Childhood obesity is one of the most significant and challenging public health issues of the 21st century - globally, and especially here in Malaysia, where up to 30% of children are found to be obese or overweight. According to the World Health Organisation (WHO), obesity and overweight are defined as abnormal or excess fat accumulation in the body that elevates the risk of health morbidities and even mortality. As children grow, understanding the causes of childhood obesity and acting early can make a lasting difference to their long-term wellbeing.

Understanding Childhood Obesity

📏 Measured using BMI-for-age percentiles

Body Mass Index (BMI) is a guideline of weight in relation to height that can be used to classify a child as obese or overweight. Using the BMI-for-age percentile growth chart from the CDC, a BMI at or above the 85th percentile for children and teens of the same age is classified as overweight; a BMI at or above the 95th percentile is classified as obese; and a BMI above the 99th percentile is classified as severe obesity.

Childhood obesity can also be categorised into two types: exogenous obesity, caused by external factors that create an imbalance between energy intake and expenditure, and endogenous obesity, caused by genetic, syndromic, or endocrine factors.

⚠️ Mostly environmental, not just genetic

Despite the fact that body fatness can be inherited, environmental influences are more significant in determining body weight, because families have the ability to change their environment. There has been a global shift in diet toward energy-dense foods that are poor in vitamins, minerals, and other beneficial micronutrients, yet rich in fat and sugar.

Additionally, there is a trend toward lower levels of physical activity as a result of rising urbanisation, changing transportation options, and the sedentary nature of many leisure activities. Children and adolescents, unlike most adults, are unable to choose their own living situation or diet, and their capacity to understand how their actions affect long-term health is limited. This is why childhood obesity prevention requires special consideration from parents, schools, and the wider community.

❗ Several serious conditions, starting young

Children who are overweight or obese are more likely to remain overweight into adulthood and to develop non-communicable diseases. They are exposed to the following health risks:

Type 2 diabetes mellitus - children as young as 8 years old may be at risk of developing type 2 diabetes mellitus. Children with obesity who consume high-calorie, sugar-rich foods face an increased T2DM risk.
High blood pressure - as obesity becomes more severe, the risk of high blood pressure rises. Long-term high blood pressure puts stress on the heart.
Liver disease - fatty liver disease (nonalcoholic steatohepatitis, or NASH) is common among children with obesity and can lead to liver failure.
Heart disease - atherosclerosis (narrowing of the blood vessels) is a common heart condition that people with obesity may experience.

✅ Largely avoidable with consistent habits

Childhood obesity is largely avoidable, as are the associated non-communicable diseases. Prevention is the most practical strategy for halting the paediatric obesity pandemic, because present treatment approaches are mostly focused on managing the issue rather than finding a permanent solution. To combat childhood obesity, an energy balance must be attained and maintained over the course of a person's lifetime. Here are some practical childhood obesity prevention tips:

Regular exercise - at least an hour a day helps children maintain a healthy weight, lowers the health risks associated with obesity, and strengthens bones and muscles. Children should participate in activities they enjoy, including team sports, swimming, yoga, biking, dance classes, and evening strolls after dinner. Stretching for flexibility and strength training for muscular growth should be part of the routine, and outdoor activity is especially beneficial during the preschool years.
Five servings of fruits and vegetables daily - prepare colourful, healthful foods like tomatoes, broccoli, corn, carrots, potatoes, and green peas to spice up a child's meals. Promote fresh whole fruits such as oranges, starfruit, and watermelon instead of juice. Hidden-veggie meals, such as blending vegetables into meat patties or meatballs, can help picky eaters get their greens.
Limit sedentary activities - cap screen time from videos, video games, or the internet to no more than two hours a day. Use the stairs instead of the elevator at the mall or school to increase daily physical activity.
Parental involvement and support - set reasonable goals that take the child's preferences and physical capabilities into account. Keep a chart to track progress and praise the child when a goal is reached. Set a positive example by making exercise a family activity.

🍎 Small swaps, big impact over time

These easy food switch suggestions can help children consume less sugar, salt, and fat as part of an everyday childhood obesity prevention plan. To make each day healthier, even just one or two small changes can make a big difference - and the more changes made, the better.

Instead of	Swap to
Milk chocolate	Dark chocolate
Cordial drinks with added sugar	Fresh fruit juices
Sweetened/flavoured yoghurt	Natural yoghurt with added fresh fruits
Chips	Nuts (almond, walnut) and seeds (sunflower, pumpkin)
Fatty cuts of poultry/meat	Lean cuts of poultry/meat

In Conclusion

Childhood obesity is a serious but largely preventable health issue. By understanding its causes, recognising the associated health risks, and committing to small, consistent changes in diet and activity, parents and caregivers can help children build healthy habits that last a lifetime. Always seek guidance from credentialed healthcare professionals when assessing a child's weight or health concerns.

References

Childhood Obesity [Internet]. PORTAL MyHEALTH. 2013 [cited 2023 Jan 25]. Available from: http://www.myhealth.gov.my/en/childhood-obesity/
Noncommunicable diseases: Childhood overweight and obesity [Internet]. World Health Organization. [cited 2023 Jan 25]. Available from: https://www.who.int/news-room/questions-and-answers/item/noncommunicable-diseases-childhood-overweight-and-obesity
Calculate Your BMI - Standard BMI Calculator [Internet]. National Heart, Lung, and Blood Institute. [cited 2023 Jan 25]. Available from: https://www.nhlbi.nih.gov/health/educational/lose_wt/BMI/bmicalc.htm
Aggarwal B, Jain V. Obesity in Children: Definition, Etiology and Approach. Indian J Pediatr. 2018 Jun;85(6):463-71.
Lee YS. Consequences of Childhood Obesity. Ann Acad Med Singap. 2009;38(1).