Doctors are concerned: parents are putting their children on diets that lead to extreme obesity

Issues of childhood obesity are one of the most pressing topics in pediatrics. According to the latest data, today in Russia 17% of children are overweight, and 9% are already diagnosed with obesity.

Recently, the focus of attention of specialists has been on the so-called sarcopenic obesity in children: along with excess fat, there is an acute lack of muscle mass. This type of obesity causes double harm to the child’s body, experts say. The reason most often turns out to be diets that mothers put their children on on their own.

According to Elena Pavlovskaya, a leading researcher at the Department of Pediatric Gastroenterology, Hepatology and Diet Therapy at the Federal State Budgetary Institution “Federal Research Center for Nutrition and Biotechnology”, by 2035 a serious increase in the number of children with overweight and obesity is predicted – up to 39% (today there is an average of 25%). In 2022, 108 thousand new cases of obesity were identified in Russia in children under 14 years of age, and another 40 thousand in adolescents 15-18 years old. “Up to 90% of adolescents, if left untreated, remain obese later in life. Obesity in children is the basis for the development of progressive comorbid pathology in adults, which reduces the quality and life expectancy,” says the expert.

There are many reasons for obesity in children, and, alas, not everything can be influenced. Among them is the lack of food culture. “We have a common belief that an obese child will become thin as an adult. And a baby with folds evokes affection; they say that he is a hero. But in fact, this is a disease,” the expert emphasizes.

Other causes of obesity include physical inactivity, sleep deficiency, eating disorders, and anxiety.

The pandemic has also contributed to the development of obesity, including in children – it is possible that its effect will only be noticeable in a few years. The World Health Organization has already conducted studies that have shown that during the period of restrictions, the level of physical activity in children decreased by more than a third. According to an international study conducted in 13 countries among 43,000 families with children 6-9 years old, it was found that during the pandemic, 1/5 of children had an increase in consumption of sweets. 28.2% of parents more often bought food in large quantities, 30.2% more often ate food with the whole family. As a result, 28.7% of children had a decrease in the level of physical activity, and 36.8% had an increase in screen time (time spent in front of TV screens, tablets, computers, etc.)

Muscle mass in children is a new object of attention for specialists. When muscle fibers contract, myokines are secreted – substances that are responsible for the beneficial effects of physical activity on the body. Science knows more than 1000 myokines, but only about 100 of them have been studied. They have anti-inflammatory effects, regulate immunity, muscle mass and metabolic activity, regulate appetite, cognitive functions, bone density, insulin sensitivity, etc. Myokines regulate most organs and systems.

In recent years, a new term has appeared in medicine – sarcopenic obesity. Unfortunately, this also happens in children. With this type of obesity, there is an excess of fat with a deficiency of muscle mass, which has a double negative effect on the body. The reasons for its development may be certain medications, diseases, as well as lack of physical activity, long-term hypocaloric diet, fasting, fasting days (for example, without protein) and vegetarianism. Often mothers put their children on diets – and as a result they develop sarcopenic obesity. It occurs even in healthy children (prevalence ranges from 5 to 60%). But in obese children the probability is up to 90%. Among obese boys, the sarcopenic form is detected in 91% of cases, and in girls – in 2/3 of cases. Among the complications of sarcopenic obesity, the expert identifies cardiac problems, liver disease, insulin resistance, dyslipedemia, metabolic syndrome, arterial hypertension, etc. Thus, 63% of children with sarcopenic obesity are diagnosed with non-alcoholic fatty liver disease, and in 29% – cardiopathology. In addition, in recent years, a new diagnosis has emerged – non-alcoholic pancreatic disease, which is also detected in obese children.

Diagnosis of obesity in children today is carried out using complex methods. The expert recommends that obese children determine their body composition: “Gadgets, fitness bracelets, smart watches, and many bathroom scales can cope with this task. In Moscow, bioimpedances are installed at the MFC.”

Simultaneously with the study of nutritional status, a diagnosis of comorbid pathology is also performed in order to fully treat the patient. As a rule, they begin with non-drug therapy – changing the nutritional system with increasing physical activity. “Children are not prescribed short-term diets; they must adhere to a healthy diet constantly. Studies have shown that a hypocaloric diet leads to a decrease in muscle mass, and it is not recommended, especially at home,” says the doctor.

Basic nutritional rules for obese children: it should be four meals a day, with a mandatory breakfast. No lists of prohibited and harmful products (a strict ban is established only on sweet soft drinks, including kvass, fruit drinks and in general any drinks with calories, as well as sweet milk drinks). Nutritionists often prescribe nutritional support: they enrich the diet of such children with probiotics, polyphenols, vitamins (for example, D), etc.

If we talk about physical activity, a combination of aerobic exercise in combination with strength training is recommended (this is the only way to reduce adipose tissue).

Experts note with regret that only 15% of patients are able to follow nutritional recommendations. If non-drug treatment and diet therapy are ineffective after 12 months, drugs that reduce appetite and affect metabolism are prescribed. The therapy of desperation – bariatric surgery – is prescribed to children in extreme cases, if the benefit outweighs the risk. And only with a body mass index above 35.