Facing Childhood Obesity: Causes, Harms, and Differentiation During Puberty

**Can childhood obesity be ignored?**

Childhood obesity can be categorized into infant obesity, toddler obesity, school-aged child obesity, and adolescent obesity. There are two main periods when children are most prone to obesity: infancy, when adipose tissue development is most vigorous, and pre-adolescence. The fact that infant obesity is accompanied by fat cell proliferation suggests a correlation with later obesity. Of course, there are also cases of natural weight loss. Therefore, infant obesity can be considered benign. Approximately 70%-80% of school-aged children who are obese or pre-adolescent will develop into adult obesity. Therefore, weight loss for children should begin in early childhood.

(1) Normal changes in children's weight

Childhood obesity, like adult obesity, is caused by excessive accumulation of body fat. Besides genetic and environmental factors, age is another significant factor in childhood obesity. Children differ from adults because they are in a period of growth and development. The average birth weight of a newborn is 3 kg, with a normal range of 2.5 kg to 4 kg. Physiological weight loss is common in the first few days after birth, typically 6-9% within 3-4 days. A loss exceeding 10% may indicate pathological conditions or insufficient feeding. After 3-4 days, weight begins to increase again, generally returning to birth weight within 7-10 days. Weight then gradually increases, with younger children experiencing faster increases. With proper feeding, the fastest growth occurs in the first three months, averaging 25-35 grams per day. In the first six months, the average monthly increase is 600 grams, and in the second six months, it's 500 grams per month. After one year, the average annual increase is 2 kg. During school age, the average annual increase is less than 2 kg. From 6-7 years old, the annual increase rises again, reaching up to 6 kg per year during puberty. A child's weight is twice their birth weight at 3-5 months, three times their birth weight at 1 year old, six times their birth weight at 6-7 years old, and twelve times their birth weight at 13 years old. Between 13 and 14 years old, both boys and girls enter puberty, and another period of gradual weight gain occurs. When a child's weight exceeds the average weight for their age group, obesity may be considered.

(2) Correctly assess the degree of childhood obesity

The methods for measuring childhood obesity are basically the same as for adults, mainly based on the normal weight standards for children of the same age group. The former National Sports Commission's Institute of Science and Technology conducted a survey on children's physical condition and established a relatively normal weight standard for different age groups. Exceeding this standard by 10% is considered overweight, and exceeding it by 20% is considered obese. The evaluation method for obesity is consistent with that for adults.

(3) Common complications of childhood obesity

Prolonged childhood obesity increases the risk of developing adult-onset diseases at an earlier age. Studies have shown that childhood obesity can lead to earlier onset of diabetes, especially non-insulin-dependent diabetes. While obese children may not necessarily develop coronary heart disease in childhood, it can cause them to develop the disease at the very end of puberty. Childhood obesity can also lead to premature hypertension, making treatment for hypertension in adulthood less effective. Excessive high-fat diets can cause obese children to develop fatty liver disease at an earlier age, making weight loss treatment very difficult; in such cases, timely treatment of fatty liver disease is crucial. In conclusion, controlling childhood obesity can reduce many unnecessary medical expenses in the future, benefiting families and society.

**(4) The incidence of childhood obesity is high in my country.**

With the continuous improvement of people's living standards and changes in parenting methods and dietary structures, recent survey data shows that the incidence of childhood obesity in my country is rising year by year. A sample survey of 160,065 people in Beijing, Harbin, Nanjing, Shanghai, Xi'an, Wuhan, Fuzhou, Kunming, and other cities, completed by a collaborative group of nine cities nationwide and the Capital Institute of Pediatrics, shows that the obesity rate among urban children aged 0-6 years has reached 0.91%, with the rate among infants from birth to 3 months reaching as high as 43.7%-94.9%. A follow-up study conducted by the Capital Institute of Pediatrics in conjunction with Beijing Children's Hospital and Beijing Anzhen Hospital for eight consecutive years starting in 1987 on 468 six-year-old students in the suburbs of Beijing, showed that the obesity detection rate among six-year-old children had reached 5%, and from age nine onwards, the rates were 22% and 11.6% respectively, showing significant gender differences. This is mainly due to parents encouraging boys to eat more.

If children with obesity do not pay attention to adjusting their eating habits and food structure, they are very likely to develop into adult obesity, and adult diseases such as high blood lipids, fatty liver, and diabetes will often follow.

my country is currently in a period of rapid economic growth. With the rapid economic growth and the continuous improvement of people's living standards, the incidence of childhood obesity is on the rise. Therefore, we should take precautions and do a good job in relevant publicity and education.

**How ​​to differentiate between normal puberty development and obesity?**

Adolescents are prone to weight gain after puberty. For girls, it's crucial to distinguish between normal puberty development and obesity. Weight gain is related to many factors, with excessive accumulation of adipose tissue being a significant one. Other factors include excessive water retention in tissues or body cavities and muscle development. Generally, exceeding the standard weight by 20% is considered obesity. However, bodybuilders and sumo wrestlers, even if exceeding the standard weight by 20%, should not be considered obese. Girls typically experience puberty between the ages of 13 and 18. During this period, the body grows rapidly. Height increases by an average of 6-8 cm per year, with some individuals growing 10-13 cm. Weight also increases accordingly, typically by about 5-6 kg per day, with some gaining up to 10 kg. Sexual development is the most characteristic change during this physiological stage. In particular, the development of a woman's secondary sexual characteristics is very rapid, such as breast enlargement, fuller chest, wider pelvis, and increased subcutaneous fat, especially in the chest, back, breasts, abdomen (around the navel), waist, buttocks, and thighs.

As the saying goes, "A girl changes drastically at eighteen," which describes the developmental changes during this period. This normal plumpness is fundamentally different from obesity. As long as weight (generally not exceeding 20% ​​of the standard weight) and subcutaneous fat thickness (generally not exceeding 2.5 cm) do not meet the criteria for obesity, they should not be considered obese. This point is important because some girls are unaware of this normal physiological change, classify themselves as obese, become anxious, and blindly adopt "dieting" measures in pursuit of so-called "slimness." This goes against the normal physiological development process and is extremely harmful to their health and development.

**How ​​to prevent obesity during puberty?**

During puberty, the body's metabolism is vigorous, and the secretion of endocrine hormones increases, leading to a greater need for nutrients to meet the needs of physical development. If overeating, especially high-calorie foods, is combined with insufficient physical activity, intake may exceed expenditure, and the excess energy will be converted into fat, causing obesity. This is particularly true for teenage girls entering puberty. Due to the influence of endocrine hormones, girls may suddenly become more quiet and gentle, participating less in vigorous activities. Combined with the fact that many girls enjoy snacking, this inevitably leads to overnutrition and weight gain. Therefore, it is important to avoid excessive weight gain during puberty. Adolescents should strengthen physical exercise to promote the secretion of endocrine hormones and accelerate physical development. In terms of diet, attention should be paid to a balanced intake of nutrients, with plenty of foods rich in protein, vitamins, and minerals, and less fatty and sugary foods, aiming to promote development while preventing weight gain.

**What is the relationship between obesity and genetics?**

Modern zoological research has found that several genetically obese mice and rats with phylogenetic characteristics pass on obesity traits to the next code in a dominant or recessive manner, and the age at which obesity occurs and the pattern of fat distribution are all unique.

Recently, scientists at the Royal Infirmary in London, England, discovered a unique gene in obese individuals that is linked to chromosome 3. Because this gene is only found in obese people, it has been named the obesity gene.

Obesity genes were originally a safety net for times of hardship, promoting the body's efficient use of all food, absorption of nutrients, and storage of those nutrients. In some chronically impoverished areas, residents accumulated more obesity genes to maximize nutrient absorption and storage from limited food sources. However, in affluent modern society, with increasingly abundant food on our tables, obesity genes have become a burden, transforming from a protector of life into a major culprit in obesity.

Studies have confirmed that obesity genes can promote the body's production of a protein that transports lipids in the blood-the APO-D gene. The more APO-D genes present, the smoother the blood transport of fat, and the more fat accumulates in the body. Clearly, the APO-D gene plays a significant role in the formation of obesity, promoting fat accumulation. The APO-D gene is not only present in obese individuals; thin people also possess it, although the composition of the APO-D gene in thin people differs from that in obese individuals, thus preventing them from becoming obese.

Where does fat reside in obese individuals?

There is no limit to the amount of fat that the human body can store. No matter how much fat there is, the fat storage can hold it all. This is why obese people can continue to gain weight indefinitely.

The first major fat reservoir in the human body is subcutaneous tissue. A moderate amount of fat in subcutaneous tissue prevents a person from appearing skinny and instead creates a charmingly full figure. The second major fat reservoir is around the internal organs, especially around the kidneys and the mesentery. A moderate amount of fat around the internal organs is beneficial, as it supports, stabilizes, and protects them. However, too much fat can restrict and affect the function of the internal organs, especially organs like the heart. The shortness of breath and palpitations experienced by obese individuals during activity is related to the compression of the heart by surrounding fatty tissue. The third major fat reservoir is located in the greater omentum of the abdominal cavity. When obesity reaches a certain level, resulting in a large belly, this is a manifestation of excessive fat storage in the greater omentum.

These fat deposits generally store a large amount of fat initially. Based on this, certain characteristics may emerge, such as uniform obesity, abdominal obesity, and truncal obesity.

Does obesity affect lifespan?

As early as the late 1980s, many scholars in Europe and America conducted research on health risk factors in large populations, finding that the relationship between weight and mortality was J-shaped or U-shaped. In other words, both overweight and obese individuals had higher mortality rates, especially obese individuals. American scholars' research suggests that the mortality rate was lowest among those 10%-20% below average weight, increased by 40% for those 30%-40% above average weight, and increased by 90% for those more than 40% above average weight.

Obesity poses a serious threat to lifespan. It can lead to coronary heart disease, hypertension, fatty liver, and hyperlipidemia, all of which are life-threatening. The greater the degree of obesity, the higher the chance of developing these diseases, and consequently, the higher the chance of death. In this sense, the heavier a person is, the shorter their lifespan, just as the saying goes, "the longer the belt, the shorter the life," meaning weight and lifespan are inversely proportional.

**What is the relationship between obesity and alcohol consumption?**

Alcohol has a long history in China, and each famous brand has a profound historical and cultural origin. Guizhou's Maotai, Jiangxi's Site, Beijing's Erguotou, and Qingdao's beer are all popular choices for festivals, birthdays, and gatherings with family and friends. Shaoxing's yellow wine and Chengde's Bazhen Yujiu are legendary health tonics. Tongrentang's Guogong wine and bone spur pain reliever are renowned both domestically and internationally. So, what kind of alcohol can cause obesity? Primarily beer and baijiu (Chinese white liquor).

The main component of alcoholic beverages is ethanol. Beer has a relatively low alcohol content, only 1.5%-4.5%, posing less harm to the body, but it offers higher nutritional value, including vitamins, yeast, minerals, various amino acids, and sugars. The hops, fresh yeast, carbon dioxide, and sweet, refreshing taste of beer stimulate the secretion of digestive juices, promoting appetite and aiding digestion. Each bottle of beer produces approximately 2092 kilojoules of energy, hence the nickname "liquid bread." However, consuming delicious food while drinking beer leads to excessive calorie intake, resulting in excess calories that are stored as fat under the skin, causing obesity.

Baijiu (a type of Chinese liquor) contains a high amount of alcohol, so why does it also cause obesity? This is mainly related to fatty liver caused by alcohol. Alcohol stimulates the activity of enzymes, reduces the pathway for fatty acids to enter phospholipids and cholesterol esters, indirectly causing an increase in triglycerides and fat conversion. In addition, consuming high-calorie dishes while drinking alcohol further aggravates the liver's impaired energy metabolism, leading to the accumulation of large amounts of subcutaneous fat and obesity.

Alcohol can invigorate the mind and relieve fatigue. Moderate drinking is beneficial, while excessive drinking is harmful. One should drink alcohol in moderation and according to one's own physical condition, and eat less staple food to achieve the goal of maximizing benefits and minimizing harm.

**What is the relationship between obesity and smoking?**

Smoking is harmful to health. Cigarettes contain nicotine, tar, and other toxic substances, including benzene. Smoke entering the lungs can cause coughing, and in some individuals, it can even lead to lung cancer. Smoke entering the stomach stimulates intestinal peristalsis, enhancing digestion; however, prolonged exposure to smoke can suppress appetite and cause weight loss.

Quitting smoking is generally a good thing, but for many former smokers, it presents new challenges. Research from the U.S. Centers for Disease Control and Prevention (CDC) shows that Americans tend to gain weight after quitting smoking, with men gaining an average of 2.8 kg and women an average of 3.8 kg. Those over 55 who smoke more than 15 cigarettes a day are particularly prone to weight gain after quitting. Why is this? Researchers have found that there are indeed emotional and behavioral reasons, including the habit of putting things in one's mouth. Nicotine in tobacco accelerates overall physiological functions, especially the frequency of food metabolism. Although smoking mostly occurs during leisure time, excessive smoking often increases heart rate; smokers' average heart rate is 84 beats per minute, compared to 72 beats per minute for non-smokers. Once smoking stops, metabolism slows down, food is consumed more slowly, and weight gain occurs.

People who quit smoking often relapse into their cravings, and when various circumstances force them to quit, they often experience a sense of emptiness and crave sweets. This is because nicotine lowers insulin levels in the blood, thus reducing cravings for sweets; without the effects of nicotine, insulin levels often rise, leading people to tend to eat more sweets.

So, can smoking be used to lose weight? Actually, no. The harm caused by smoking is far greater than the harm caused by being overweight; a significant number of patients die from smoking-related diseases. Do Chinese people experience the same thing as Americans? Although we haven't conducted large-scale epidemiological surveys, we have found in clinical practice that many thin patients experience a significant improvement in facial radiance after quitting smoking, but their weight does not increase significantly. In some cases, weight gain is closely related to changes in dietary habits.

**What is the relationship between obesity and ethnic customs?**

Different ethnic groups have different understandings of obesity, reflecting their cultural values. In some countries, obesity is considered beautiful. In London, England, a group of obese women weighing a total of 1100 kg held an obese women's convention, emphasizing the beauty of plumpness. They believed that for painters, plump women symbolized wealth, fertility, and happiness; the rounder a woman was, the happier she was considered, and only then could she be considered a "real" woman. In the island nation of Tonga in the western Pacific, plumpness is universally considered beautiful; women who are not plump will not be married, and the requirements for beauty include a short neck and a round body with no visible waist. In some regions of Mauritania, the plumper the better; women are expected to eat well and sleep soundly for a period of time before marriage to fatten themselves up.

The ideal of plumpness as beauty has a long history in my country. Women depicted in Han and Tang dynasty paintings are typically portrayed as having full faces and broad figures; even the famous concubine Yang Guifei was depicted as somewhat overweight. Although the Ming and Qing dynasties were ruled by different ethnic groups, obesity was prevalent, with many emperors referred to as "fat noblewomen." Of the 16 Ming emperors, including Zhu Yuanzhang, 10 suffered from obesity (62.5%); of the 12 Qing emperors, including Nurhaci, 3 were obese (25%). Before the introduction of Western medicine to my country, obesity was not considered a disease but rather a manifestation of body constitution. Treatment focused on improving constitution through herbal remedies. Qing dynasty medical records document dozens of herbal tea formulas used to aid digestion, promote weight loss, and lower cholesterol, including the "Three Immortals Drink" (fried hawthorn, medicated leaven, and fried malt), modified "Three Immortals Drink," heat-clearing and dampness-removing tea, heat-clearing and qi-regulating tea, heat-clearing and dampness-resolving tea, and "Immortal Tea of ​​the Palace." This provides a reference for drug screening in the clinical treatment of obesity.

**★What is Pickwick syndrome? How can it be prevented and treated?**

Pickwickian syndrome is a serious complication of obesity, characterized by obesity, lethargy, insufficient lung ventilation, and polycythemia; it is also known as obesity-hypoventilation syndrome. It is characterized by a high mortality rate, but significant improvement can be achieved with aggressive weight loss, which is a major difference from other heart diseases. Management should focus on symptomatic treatment, rapid weight loss, and prevention.

**(1) Prevention**

For severely obese individuals, weight loss education should be strengthened, specific weight loss measures should be developed, dietary restrictions should be implemented, exercise should be increased, and appropriate integrated traditional Chinese and Western medicine weight loss methods should be used to gradually reduce weight to a normal level and prevent recurrence of the disease.

**(2) Symptomatic treatment**

① Oxygen therapy, preferably at a low concentration (flow rate 2L/min), is recommended. Oxygen therapy at night can reduce periodic apnea and daytime drowsiness. ② Respiratory stimulants: such as coramine, lobeline, etc., can be administered intramuscularly or intravenously. ③ Cardiotonic agents: Digoxin or strophanthidin K can be added to 20-40ml of glucose solution and administered intravenously. ④ Diuretics: Furosemide 20-40mg orally, intramuscularly, or intravenously. ⑤ If infection occurs, antibiotics should be used appropriately.

(3) **Rapid weight loss**

The main treatment principle for this disease is strict dietary control, employing a fasting therapy to reduce calorie intake and rapidly decrease weight in a short period, thereby controlling the condition and achieving therapeutic effects. Simultaneously with weight loss, fat decreases in the chest wall, intercostal muscles, diaphragm, and tissues surrounding the airways, improving lung ventilation and gas exchange, alleviating hypoxia, improving cardiopulmonary blood circulation, and relieving symptoms. If the patient still experiences symptoms such as hunger, fatigue, constipation, and other symptoms of stomach heat and dampness, traditional Chinese medicine for weight loss based on syndrome differentiation can be added, such as herbal formulas that promote diuresis and clear stomach heat, or decoctions of herbs like hawthorn, alisma, senna leaves, and soapberry.

Why does weight gain start in the belly?

As the saying goes, fat people gain weight in their belly first. This is partly because fat that is not used regularly tends to accumulate in the abdomen, and partly because excess fat tends to accumulate in the mesentery. The intestines, which are about 7 to 8 meters long, are coiled in the abdominal cavity, and the mesentery has a very large surface area, so fat accumulates more and more, and the abdomen naturally becomes more and more distended.

The location of weight gain differs between men and women: men tend to gain weight in the abdomen, resulting in a large belly, while women tend to gain weight in the hips and thighs. This is because fat cells have two types of molecules with different functions: molecule A promotes fat absorption by fat cells, while molecule B inhibits fat absorption. In men, molecule A is mostly distributed in the abdomen, which is why male obesity often starts in the abdomen. In women, due to physiological needs such as childbirth, molecule A is mostly distributed in the hips and thighs.