Académie royale de Médecine de Belgique

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Marie-José Mozin. Le point de vue de la diététicienne pédiatrique. - Vidéo

(HUDERF)

Management of obesity in the very young

M.-J. Mozin

Pediatric dietician, Brussel’s University Children’s Hospital – HUDERF

Overweight and obesity during infancy and early childhood need to be considered as potentially health threatening as well as a higher risk factor for the development of obesity in childhood and adolescence. There are different opinions among health professionals. Some propose to postpone nutritional interventions until three years of age whereas others recommend a controlled diet and the promotion of a healthy lifestyle as soon as weight excess appears. The following questions are major issues:

  • Are overweight infants and toddlers at risk of developing immediate health problems?
  • Do early interventions help to establish lifelong healthful behaviors and prevent obesity in later life?
  • What are the nutritional risks related to dietary restrictions?

Morbidity is described in overweight children as well as in adults but less in infancy and in early childhood. Nevertheless, studies show more frequent developmental delays, mainly delayed gross motor skills, breathing difficulties like asthma, sleep apneas and other dyssomnias1

It is commonly admitted that parents provide both genes and environment2. The child’s food choice is dependent on its parents own food preferences. Furthermore, eating behavior is influenced by the environmental conditions during the meals. Familial tensions, sibling’s attitude, noise, television viewing3 and organoleptic food characteristics may enhance or diminish the intakes and determine their specificities. Adults serve as model and may also influence food habits in terms of quality and quantity. Early eating experiences may occur in different social contexts. The first weaning food is mostly experienced with the mother and occurs progressively with others and sometimes in a new environment. So, other eaters can serve as models.

Eating behavior is also dependent on meal schedule4 and other food distribution throughout the day and sometimes during the night. The child may also be confronted with pressuring and coercing actions5.

When a young overweight or obese child is presented to the pediatric team, these difficulties are frequently described. The parents are anxious and usually waiting for rapid solutions. Confronted with inaccurate comments expressed by family members, friends, teachers or medical teams, they often feel guilty, considering their educational system as poor and they are frequently hoping that the child is suffering from undiagnosed inherited hormonal disease.

In this context, after medical examination and advice, early dietary intervention by an appropriate approach conducted by a well trained pediatric dietician may help to modify food habits and to establish healthful behaviors resulting in efficient obesity prevention in later life.

There are nutritional risks related to dietary restrictions sometimes prescribed with the aim to obtain rapid weight/height normalization. The nutritional needs are proportionally very high, taking into account the rapid growth rate in a very young child. The prescription of a fat restricted diet with use of skimmed milk, avoiding oil and butter, is frequently associated with an unbalanced diet, with a lack in essentials fatty acids, and in vitamins A, D and E. Moreover, this diet is proportionally high in carbohydrates and proteins, which can lead to digestive disturbances due to fermentation or putrefaction in the colon expressed by abdominal pain and diarrhea.

Proposed modifications must take into account recommended allowances adapted for the age, taking into account a normal weight for age and height. Other considerations like certain food habits based on religion or philosophy are to be included in the prescription. Some attitudes are discussed in order to help parents whose child dislikes certain foods and to inform them about the child’s capacity when older than 6 weeks, to adapt their energy intake to their physiological needs.



1Rana Shibli, Lisa Rubin, Hannah Akons, Ron Shaoul. Morbidity of overweight (85th Percentile)in the first 2 years of life. Pediatrics Vol 122 N°2 August 2008,267-272.

 

2 Birch, L.L. Childhood overweight : Family environmental factors – in Obesity in Childhood and adolescence – Chunming Chen, William H. Dietz- Nestle Nutrition Workshop Series,Pediatric Program,Vol.49-161-176

 

3 Mealtime television and dietaryquality in low-income African American aand Caucasian mother-todler dyads

Horodinski MA, Stpmmel M., Brophy-Herb HE,Weatherspoon L. MaternChild Health J. 2009 Jul 23 Epub.

 

4 Anderson SE, Whitaker RC. Household routines and obesity in US preschool-aged children. Pediatrics 2010 mar;125!3):420-8.Epub 2010 Feb 8.

 

5 Scaglioni S. Salvioni M., Galimberti C. Influence of parent attitudesin the development of children. Br J Nutr 2008 Feb;99 Suppl 1:S22-25