It is impossible to make any clinical diagnosis without a thorough examination of the patient: physical, laboratory, and instrumental examination. This is an axiom. You will learn from the article the way how obesity is diagnosed in children and what does leptin have to do with it. In addition, we will tell you how an adequate therapeutic tactic for managing young patients is chosen based on a correct diagnosis.
The examination algorithm is standard and includes:
- Patient intake: height, birth weight, signs of excess weight, hereditary burden.
- Anthropometry: height, weight, body fat distribution, BMI, circumference of waist and hips, blood pressure indicators, skin condition, sexual development.
- Blood biochemistry: high and low density lipoproteins, triglycerides, total cholesterol, AST, ALT, leptin concentration.
- Blood sugar level on an empty stomach, glucose tolerance.
- Hormonal profile: insulin, cortisol, T3, T4, c-reactive protein, according to TSH indications.
- U/S of the liver, kidneys, pancreas, adrenal glands.
- Bioimpedancemetry: analysis of body composition.
- Molecular genetic testing with DNA testing.
- Consultations of narrow specialists.
Since obesity has many reasons of its occurrence and development, the treatment of pathology is complex. The main emphasis is placed on the observance of a special diet, physical activity, and on drug correction at last.
An important place in the treatment of obesity belongs to the diet. Nutrition should be varied, balanced, contain vitamins and minerals. Spicy, salty dishes, canned food, seasonings, snacks, which only increase appetite, are excluded. Food is steamed or boiled, baked. It is advisable to eat raw vegetables and fruits. These can be salads, vinaigrette. Easily digestible carbohydrates are minimized, the amount of fat is reduced to 70% maximum. Moreover, fats are not simply reduced, mainly due to animal fats, they are redistributed and half of the animals are replaced with vegetable fats. Since it is incredibly significant that the diet is balanced, the restriction of easily digestible carbohydrates and animal fats is compensated by an increase in protein in the diet.
Bread, pastries, flour, potatoes, sweets are removed from food in favor of vegetable dishes, low-fat milk and its derivatives, vegetables and fruits rich in fiber. The latter guarantee a feeling of fullness and prevent the transformation of carbohydrates into fats. The diet for obesity assumes hypocaloric content, which activates the mobilization of fat from the places of its accumulation, that is, it inhibits liposynthesis. Calorie content is reduced by 200-600 kcal per day. With obesity of the 1st degree, this is approximately 20% of the daily diet, with the second is 30%, with the third is up to 50%. Minimizing calories is the result of restricting both carbohydrates and fats.
When diagnosing obesity of any degree in a child, a dietary correction is initially recommended that corresponds to its physiological norm. This is already a limitation, since as a result of impaired leptin metabolism, most young patients consume significantly more food than the age norm. The child is prescribed a hypocaloric diet after a few weeks of adaptation. There is no need to drastically limit the child in food and quickly move from one diet to another. This can lead to the development of weakness, headache, and other unpleasant sensations or general discomfort. Transferring a child from one diet to another is the prerogative of the doctor. He sets the adaptation time, focusing on the general condition of the baby, the dynamics of weight loss, metabolic indicators.
Obesity is corrected more easily and quickly in the early stages. Since it is possible to normalize metabolism and achieve weight loss. In these cases, adaptation takes place in one to three weeks. The adaptation increases to a month and a half in patients with the 2nd and 3rd degree of obesity. The daily distribution of calories in obesity differs from the physiological diet. Until noon, the processes of fat breakdown (lipolysis) predominate, from 18-00 liposynthesis is accelerated. Knowing this feature of the child’s body in the first half of the day (breakfast and lunch), the patient is given up to 75% of the total daily calorie content.
A necessary condition for diet therapy for obesity is compliance with the diet. As a rule, overweight children rarely eat, very little in the morning, and a maximum in the afternoon and at night. Rare meals, plentiful portions increase the volume of the stomach, increase the absorption of fats and carbohydrates. Obesity dictates a slow pace of eating, fractional six meals a day in small portions. This stops the feeling of hunger and promotes a feeling of satiety. Fasting days are held only for older children once a week. At the same time, the daily calorie content is no more than 800 kilocalories. Fruits, cottage cheese, kefir are popular. Fasting treatment is unacceptable, as catabolism increases, which leads to growth retardation and disrupts the baby’s maturation process.
If you follow a diet for obesity, you can get a weight loss of up to 1 kg per week. However, a violation of the diet will nullify all efforts. And now attention! All diets for weight loss only make sense if a person has everything in order with the level of leptin. And it can be both high and low. Blood tests during the initial examination will warn parents about this. And then you need to remember that high-fat foods are suitable for lowering the hormone level: milk, sour cream, cream, yogurt, and other high-calorie foods. To increase leptin the patients should follow a low-calorie diet: vegetables, fruits, low-fat cottage cheese, milk, yogurt, cereals, soy, peas, beans, lamb, turkey meat.
Physical activity is another important factor in losing weight. Sport increases the intensity of metabolism and accelerates the mobilization of fat. Patients with an obesity should prefer walking instead of an afternoon rest, they widely use the possibilities of physiotherapy exercises.
The choice of a set of exercises is correlated with the phase of obesity. Movements that minimize the load on the legs are preferable: exercises while sitting, lying down, on the gym wall bars, swimming, skiing, cycling. Physical activity should be increased gradually under the supervision of a physician.
Patients should use classical massage, hydromassage, vacuum, balneotherapy in combination with manual massage. This improves peripheral blood and lymph circulation, but does not cause significant weight loss. Therefore, it is used only in combination with other methods of treating obesity.
Drugs can be prescribed with hyperinsulinemia, insulin resistance, biguamides are recommended, but only for children after reaching the age of 10 years. Metformin-based preparations are recommended at a dosage of 500 mg 1-2 times a day. When prescribing antihypertensive drugs, preference is given to ACE inhibitors: Kapoten, Renitek, which can be used from birth. They have nephro- and cardioprotective effects.
Orlistat is prescribed in adolescents from the age of 12. It inactivates pancreatic enzymes, gastric lipase. At the same time, the breakdown of exo-fats is disrupted and absorption in the intestine is minimized. Body weight decreases with regular use of the drug. Patients should take the remedy in a capsule three times a day before meals. Duration of admission can be from three months to a year.
Children with obesity correction need psychological support to improve their quality of life. Surgical correction in the Russian Federation is prohibited.
Treatment of obesity is a difficult task, but even the early stages of weight gain are effectively corrected only if the family and the child himself realize the need for treatment. The main task of the doctor in this case is to create motivation for treatment, the formation and maintenance of a rational lifestyle of the child, psychological rehabilitation, and the development of self-control skills. Prevention of obesity is a rational nutrition of the child throughout life.