Today, people generally view babies that are plump or chubby as "cute" or "cuddly". They tend to associate these babies with feeding well and being healthy. However, if this chubbiness continues through childhood, it becomes less acceptable. While not all the overweight children go on to become overweight adults, obesity in adulthood has its origin in childhood.

Obesity is defined as excess body fat in a person. There are many ways to quantify body fat and determine whether a child is obese.

In Singapore, the weight for height chart is the most commonly used tool to determine obesity.

In both adults and children, obesity is a major risk factor for chronic illnesses such as diabetes, hypertension, obstructive sleep apnoea and osteoarthritis. Obese children also have difficulty establishing friendship, maintaining peer support and self expression. In the long term, it is far more realistic to prevent children from becoming overweight than to treat the chronic illnesses that arise from obesity.

Understanding the causes of obesity is an important step in its prevention. Both genetic and environmental factors contribute to childhood obesity.

An abundance of food allows for excessive intake of food from all food groups, especially fats. A diet high in fat is associated with increased prevalence of obesity.

As society becomes more affluent, the amount of incidental exercise reduces. Children no longer need to walk to school. They ride the school buses or are dropped off at the schools' doorstep by their parents.  Instead of engaing in outdoor games, children spend more time in front of the television or computer. The excess calories consumed then leads to obesity.

What Needs To Be Done For Obese Children?

Obesity treatment programmes focus on decreasing caloric (food) intake and increasing energy expenditure through exercises. Behavioural modification of the child and his family may enhance the effectiveness of these programmes.

Interviews with obese children and their families reveal that regular family activities often include food or eating but rarely involve physical activities. Hence, it is hardly surprising that obese children often have obese siblings, parents or grandparents as everyone in the family has a similar diet (excessive calories and high in fats) and a similar lifestyle (sedentary). Interventions to reduce obesity in children should also be directed at their families and caregivers.

Today, domestic helpers and granparents often take the place of mothers as the main caregivers. A holistic approach to obesity management should also include education and empowerment programmes for this new generation of caregivers.

Regular physical activity encourages energy expenditure, helps to build and maintain healthy bones, muscles and joints, improves eye-hand and eye-leg coordination and night rest. Other benefits of exercise in children are weight control, maintainenance of blood sugar and cardiovascular fitness. Children who are physically fit have a tendency to be physically active as an adult. In addition, exercise also improves their psychological well being, self-perception, self-esteem and social interaction skills.

At KK Hospital a Weight Management Clinic is available to help obese children (aged 6 to 18 years) and their families. A medical doctor and a dietitian first see the child and his caregivers. He is then referred to the rehabilitation department's physiotherapist for exercise prescription.

The aims of physiotherapy in obesity are to control the rate of weight gain or reduce weight, increase physical activity and reduce sedentary lifestyle behaviours.

At the start of the physiotherapy programme, a comprehensive family and social history of the child is taken, followed by an initial exercise stress test. The physiotherapist then recommends physical exercises and strategies. The child is encouraged to keep an exercise diary to keep track of his progress. Family involvement is vital to ensure success of the programme.

1 - 3 years
During this phase, children are curious, like to touch, pick and feel everything in sight. They tend to climb upward more than down and are able to jump. Towards 2 to 3 years, they should be able to kick a ball and ride a tricycle. Physical activities that allow play with active movement are encouraged. Types of activities should be changed frequently because of their short attention span.

3 - 6 years
Children have improved fine and gross motor skills with increased walking stride. They are able to hop, skip and run at variable speed. Skills like ball throwing have improved control and precision. They should be encouraged to participate in activities that develop their muscles, strength and coordination e.g. riding tricycle or bicycle, running, skipping, hopping and swimming. Parents are important role models during this phase as children are beginning to participate in physical activities with parents and others.

6 - 12 years
Children have improved strength, physical ability and coordination. Their own physical ability, interest and reaction of peers will influence them. Encourage participation in activities that interest the child. Activities that focus on aerobic conditioning, strength and endurance development are encouraged.

12 - 20 years
Growth and development continue to increase and physical activities are greatly influenced by peer pressure. The use of role models should be encouraged to increase physical activities that improve strength, endurance and coordination.

Treatment of obese children is successful if realistic goals are set, balanced diet emphasised, physical activity increased, with strong parental support and behavioral modification. However, preventing obesity is more important than the treatment itself. So, adopt a healthier and active lifestyle.