagnosis and Treatment of Obesity include group work, individual counseling on eating behavior, family involvement in the educational process, lifestyle changes, moderate caloric restriction with the goal of reducing body weight by 5-10% and reducing the risk of complications, a physical exercise program with the right to choose the type of physical activity and abandoning a sedentary lifestyle, the ability to maintain achieved results and prevent a relapse of progressive obesity. The main objectives of training should be: developing medical motivation for long-term treatment, gradual weight loss and sustainable weight retention, changing eating habits and lifestyle, increasing personal responsibility for one’s treatment.

In accordance with the Federal Health Care Program, in most cases, responsibility for the treatment of obese children rests with the primary care physician (clinic). It is very important to promptly identify overweight children and begin working with them before obesity develops. Dietary recommendations should be given at the appointment. They include: familiarization with the food pyramid (Fig. 3), exclusion of all sugary drinks, including carbonated high-calorie drinks; consumption of skim milk by children over two years of age; portion control; increasing consumption of fruits and vegetables; cutting back on fast food, as well as advice on daily exercise. Weekly monitoring of body weight in the clinic helps track the effectiveness of recommendations; if this turns out to be insufficient, consultation with a nutritionist or inclusion in one of the weight loss programs is carried out. If a child, in addition to obesity, has the following features: rapid growth in combination with growth retardation, features of a genetic syndrome, neurological disorders, abnormal distribution of subcutaneous fat, consultation with specialists (endocrinologist, geneticist, neurologist) is required.

All children and adolescents with obesity (BMI > 95th centile) certainly require treatment. Children who are underweight early in life and then rapidly gain weight have a higher risk of obesity, IGT, and type 2 diabetes. These children also need specialist advice.

Children with obesity and accompanying conditions: sleep apnea, IGT, hypertension, fatty hepatosis, polycystic ovary syndrome (PCOS), dyslipidemia, require the help of specialists in the field of pediatric endocrinology, gastroenterology, nutrition, cardiology, physical therapy, orthopedics, psychology; their efforts can be combined within a specialized clinic (center) for the treatment of obesity. Currently, until effective and safe treatments for severe obesity in children have been proposed, intensive techniques should be used for a limited period of time in a specialized center, as part of a comprehensive long-term treatment program. Intensive treatments for obesity include low-calorie diets and pharmacotherapy.

Prevention

Promoting healthy lifestyles to prevent obesity should start at school and then spread throughout the community. The education system should reconsider its policy in terms of providing children with healthy food products (this applies to the menu of school canteens, the range of buffets, drink machines, etc.). Educational programs should be introduced in schools to teach proper nutrition, the basics of a healthy lifestyle, and weight management. School cafeterias and cafeterias should provide a choice of fresh fruits and vegetables, as well as low-fat foods.

The first step towards expanding children's physical activity should be limiting sedentary activities. Another important element should be the availability of sports and sports games both at school and at home. Physical exercise should be fun, not a punishment.

Screening programs to identify obesity and its complications should be legalized; doctors and nurses working in primary health care should identify children with obesity and its complications during preventive examinations. Ideally, where resources are available, overweight children (BMI > 85th centile) and their parents should receive counseling on weight management and the benefits of weight loss, and obese children (BMI > 95th centile) should be screened for hypertension, dyslipidemia, musculoskeletal disorders, sleep apnea syndrome, gallbladder pathology, insulin resistance, and if these problems are detected, refer to the appropriate specialists to clarify the diagnosis and include them in the therapy program.

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Over the past few years, various medical and public health organizations have become increasingly concerned about the development of a veritable “epidemic” of childhood obesity.

But excess weight in a child not only contributes to the deterioration of health in childhood, but also leads to the development of quite serious problems in many social spheres of life when such children reach adulthood.

According to researchers, the factors that directly influence the appearance of excess weight in a child are varied: genetic predisposition, consumption of foods that are too high in calories but have low nutritional value, and a minimal level of physical activity.

Consequences of the problem of childhood obesity

Children who are extremely overweight often experience the following social and emotional problems, which can have far-reaching consequences on their quality of life.

Bullying. A child who is overweight or obese is often the target of both psychological and physical bullying. A 2004 study published in the journal Pediatrics found that these children are more likely to be the target of rumors, ridicule, nicknames, or physical harm than their normal-weight peers.

Anxiety. Excessive weight can also lead to increased anxiety in children. This statement is supported by a 2010 study published in the French journal Obesity, which states that children who experience ridicule from peers at school or from family members begin to position themselves as isolated from others, which leads to the development of social anxiety or phobias. .

Academic problems. A child’s difficulties with social interaction with peers, combined with low self-esteem, can play a negative role in mastering school material and getting high grades. Academic achievement may take a backseat as a child struggles with growing anxiety, social isolation, or other psychological issues.

“Such students are much less likely to enroll in higher education after high school,” according to a 2007 study.

Depression. Dissatisfaction with oneself and a decrease in self-esteem often lead to the development of depression in a child, which is a serious mental illness that affects all aspects of a child’s life. Such children are characterized by long-term closed states without showing any emotions, stopping visiting thematic sections and giving up their favorite hobbies, which can contribute to complete social isolation.

During adolescence, obese children are more likely to have problems with drugs and eating disorders, in which depression plays a key role.

Proper nutrition for obesity in children

Breakfast. Perhaps you think that the best solution in this situation would be to skip breakfast to reduce your child's total calories!? However, according to authoritative nutritionists, skipping one of the main meals, on the contrary, will contribute to weight gain rather than weight loss. Therefore, give your child a couple of fruits, such as bananas, so that he can enjoy them on the way to school.

Dinner. A good way to help your child make healthy food choices for lunch is to pack it yourself at home instead of having him buy it at the store closest to school. For example, this could be a sandwich of lean meat and low-fat cheese on whole grain bread, 0% fat cottage cheese or yogurt. For liquid, place a bottle of water in your school bag, which can be sweetened with a little lemon juice.

Afternoon snack. It should not include foods high in fat and calories. The best option would be to prepare low-fat dairy or dairy products yourself.

Snacks. As paradoxical as it may sound, eating snacks between meals will help your diet, but only if he chooses healthy foods to do so. Make sure the meals are nutritious and low in sugar and fat. For example, baked whole grain crackers are a good alternative to chips, and a fresh vegetable salad with natural yogurt will fill him up well until his next meal.

Exercise program for adolescents with obesity problems

Reducing daily calorie intake is not the only way to help your child lose weight. It is equally important to interest and accustom him to regular physical training.

Parents should choose exercises that are appropriate to the child's current skill level. This will gradually lead him to more difficult and intense loads. Exercise for 30 to 60 minutes every day of the week if possible.

Warm-up

Start with a combination of moderate-intensity cardiovascular exercises (jumping, walking in place, walking sideways to the right and left), static and dynamic stretches (alternate leg lunges, shoulder rolls back) and strength movements (shoulder raises, squats, push-ups) . This stage is very important for obese children to properly warm up the muscles, which will help prevent injury and increase muscle strength and flexibility. Warm-up should last from 5 to 10 minutes.

Aerobic exercise

The three main elements of fitness include endurance, strength and flexibility. Endurance develops in children who regularly participate in aerobic activity. For example, this could be walking, running or cycling, each of which can be done both in your own home (if available) and in the fresh air.

Jumping forces the muscles of the whole body to work and burns a large number of calories in a short period of time. Of course, due to excess body weight, the child may have difficulty with the duration of the jumps. Don’t worry, start jumping even for 5 seconds, but gradually increase the duration of the approach.

Strength exercises

This type of training is carried out on a day free from aerobic exercise (previous point). Strength exercises help increase muscle mass. The thing is that a muscle cell burns several times more calories than fat, so this will allow the child to quickly adjust his weight.

Before starting any strength exercise, children must learn the correct technique for performing it. Try the following loading variations: push-ups, leg lunges, crunches, dumbbell curls, quad crawls, and lateral raises. Each exercise consists of 10 – 15 repetitions.

Flexibility exercises

In addition to aerobic and strength training, exercises that develop flexibility are no less important. Stretching movements of the body help improve a child's mobility by forcing muscles and joints to move through their full range. Performed at the end of each lesson.

Pulling the feet with the tips of the fingers, pulling the shoulders back, bending in different directions - these are some simple exercises that your child can do to increase the flexibility of the body. But remember that the stretching itself should not reach the point of discomfort. Each stretch should be held for 10 to 30 seconds.

Warning: Before starting any treatment for an overweight child, his parents should consult a pediatrician.

Talking to children about excess weight can be a sensitive topic for them, regardless of age. So it can be tempting to avoid this conversation, even if you are genuinely concerned about your baby's physical and emotional health.

Although this topic may be uncomfortable for you, the sooner you decide to discuss it, the sooner you can help your child take steps to correct the situation. Ignoring the problem will not solve it on its own; as a result, your child will get older, and it will become much more difficult to achieve a positive result later, although it is possible.

Also keep in mind that untreated obese children are more likely to be overweight as adults, making them more vulnerable to terrible diseases such as type 2 diabetes, stroke and heart attack.

1. Become your child's ally.

Always try to be honest with your children about their weight if they ask you to do so. If your child is concerned about their weight, tell them you want to help and you will work together to achieve results.

Then propose and discuss with him some options for your future joint actions. For example, master the secrets of cooking to learn more about healthy ways to prepare your favorite dishes. Go grocery shopping together and pick out a new fruit (like ) or vegetable to use in a recipe.

Buy pedometers for everyone in your family and set a goal for everyone to walk a certain number of steps per day. Involving your child in the decision-making process about their situation helps them take responsibility for their health and build self-confidence.

2. Be a good role model.

When it comes to children and obesity, what you do is always more important than what you say. Parents are the first role models for children! This is confirmed by a study in which 70% of children answered that the most important factor for them is the actions of their parents.

Children base their relationship with food on the principles of their own parents, so if they like to eat unhealthy food at fast food restaurants, then the child will develop the same habits, which will later be very difficult to eradicate.

3. Start by establishing healthy habits now.

Remember – it’s never too late to join the canons of healthy eating! You may not have always lived the right lifestyle in the past, but today is a fresh start. Improving your own life will help inspire your child to do the same.

Make all the fundamental changes in a few small steps. Gradually clear your home of all unwanted food items. Look in your refrigerator and remove anything high in saturated fat and sugar. Don't allow yourself to buy unhealthy food. Stock up on options such as low-fat yogurt, fresh fruit, raw vegetables, crackers (whole grain), low-fat cottage cheese, and peanut butter.

4. Don't make critical comments about your child's weight.

Criticizing children about their weight is one of the worst things adults can do!

5. Talk to your children about issues that may affect their weight.

Excess weight can be a symptom of a deeper problem in the child, so parents need to be sure to know how your child behaves at school and in society. The same loneliness for many children is the root cause of weight gain.

Therefore, parents need to interest and encourage their baby to participate in various activities. Attending a school disco or volunteering will help him become more active and meet many people who share his interests.

A child may also overeat in response to unresolved issues in their family, such as parental discord or financial problems.

6. Don't force your children to give up their favorite foods completely.

Creating a healthy approach to eating is a much more effective solution than restricting food. But this does not mean that your child can never enjoy cake on his birthday or other holiday.

It is better to teach him to enjoy his favorite treats, and not eat them instantly. Tell them that even sweets can be part of a healthy diet if they are consumed in reasonable quantities.

7. Try to eat together as a family.

There is evidence that in families where adults share meals with children, the problem of childhood obesity is virtually non-existent. This is due to the fact that at a common table the child absorbs food more measuredly, which makes him feel full earlier and stop eating.

8. Don't force children to follow a strict training plan.

Parents who encourage physical activity in the family as a natural part of life and do not make it a chore have children who cope with the problem of obesity faster. Instead of forcing your child, consider taking a cross-country walk together.

9. Make sure your child gets enough sleep.

More and more researchers have now come to the conclusion that lack of sleep is closely linked to the problem of weight gain and other medical diseases. So always make sure your baby gets enough sleep every night.

Of course, individual needs vary, but general guidelines look like this:

• Ages 1 – 3 years: 13 to 14 hours of sleep

• 3 – 5 years: from 11 to 12 hours

• 5 – 12 years: from 9 to 10 hours

• 12 – 18 years: at least 8.5 hours per day

To help your child get the right amount of rest at night, ask him to turn off the computer, cell phone or TV at least two hours before bed. Artificial light from electrical appliances stimulates the brain and makes it difficult to fall asleep.

Also, remember that the more time your child spends watching TV or on the computer, the less time he will spend interacting positively with his family or engaging in physical activity.

10. Let your child know that you love him in any way.

Remember that you will achieve your long-term goals faster if your child feels how much you love him.