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OBJETIVO: Revisar a abordagem terapêutica da obesidade infantil, bem como aspectos de seu diagnóstico e prevenção. FONTES DOS DADOS: Foi realizada busca de artigos científicos através das bases de dados MEDLINE, Ovid, Highwire e Scielo. As palavras-chave utilizadas foram: "childhood obesity" e também combinações junto a "treatment", "prevention" e "consequence". Dentre os artigos provenientes da busca incluíam-se artigos de revisão, estudos observacionais, ensaios clínicos e posições de consenso. Percebida a relevância, também se buscou diretamente referências indicadas. O período de coleta de dados foi de 1998 a 2003. SÍNTESE DOS DADOS: Foram encontrados vários trabalhos de prevalência no Brasil. No entanto, poucos trazem resultados de programas educativos aplicáveis em nosso meio. CONCLUSÕES: Deve-se prevenir a obesidade infantil com medidas adequadas de prescrição de dieta na infância desde o nascimento, além de se estudar mais sobre programas de educação que possam ser aplicados no nível primário de saúde e nas escolas.
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173
1. PhD; Professor, Department of Pediatrics/School of Medicine, Universida-
de Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.
2. Undergraduate student of Nutrition, School of Medicine, Universidade
Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.
3. PhD; Associate professor, School of Physical Education, Universidade
Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.
Financial support: FIPE - HCPA
Manuscript received Oct 08 2003, accepted for publication Jan 09 2004.
Abstract
Objective: To review therapeutic approaches to childhood obesity and also its diagnosis and prevention.
Sources of data: Searches were performed of scientific papers held on the MEDLINE, Ovid, Highwire and Scielo
databases. Keywords utilized were: childhood obesity and a variety of combinations of this term with treatment,
prevention and consequence. The search returned papers including review articles, observational studies, clinical
trials and consensus statements. Bibliographical references in these articles were also investigated if it was perceived that
they were relevant. Data was collected from 1998 to 2003.
Summary of the findings: While a number of different Brazilian prevalence studies were found, few gave details
of the results of educational programs in our country.
Conclusions: Childhood obesity must be prevented through prescriptive diets from birth throughout childhood.
Educational programs that might be applicable to primary health care or schools should receive further study.
J Pediatr (Rio J). 2004;80(3):173-82: Obesity, overweight, eating habits.
0021-7557/04/80-03/173
Jornal de Pediatria
Copyright © 2004 by Sociedade Brasileira de Pediatria
REVIEW ARTICLE
Childhood obesity  Towards effectiveness
Elza D. de Mello1, Vivian C. Luft2, Flavia Meyer3
There is consensus that childhood obesity is increasing at
a significant rate and that it is responsible for a number of
different complications both during childhood and adulthood.
During childhood, obesity management can be even more
difficult than with adults because it is dependent on both
changing habits and availability of parents and is further
complicated by the childs lack of understanding of the
damage caused by obesity.
The objective of this paper is to present the general
characteristics of obesity and especially to highlight the
practical aspects of broad coverage childhood obesity
treatments, in addition to the importance of prevention
together with how, in practical terms, this can be achieved.
Obesity prevalence in Brazil
According to World Health Organization reports, the
prevalence of childhood obesity has risen by between 10
and 40% in the majority of European countries during the
last 10 years. Obesity is most common during the first year
of life, between five and six and during adolescence.1,2
Studies3-7 have been performed in Brazil to verify the
increase in childhood obesity, as shown in Table 1.
Figure 1 shows the frequency of elevated obesity and
malnutrition rates in two regions of the country over three
decades.8
Obesity affects all economic classes. In Brazil it is more
often present in the higher social classes. Higher
socioeconomic status impacts on obesity by means of
education, income and profession, which result in specific
behavioral patterns that affect the number of calories
ingested, energy expended and metabolic rate. In contrast,
the extent to which healthier foodstuffs, such as fish, lean
meat and fresh fruit and vegetables are generally less
available for individuals living under more restricted
conditions and as such obesity and low socio-economic
class are observed to be related in developing countries.2,9
174 Jornal de Pediatria - Vol. 80, No.3, 2004 Childhood obesity  de Mello ED et alii
Table 1 - Prevalence of malnutrition, overweight and obesity in children and adolescents in Brazil
* The 1978 National Center for Health Statistics (NCHS) curves were used as reference standard.
BMI = body mass index.
IOTF = International Obesity Task Force.
Author City or Age n Criterion Results
region group
Monteiro & Conde, São Paulo 0 to 59 1973/74: 756 index 1973/74 - malnutrition: 5.5%; obesity: 3.2%
20003months 1984/85: 999 weight/height 1984/85 - malnutrition: 1.7%; obesity: 4.0%
1995/96: 1,266 and z score* 1995/96 - malnutrition: 0.6%; obesity: 3.8%
Leão et al., 20034Salvador 5 to 10 years 387 BMI obesity - public school: 8%;
private school: 30%
Anjos et al., 20035Rio de Janeiro < 10 years 3,387 IOTF obesity: 5%
Balaban & Silva, Recife Children and 762 BMI overweight - high income: 34.3%;
20036adolescents low income: 8.7%
obesity - high income: 15.1%;
low income: 4.4%
Abrantes et al., Southeast and Children and 7,260 BMI obesity - female: 10.3%;
20027Northeast adolescents male: 9.2%
Figure 1 - Frequency of elevated obesity and malnutrition rates
in two regions of the country over three decades8
1975
8.9
14
12
10
8
6
4
2
0
1
4.9
2.5
5.9
8.2
3.9
5.3
4.6
2.5
7.3
12.9
1989
Northeast
Malnutrition Obesity
1997 1975 1989
Southeast
1997
Wang et al.10 compared the prevalence of obesity
according to family income across a number of different
countries during the seventies, eighties and nineties. Figure
2 shows how Brazil and the United States compare in terms
of these factors. In Brazil, in common with the United States
and Europe, there is an observed increase in the prevalence
of obesity that is strictly related to lifestyle changes (different
types of toys, more time in front of the television and
computer games and greater difficulty playing outside
because of the lack of public safety) and modified eating
habits (the greater appeal to consumers of products that are
rich in simple carbohydrates and fat and high in calories, the
greater ease of preparation of meals that contain high levels
of fat and calories, and the lower cost of bakery products).10
In Brazil, two large-scale inquiries have been performed,
in 1989 and in 1996. They were later critically analyzed by
Taddei et al.11 During these seven years, changes were
observed in the prevalence of obesity among children under
5 years old. Increased prevalence was observed in less
developed regions and reduced prevalence was observed in
more developed regions. Both increases and reductions
occurred more intensely among the children of mothers with
Figure 2 - Comparison of the prevalence of obesity according to
family income between Brazil and the United States in
the 70s and 90s10
Low LowMedium MediumHigh High
6.1
5
10
15
20
25
30
0
14.5
6.9
29.3
3.2
16.7
3.2
13.1
21.3 21.7
13.9
25.1
Brazil (1974-1997) United States (1971-1994)
Jornal de Pediatria - Vol. 80, No.3, 2004 175
greater degrees of education and among children less than
two years old (Figure 3).
Definition and assessment of obesity
The definition of obesity is very simple when one is not
a prisoner to scientific or methodological formalities. The
appearance of the patients body is the major element. As
children gain weight there is accompanying increase in
stature and bone aging accelerates. Later, weight continues
and stature and bone age remain constant. Puberty can
begin earlier which results in reduced final height because
the cartilage growth plates close earlier.12
There are a number of different diagnostic methods for
classifying obese and overweight individuals. Body mass
index (BMI, weight/height or length2) and tricipital skin
folds (TSF) are often used in clinical and epidemiological
studies. The 85th and 95th BMI and TSF percentiles are
often used to detect overweight and obesity, respectively.13
More recently, Cole et al.14 have produced a table of world
standards for overweight and obesity in childhood. Another
commonly used indicator is the obesity index (OI, current
weight/weight at 50th percentile, current stature/stature at
50th percentile x 100), which shows us if the patients
weight exceeds that to be expected for their weight,
corrected for height/length. According to this scale, obesity
is mild if the OI is between 120 and 130%, moderate when
Figure 3 - Prevalences of overweight and obesity in two inquiries performed in Brazil11
12
1989 1996
10
8
65.5
4.9
2.5
4.5
8
4.7
7.1
8.6
4.1
5.3
3
4.5
3.9
7.3
5.5
12
9.9
5.4
4
2
0
Brazil Northeast South Maternal
education
> 4 years
Less
developed
region
South
Maternal
education
> 4 years
Northeast
< 24
months
South
< 24
months
Northeast
Maternal
education
> 4 years
between 130 and 150%, and severe when over 150%. A
major problem with this method is that it assumes any
weight gain over normal body weight represents increase in
fat. In fact, not all children with an OI over 120% are
actually obese. Even so, this method can be of use when
screening for obese children.15,16
The choice of one or a number of different methods must
be made carefully, taking into consideration sex, age and
sexual maturity in order to obtain reference values and
classifications of obesity.17,18 Among females, skin folds
can be larger because of the larger proportion of fat.13 In
children and adolescents, BMI is related to age and sexual
maturity.19 There are differences in the proportion of fat and
its regional distribution which may be or genetic origin.20
Complications of childhood obesity
The total quantity of fat, excessive fat in the torso or
abdominal region and excessive visceral fat are aspects of
body composition that are associated with chronic-
degenerative diseases. Increased serum cholesterol is a
risk factor for coronary disease and the risk is increased
when associated with obesity. Being overweight triples the
risk of developing diabetes mellitus.21 Obesity, elevated
cholesterol levels, smoking, the presence of systemic arterial
hypertension, diabetes mellitus and a sedentary lifestyle
are all independent risk factors for coronary disease. Obesity
Childhood obesity  de Mello ED et alii
176 Jornal de Pediatria - Vol. 80, No.3, 2004
Table 2 - Reference values of total cholesterol, LDL cholesterol
fraction, HDL cholesterol fraction and triglycerides in
children from 2 to 19 years old26
LDL = low-density lipoprotein; HDL = high-density lipoprotein ;
LDLc = LDL cholesterol fraction; HDLc =HDL cholesterol fraction.
Lipid Age Value (mg/dl)
(years) Normal Borderline Elevated
Total
Colesterol 2 - 19 < 170 170 - 199 > 200
LDLc 2 - 19 < 110 110 - 129 > 130
HDLc < 10 > 40
10 - 19 > 35
Triglycerides < 10 < 100 >100
10 - 19 < 130 >130
Articular diseases Higher risk of arthrosis, osteoarthritis
Femoral head epiphysiolysis
Genu valgum, coxavara
Cardiovascular Systemic arterial hypertension
diseases Cardiac hypertrophy
Surgical risk Elevated surgical risk
Growth disorders Advanced bone age, height increase
Early first menstruation
Skin diseases Higher risk of mycosis, dermatitis and
pyodermitis
Endocrine-metabolic Insulin resistance and
disorders higher risk of diabetes
Hypertriglyceridemia and
hypercholesterolemia
Gastrointestinal Higher frequency of biliary lithiasis
disorders Hepatic steatosis and steatohepatitis
Mortality Higher risk of mortality
Neoplasia Higher risk of endometrial cancer, breast
cancer, vesicle cancer, colon/retum cancer,
prostate cancer
Psychosocial Social prejudice and isolation
disorders Withdrawal from the social activities
Difficulties to express feelings
Respiratory Predisposition to hypoxia due to increase in
diseases the ventilatory demand, increase in the
respiratory effort, reduction in the muscle
efficiency, reduction in the functional
reserve, microectasias, sleep apnea,
Pickwicky syndrome
Infections
Asthma
Table 3 - Complications of obesity
is a risk factor for dyslipidemia, which in turn encourages
increased cholesterol and triglycerides and a reduction in
the HDL cholesterol fraction. Wight loss improves the lipid
profile and reduces the risk of cardiovascular diseases.22
Oliveira et al.23 state that the quality of ingestion is a risk
factor for coronary disease and that childrens ingestion is
intimately related with that of their parents.
Atherosclerosis onset is during childhood, with cholesterol
deposited on the tunica intima of muscular arteries, forming
fatty streaks. These streaks forming in the coronary arteries
of children can, in some cases, progress to advanced
atherosclerotic lesions in a few decades. This process is
reversible during the start of its development. It is important
to point out that the rhythm of progression is variable.24-26
Systematic lipid profiling during childhood and adolescence
is not to be recommended. It should, however, be performed
for high-risk patients aged between 2 and 19. Borderline
and elevated lipid values are listed in Table 2. If dyslipidemia
is confirmed, dietary treatment should be started, for
children over two, taking care to give priority to the vitamin
and energy requirements that are appropriate for the
patients age and allowing a certain degree of flexibility with
relation to, in specific situations, permit the ingestion of fat
levels greater than 25%. Patients should be encouraged to
ingest fiber and discouraged from foods that are rich in
cholesterol and saturated fat and also from the excessive
use of salt and refined sugar. When it proves necessary to
increase fat levels, this should preferably be done through
monounsaturated fats.26
Wright et al. present a study aimed at investigating
whether childhood obesity increases the risk of obesity in
adult life and the risk factors associated with it. They
concluded that this risk does exist, but that being slim
during childhood is not a protective factor against adult
obesity. Thus, they state that childhood BMI has a positive
correlation with adult BMI and that obese children have a
greater risk of death compared to adults. Notwithstanding,
BMI does not reflect fat percentages, and only children
obese at thirteen years really have a greater chance of
becoming an obese adult.27
The relationship between low birth weight and insulin
resistance is uncertain. A recent study showed that there
was no significant correlation. However, current weight
continues top be a contributing factor to this outcome. This
being the case, it is important to manage and prevent
childhood obesity, since it is more easily remedied or
avoided than low gestational weight, in addition to resulting
in consequences that more significant to health.28
Childhood obesity is related to a number of different
complications in addition to an increased mortality rate.
Furthermore, the longer the period for which a person
remains obese, the greater the chances that complications
will occur, and the earlier they will occur.29 Table 3 lists the
possible complications of obesity.22,24,30-33
The scale of weight loss to be recommended and the
timescale over which it should be lost can vary depending on
the degree of obesity and the nature and severity of
complications. Children suffering complications that
potentially involve a risk of death are candidates for more
rapid weight loss. Available research data is limited to
suggesting a safe rate at which children and adolescents can
lose weight with no deceleration in the speed of their
development. In general, the greater the number and
severity of complications, the greater the probability that
Childhood obesity  de Mello ED et alii
Jornal de Pediatria - Vol. 80, No.3, 2004 177
this child will require assessment and treatment, perhaps
drug-based, at a specialized pediatric obesity control
center.25,26,34
Obesity and physical activity
Exercise is defined as a type of physical activity that is
planned, structured and repetitive. Physical aptitude is an
attribute of the individual that includes aerobic potential,
strength and flexibility. Studying these parameters can be
of assistance for the identification of children and adolescents
at risk of obesity. Children and adolescents tend to become
obese when they are sedentary and obesity itself can make
them more sedentary still.35 Physical activity, even when
spontaneous, is important for body composition, to increase
bone mass and prevent osteoporosis and obesity.36
Sedentary habits, such as watching television and
playing video games, contribute to reduced daily calorific
expenditure. Klesges et al. observed a significant reduction
in resting metabolic rate while children watched a specific
television program. The reduction was greater among
obese children.37 Therefore, in addition to the metabolic
expenditure involved in daily activity, resting metabolism
can also affect the occurrence of obesity. Increased
physical activity, therefore, is an objective to be aimed
at38,39 in conjunction with a reduction in the ingestion of
food.40 Physical activity also results in an individual
tending to choose less calorific food.41
There are studies that relate the amount of time spent
watching television with obesity prevalence. The proportion
of children that watch less than one hour daily and are obese
is 10%42 whereas, if the habit is maintained for 3, 4 or 5 or
more hours watching television per day it is associated with
prevalence of 25%, 27% and 35%, respectively.43 Television
fills free time that children could be using to perform other
activities. Children often eat in front of the television and a
large proportion of television commercials offer food that is
not nutritional and is high in calories.40,44,45 Grazini &
Amâncio analyzed the content of commercials aired during
programs aimed at adolescents, finding that a majority of
them (53%) were for snacks and soft drinks.46
Obesity is difficult to treat because base metabolic
rates vary from person to person and for any given person
under changing circumstances. Thus, at a given level of
calorie consumption, one person may fatten and another
not. Furthermore, obese people generally perform less
physical activity than those who are not obese. It is
difficult to decide whether a sedentary lifestyle is the
cause o obesity or its consequence.47
In terms of physical activity, obese children generally
have little sporting ability and do not stand out. Before
starting systematic physical activity a careful clinical
evaluation should be performed.48 Notwithstanding, formal
gymnastics, carried out at a gym, unless particularly enjoyed
by the patient, are unlikely to be tolerated for long periods.
This is because the processes are repetitive, lack any
element of play and are artificial in the sense that the
movements performed do not form part of the day-to-day
lives of the majority of people. Additionally, parents and/or
guardians may encounter problems with taking children to
systematic activities, both because of cost and transportation
considerations. Creative ideas for increasing the level of
physical activity are therefore required, such as using the
stairs if living in an apartment block, playing with balloons,
skipping, walking around the block and helping with domestic
chores.49,50 Even changing between sedentary activities
results in an increase in energy expenditure and in behavioral
changes, avoiding remaining inert for hours performing a
single, sedentary activity, as though it was an addiction.42
Bar-Or discusses aspects of obesity and physical activity,
pointing out that programs should stimulate spontaneous
physical activity and that, at the end of a program of intense
sporting participation an assessment should be made of
whether the childs lifestyle has changed. The child should
be motivated to remain active and the activity should
preferably be taken up by the whole family.51
Obesity and eating habits
A number of different have an influence of eating
behavior. These include external factors (the family unit and
its characteristics, the attitudes of parents and friends,
social and cultural values, the media, fast food, nutritional
knowledge and food fads), internal factors (psychological
needs and characteristics, body self-image, personal values
and experience, self-esteem, eating preferences, health
and psychological development).
Problems attaining good control of satiety are a risk
factor for the development of obesity, both during childhood
and adulthood. When children are obliged to eat everything
that is served to them, they may lose the point of satiety.
Satiety originates after the consumption of food and
suppresses hunger maintaining this inhibition for a
determined period of time. The cephalic phase of appetite
begins even before food is brought to the mouth, consisting
of physiological signals, generated by vision, hearing and
smell. These physiological stimuli involve a large number of
neurotransmitters, neuromodulators, channels and
receptors. Stomach distension is an important signal of
satiety. In addition to mechanical stimuli, neurotransmitters
and peptides such as cholecystokinin, glucagon, bombesin
and somatostatin are involved. Cholecystokinin is considered
a satiation-mediating hormone. Within the central nervous
system, principally in the hypothalamus, seratonin-based
appetite control systems are found. Other peptides, such as
beta-endorphin, dynorphin and galanin, are active within
the central nervous system affecting ingestion and/or satiety.
Neuropeptide Y is the most potent known appetite stimulator.
Leptin, produced within adipose tissues, has both a central
and peripheral role, participating in energy control and
probably interacts with neuropeptide Y in appetite and
satiety control. Thus, the size of a plate or portion does not
determine satiety; the child may be sated earlier or want to
eat more.52,53
Aspects of those eating habits that are most related
with obesity have been very well studied. Maternal
Childhood obesity  de Mello ED et alii
178 Jornal de Pediatria - Vol. 80, No.3, 2004
breastfeeding is preached as a protective factor against
obesity.54,55 Notwithstanding, habits such as not eating
breakfast, eating large quantities of calories late in the
day, ingesting a limited range of foods and preparations,
and in large quantities, consuming high-calorie, lightweight
liquids in excess, and having inappropriate feeding
practices at an early age are all prejudicial and induce
obesity.56,57 A prospective study, 19 months in duration,
involving 548 children from the fifth and sixth grades,
found that BMI and obesity frequency increased for each
additional portion of drinks containing refined sugar.58
Snacking habits, analyzed for individuals between 2 and
18 years of age, has also altered over the last few
decades. Nowadays, more children eat snacks than in the
past, with the largest increase occurring during the last
decade. Average ingestion of calories in the form of
snacks has increased from 450 to 600 calories a day and
nowadays makes up 25% of daily energy intake. The
calorific density of childrens snacks has also increased
from 1.35 to 1.54 kcal/g.59 This finding is important since
small increases in calorific density of food consumed can
lead to large increases in total calorie consumption. This
being so, the tendency towards consuming snacks could
be contributing to increased childhood obesity. Added
sugar can reach a third or all calories ingested by the
American population.60
Parents exercise a strong influence over the foods
their children ingest. However, the more parents insist
that a child consumes a certain foodstuff, the lower the
probability that the child will do so. Similarly, restrictions
made by parents can have deleterious effects. During
early childhood, parents are recommended to provide
their children with snacks and meals that are health,
balance, with sufficient nutritional levels and allow the
children themselves to choose the quality and quantity
they want to eat of these healthy foods.21,23
Management of childhood obesity
Obesity can be divided into obesity of exogenous origins
 the most common  and obesity of endogenous origins. In
endogenous cases, the underlying disease should be identified
and treated. Exogenous obesity starts with an imbalance
between calorific intake and expenditure and should be
managed with dietary guidance, in particular changing
habits and optimizing physical activity.61
It is essential that the following be assessed: the
availability of food, preferences and refusals, prepared
foods habitually consumed, the location where meals are
taken, who prepares and serves them, the childs habitual
activities, liquid consumed with and between meals and
beliefs and taboos about food. Reducing the consumption of
hypercalorific foodstuffs alone is enough to reduce weight.62
It is also important to point out that children and
adolescents follow paternal patterns and, if these are not
modified or managed in conjunction, an unsuccessful
treatment outcome can be expected63,64 (Figure 4).
It is important that dietary guidance defines a controlled
rate of weight loss, normal growth and development, the
consumption of micro and macronutrients in adequate
quantities for sex and age, a reduction in appetite or
voracity, the maintenance of muscle mass, the absence of
negative psychological consequences along with the
maintenance of correct eating habits and the modification of
unsuitable ones.65 Smaller children should maintain their
weight or gain a little in order to avoid compromising their
development.15,61,62
Figure 4 - Behavioral measurement of family similarities regarding eating habits and
nutritional status64
Parents´
nutritional
status
Childrens´
nutritional
status
Childrens´ eating
practice
Parents´ eating habits Childrens´ eating habits
Restriction
Pressure to eat
Monitoring
Eating preferences
Food selection
Food availability
Regulation of energy intake
Eating preferences
Food selection
Food availability
Regulation of energy intake
Childhood obesity  de Mello ED et alii
Jornal de Pediatria - Vol. 80, No.3, 2004 179
The American Academy of Pediatrics 2003 guidelines for
the treatment of childhood obesity are as follows:33
Health supervision: identify at-risk patients by means of
family history, birth weight or socioeconomic, ethnic, cultural
or behavioral factors, calculate and record BMI once a year
for all children and adolescents, use change in BMI to
identify excessive rates of weight gain to linear growth,
encourage maternal breastfeeding, direct parents to
encourage healthy eating patterns offering healthy snacks,
encourage children to achieve autonomy in controlling their
food intake, establish appropriate limits at schools, routinely
promote physical activity including unstructured play at
home, set limits to time spent watching television and video
to a maximum of 2 hours per day, recognize and monitor
changes in risk factors associated with obesity for adults
with chronic diseases such as systemic arterial hypertension,
dyslipidemia, hyperinsulinemia, glucose intolerance and
obstructive sleep apnea symptoms.
General support: help parents, teachers, coaches and
other professionals who have an influence of youth to
discuss healthy habits and not body-beautiful culture as
part of the effort to control overweight and obesity,
encourage the management at local, state and national
organizations and schools to provide the necessary
conditions for all children to have a healthy lifestyle
including suitable nutrition and adequate opportunities
for regular physical activity, encourage the organs that
are responsible for health finance and care to promote
effective strategies for the prevention and treatment of
obesity, encourage public and private entities to channel
funds into research into effective strategies for preventing
overweight and obesity and to maximize limited family
and community resources to achieve results that are
healthy for youth, promote support and defend by social
marketing with the intention of promoting healthy
nutritional schools and more physical activity.
Treatment programs that involve overweight children
and adolescents in rigorous physical activities and
gymnastics demonstrate significant benefits in terms of
weight loss and in terms of physical condition. However,
a majority of the programs described extend for periods
of up to 10 months, involving continuous and intensive
treatment and requiring incentives to ensure that
participants adhere, which cannot be applied in daily
practice.62,66 The results of these programs are not so
encouraging, although when applied to children the results
are better.62,67
A majority of dietary intervention techniques focus on
reducing the consumption of fats, even when dietary fat
may not be a significant cause of obesity. Many studies of
techniques based on physical activity have prescribed
conventional exercise programs, even though encouraging
an active lifestyle or reducing sedentary behavior may be
more effective at controlling weight over the long
term.2,62,65
Innovative programs have been developed that are
designed to widen childrens nutritional knowledge and also
to have a positive influence on diet, level of physical activity
and inactivity.67-70 Campell et al. performed a review of
childhood obesity management programs, concluding that
there are yet too few studies for effective conclusions to be
established, but that strategies aimed at reducing sedentary
habits are useful.71 Protocols for a number of different
childhood obesity management programs were also studied
by Summerbell et al., who found that their orientation varies
greatly. Some are group interventions others are for
individuals, there are programs with and without medical
supervision, family, behavioral and cognitive therapy and
pharmaceutical treatment. In the face of this, greater
consensus is required in terms of effectiveness conclusions,
since intervention techniques vary significantly.72
Currently, school-based health-education programs
are the most effective strategy for reducing chronic public
health problems related to sedentary lifestyle and incorrect
eating patterns, although more studies are necessary.73
Preventing childhood obesity
As intervention programs continue to enjoy little
consensus, prevention remains the best approach. Efforts
at preventing childhood obesity are probably more effective
when directed at primordial, primary and secondary targets
simultaneously, with appropriately objectives for each.
Primordial prevention aims at preventing children from
being at risk of becoming overweight, primary aims at
preventing at risk children from becoming overweight and
secondary prevention aims at opposing the growing severity
of obesity and reducing its co-morbidity among overweight
and obese children. Against this background basic action
priorities can be identified, prioritized and linked to potentially
satisfactory intervention strategies.34
Primordial and primary prevention strategies are most
effective, probably if begun before school age and continued
throughout childhood and adolescence. Significant effort
should be made in order to aim them towards the prevention
of obesity during the first ten years of life. Scholl policy
can either promote or discourage healthy diet and physical
activity.67,74,75 It is highly important that, at all grades,
the study of nutrition and healthy living habits are
incorporated into schools formal curricula, since it is at
this point and in this place that interest and understanding
may begin and even adults habits can be changed through
children and adolescents.
Figure 5 presents the principal targets in childhood
obesity prevention.76
The majority of these recommendations should be
adhered to by the whole family, whether individual family
members are obese or not.25,61,64,77,78
In our country childhood obesity is a serious public
health problem which has been increasing in all social strata
of the Brazilian population. It seriously affects current and
future health. Preventing childhood obesity results in a
reduction in chronic degenerative diseases by rational and
little onerous means. School is an important site for this
work since children eat at least one meal at school which
makes nutritional education work possible and also allows
Childhood obesity  de Mello ED et alii
180 Jornal de Pediatria - Vol. 80, No.3, 2004
for increased physical activity to be provided. School meals
should meet the nutritional needs of its children, in both
quality and quantity, and be an agent for the formation of
healthy habits.67
To achieve healthy nutrition, in addition to providing
the correct information on nutrition and health (promotion),
it is also necessary to prevent incorrect and contradictory
information from reaching individuals (protection) and, at
the same time conditions must be created that make
adoption of the guidance they receive practicable
(support). This entails that a consistent obesity prevention
policy should cover not just educative and informative
activities (such as mass media campaigns), but legislative
measures (such as controlling the advertisement of
unhealthy foods, particularly aimed at children), tax
measures (making healthy food tax exempt and increasing
the prices of unhealthy ones), the training and refreshing
of health professionals, measures to support the production
and sale of healthy foods and even measures related to
urban planning (for example, giving priority to pedestrians
and not automobiles and providing grants for
underprivileged areas that lack the minimum resources
necessary to practice physical leisure activities).32,33,78-80
Figure 5 - Principal targets in childhood and adolescence obesity prevention76
Eat
low fat
dairy
Reduce
fatty food
intake
Reduce
the amount
of food
intake
Walk or ride a
bicycle instead
of driving
Reduce
sedentary
behavior
Life
style
Family
activities
Structured
activity
New sidewalk s
and leisure areas
Physical education
at school
After school and
on weekends
Do not watch
so many
food
commercia ls
Eat more
fruit,
vegetables
and fiber
Reduce
soft drinks
intake
Decrease of energy intake
Prevention of overweight
Increased fat burning
More
physical
activity
Do not eat
while
watching
TV
Childhood obesity  de Mello ED et alii
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Corresponding author:
Elza Daniel de Mello
Passo da Taquara, 1414
CEP 91787-731 - Porto Alegre, RS, Brazil
Tel.: +55 (51) 9982.7448
Childhood obesity  de Mello ED et alii
... Inclusive, a mediação do tratamento por meio da família é uma ferramenta que os profissionais da saúde precisam ter conhecimento, domínio e preparação (BRASIL, 2014). A redução do consumo de alimentos industrializados, redução do tempo de tela, aumento de práticas de atividades físicas, controle de questões emocionais e psicológicas que possam estar envolvidas com a alimentação, são imprescindíveis para o tratamento da obesidade infantil (MELLO; LUFT;MEYER, 2004;OLIVEIRA, 2019). ...
... Inclusive, a mediação do tratamento por meio da família é uma ferramenta que os profissionais da saúde precisam ter conhecimento, domínio e preparação (BRASIL, 2014). A redução do consumo de alimentos industrializados, redução do tempo de tela, aumento de práticas de atividades físicas, controle de questões emocionais e psicológicas que possam estar envolvidas com a alimentação, são imprescindíveis para o tratamento da obesidade infantil (MELLO; LUFT;MEYER, 2004;OLIVEIRA, 2019). ...
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... Níveis satisfatórios de APCR durante a infância e adolescência parecem reduzir o risco de comorbidades relacionadas à obesidade 17 , o que evidencia a necessidade de monitorar não apenas o estado nutricional, mas também a aptidão física nessas faixas etárias. A avaliação da aptidão física de obesos pode identificar possíveis alterações fisiológicas que ofereçam risco à saúde dos avaliados 18 . ...
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Resumo Introdução: Para a Organização Mundial da Saúde (OMS) a obesidade representa um problema de saúde pública. O estilo de vida, baseado no consumo cada vez mais crescente de alimentos industrializados e no sedentarismo, tem provocado mudanças significativas na qualidade de vida, acarretando vários riscos para a saúde. Tornam-se imprescindíveis estudos sobre o aumento da obesidade, não somente com dados nacionais, mas também com dados locais, mostrando como está esse problema em cada município, além de destacar as diversas doenças causadas por ela. Objetivo: Identificar o perfil de sobrepeso e obesidade em crianças e adolescentes do município de Jaú-SP, comparando-o com dados do estado de São Paulo e nacionais. Método: Estudo retrospectivo, com base em informações provenientes da base de dados pública do Departamento de Atenção Básica, com acesso ao Sistema de Vigilância Alimentar e Nutricional (SISVAN). Os dados analisados compreenderam o período 2008 a 2018, referentes ao município de Jaú, ao estado de São Paulo e Brasil. Resultados: verificou-se um aumento das crianças e adolescentes com excesso de peso nas regiões estudadas. O município de Jaú, em vários anos, ficou acima dos valores nacionais e do estado de São Paulo. Conclusão: Os níveis de crianças e adolescentes com sobrepeso e obesidade em Jaú acompanharam os valores estaduais paulistas e nacionais no período estudado e sinalizaram a necessidade do desenvolvimento de ações educacionais, políticas e familiares para a formação de crianças e adolescentes conscientes sobre as escolhas relacionadas ao próprio estilo de vida. Palavras-chave: Sobrepeso. Obesidade. Crianças e adolescentes. Abstract Introduction: According to the World Health Organization (WHO), obesity is a public health problem. The lifestyle, based on t he increasing consumption of industrialized foods and sedentary lifestyle, has caused significant changes in the quality of life, leading to several health risks. Studies on the increase in obesity are essential, not only with national data, but also with local data, showing how this problem is in each municipality, as well as highlighting the various diseases caused by it. Objective: To identify the profile of overweight and obesity in children and adolescents in the city of Jaú-SP, comparing it with data from the state of São Paulo and from Brazil. Method: Retrospective study, based on information from the public database of the Department of Primary Care, with access to the Food and Nutrition Surveillance System (SISVAN). The data analyzed included the period 2008 to 2018, referring to the municipality of Jaú, the state of São Paulo and Brazil. Results: There was an increase in overweight children and adolescents in the studied regions. The municipality of Jaú, in several years, was above national values and the state of São Paulo. Conclusion: The levels of overweight and obese children and adolescents in Jaú followed the São Paulo and Brazilian state values in the period studied and signaled the need to develop educational actions, policies and family for the education of children and adolescents aware of the choices related to their own lifestyle.
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A obesidade tem se tornado cada vez mais presente na vida de crianças e adolescentes, trazendo consigo uma gama de doenças responsáveis pelo comprometimento da saúde deste público. Muito se discute quanto a utilização do exercício físico na prevenção e combate da obesidade infantil, pois é responsável por uma melhora significativa no crescimento, maturação e desenvolvimento. Assim, foi discutida que a aplicabilidade da musculação no cotidiano deste público demonstrando as possibilidades de contribuir de forma positiva em seu desenvolvimento físico e cognitivo, o que pode resultar num crescimento mais saudável. Uma revisão narrativa foi realizada para o alcance do objetivo. Conclui-se: caso o exercício físico for praticado de forma correta e através do acompanhamento de um profissional responsável pode ser efetivo no combate a obesidade infantil e doenças adjacentes. Uma infância na qual onde a criança não vivencia hábitos e práticas saudáveis como o exercício e atividade física, pode haver um comprometimento em seu desenvolvimento e crescimento, além de se tornarem passíveis a doenças, como a obesidade. Uma criança saudável se tornará um adulto saudável, com isso, ela pode extrair o melhor da vida.
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Resumo O objetivo deste artigo é analisar criticamente como as compreensões a respeito da noção de cultura alimentar têm sido articuladas em artigos científicos sobre educação alimentar e nutricional (EAN) desenvolvidas em escolas brasileiras da educação básica. Para isso, fez-se um registro dos usos e aplicações desse conceito nos textos e leu-se criticamente as formas de relação propostas entre a inclusão da cultura alimentar no planejamento teórico-metodológico e a prática das ações analisadas. O artigo parte de uma pesquisa qualitativa de base documental. O escopo teórico da socioantropologia da alimentação serve de embasamento para sustentar as reflexões. Para a produção dos dados foram selecionados 20 artigos científicos sobre EAN publicados entre 2010 e 2018 em diferentes bases de dados. Para o processo de análise dos dados foram utilizadas técnicas da análise do discurso. Concluiu-se que a cultura alimentar, apesar de mencionada de forma repetida nos textos, não se consolida como uma dimensão legítima no campo da EAN. Ainda que na maior parte das vezes esteja reivindicada nos textos, nem sempre é referenciada de forma explícita e concreta. Por isso, acaba perdendo a relevância e o peso que, paradoxalmente, já tem.
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Context: The proportion of children eating dinner with their families declines with age and has decreased over time. Few data exist concerning the nutritional effect of eating family dinner. Objective: To examine the associations between frequency of eating dinner with family and measures of diet quality. Design: Cross-sectional. Setting: A national convenience sample. Participants: There were 8677 girls and 7525 boys in the study, aged 9 to 14 years, who were children of the participants in the ongoing Nurses’ Health Study II.
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