Treatment of Childhood Obesity II

2. Treatment of Childhood Obesity

The principle of obesity treatment is to reduce body fat by lowering calorie intake and increasing energy expenditure so that body fat is used as energy. The treatment goal for childhood obesity is to reduce the degree of obesity and maintain the child within the standard weight range. However, younger children often have weak willpower, lack patience, and are not very motivated, so active participation and cooperation from parents and family are needed. Relapse is common after treatment, so weight loss should be gradual over a long period of time. Above all, changing the lifestyle habits that caused obesity is the most important way to prevent relapse.

Methods for treating obesity include diet therapy, exercise therapy, behavioral modification therapy, medication, and surgery.

However, in childhood obesity, medication and surgery are, in principle, prohibited, so the main treatments are the three methods of diet therapy,

exercise therapy, and behavioral modification therapy.

1. Diet therapy

Children are still in a period of growth, so they need sufficient nutrition for growth. It is important to control excessive food intake and correct poor eating habits. The entire family must participate and help with this. The diet should consist of 20% protein, 35% fat, and 45% carbohydrates of total calories. It should contain enough protein needed for growth, while carbohydrates and fats should be restricted. Therefore, rice and bread should be eaten in smaller amounts, and vegetables, fruits, meat, and fish should be eaten mainly. For meat and fish, fatty kinds should be avoided.

In the treatment of childhood obesity, an ultra-low-calorie diet (800 calories/day or less) and a low-calorie diet (800–1,000 calories/day) are, in principle, contraindicated.

As families have become smaller and parents spend a lot of time at work during the day, children are often left alone and have less time to be supervised, so their television viewing time may increase. As a result, seeing advertisements for fast food or drinks increases the desire to eat them, and staying indoors and playing only computer games reduces physical activity. Therefore, reducing television viewing and computer game time increases physical activity and reduces exposure to foods that may be tempting because of advertising, so it is a highly recommended method.

The traffic light diet is a method that can be usefully applied to children. It divides foods into green, yellow, and red groups according to the colors of a traffic light. The green group consists of foods rich in fiber and low in calories, and most vegetables fall into this category and can be eaten without restriction. The yellow group includes foods of moderate calorie content, including protein, and only the prescribed amount should be eaten, with care taken not to overconsume. The red group includes very high-calorie greasy foods or foods containing sugar, and these should be avoided as much as possible.

2. Exercise therapy

The advantages of exercise therapy are that it is effective in reducing weight, improving cardiopulmonary function, and maintaining reduced weight.​ Among these, it is more effective for maintaining reduced weight than for weight loss. However, ordinary exercise does not consume that much energy, so only regular and continuous exercise will produce results. Exercise should generally be done for about 1 hour a day, and the type of exercise can be as simple as playing outside with friends.

Since most children with obesity dislike exercise, exercise that is enjoyable and interesting is best, and doing it with parents is much more effective. Aerobic exercise—that is, exercise done while breathing, such as walking, cycling, swimming, and hiking—is recommended because it burns fat. For about the first 20 minutes after starting exercise, carbohydrates in the body are used as energy, and after 20 minutes, fat begins to be used as energy. Therefore, about 1 hour of continuous aerobic exercise is good. It is often incorrectly believed that exercise increases appetite, but research has shown that exercise for about the first hour actually decreases appetite. Therefore, about 1 hour of continuous aerobic exercise is the best way to address obesity. Exercise therapy must always be done together with dietary control.

For example, one serving of ramyeon contains about 500 kcal. To burn that many calories, you would need to run for 1 hour or cycle or walk for about 3 hours, so it can be said that weight loss is impossible with exercise alone without dietary control. The appropriate intensity of exercise is about 50–85% of maximum exercise capacity, which is an intensity at which your clothes become damp with sweat and you are short of breath, but you can still talk with the person next to you. If symptoms such as headache, pallor, dizziness, chest pain, or muscle paralysis occur during exercise, exercise should be stopped.

3. Behavioral modification therapy

The goal of behavioral modification therapy is to correct poor eating habits and lifestyle habits that lead to obesity, reduce food intake, increase activity and exercise, and create a negative calorie balance to improve weight-loss effectiveness. Rather than quickly losing weight through short-term diet and exercise therapy, it is much more effective to identify and correct inappropriate eating and lifestyle habits that cause obesity. At first, two or three bad habits are corrected, and once some improvement has been made, other bad habits are addressed. When the entire family participates and changes the family’s behavior and environment, the effect on weight loss is greater and lasts longer.

So far, I have explained the treatment of childhood obesity II.

In the next part, we will look at toxic liver damage.

Source: Korea Disease Control and Prevention Agency, National Health Information Portal