    Among the 18 children patients, there are 15 emaciated children and only 3 obese children. This is the patient’s condition that Xia Lulu, the attending physician of the Clinical Nutrition Department of Beijing Children’s Hospital affiliated to Capital Medical University, attended one day. However, if we turn our attention to the inpatient ward, the proportion will be reversed, and there are more children hospitalized because of complications caused by obesity in the ward.
    Xia Lulu said: "This is a phenomenon worthy of attention. Clinically, children’s obesity will cause more diseases and harm than emaciation, but parents are more concerned about the influence of children’s emaciation on height. "
    The 8-year-old Huihui is 1.29 meters tall, but her weight has reached 40 kilograms, which belongs to the category of obesity. Because the body mass index (BMI) is not up to standard, which affects the sports performance, the school requires "calling parents". Huihui was taken care of by her grandmother when she was a child. Grandma took Huihui to the hospital and asked inexplicably, "Huihui’s chubby figure and cheerful and optimistic personality are loved everywhere. When you are fat as a child, you will naturally lose weight when you grow up. Will it affect your health if your child starts to lose weight at such a young age? "
   Is it a good thing that children are fat?
    "Childhood obesity can be complicated with fatty liver, insulin resistance, hyperlipidemia, hypertension, hyperuricemia, obstructive sleep apnea, precocious puberty, etc., and severe cases can also lead to nonalcoholic steatohepatitis and type II diabetes. Studies have shown that obese children have a higher risk of advanced bone age, and advanced bone age may lead to children’s growth. " Referring to the harm of childhood obesity, Xia Lulu said with concern: "Fat children may also be discriminated against and have psychological barriers such as inferiority complex."
    According to the Report on Nutrition and Chronic Diseases of Residents in China issued by the National Health and Wellness Commission in 2020, the overweight and obesity rates of urban and rural residents of all age groups in China are on the rise, among which the overweight and obesity rates of adult residents have exceeded 50%, children and adolescents aged 6-17 are close to 20%, and children under 6 have reached 10%. This report predicts that by 2030, the prevalence of overweight and obesity among adults in China will reach 65.3%, among which the proportion among school-age children and adolescents will reach 31.8% and preschool children will reach 15.6%.
    In 2020, the Notice on Printing and Distributing the Implementation Plan of Obesity Prevention and Control for Children and Adolescents issued by the General Offices of the National Health and Wellness Commission, the Ministry of Education, the General Administration of Market Supervision, the General Administration of Sports, the Central Office of the Communist Youth League and the All-China Women’s Federation mentioned that overweight and obesity has become an important public health problem affecting the physical and mental health of children and adolescents in China. In order to improve the health level and literacy of children and adolescents, the government, society and individuals should take multiple measures and cooperate closely. In 2020-2030, the average annual growth rate of overweight and obesity rate of children and adolescents aged 0-18 should be reduced by 70% on the basis of the baseline, laying the foundation for the ultimate realization of zero growth of overweight and obesity of children and adolescents.
    Obesity in children is more harmful than "getting fat in middle age". Childhood obesity is one of the risk factors for adult obesity and various complications, and the risk probability of children suffering from chronic diseases, especially cardiovascular diseases and metabolic diseases, increases in adulthood.
    In recent years, with the inclusion of BMI index in sports scores in many provinces, parents began to pay attention to their children’s height and weight, but there are also many misunderstandings that need to be clarified.
   Fat children don’t eat too well, they just eat too badly.
    Jojo was also brought to the nutrition department by her mother because her BMI was not up to standard. After being diagnosed as obese, Jojo’s mother said that the child was eating too well and was overnourished.
    When Xia Lulu heard this, he immediately corrected: "In a broad sense, children who are overweight and obese, too emaciated and lack of micronutrients are all malnourished. Children who are overweight and obese are indeed eaten, but they are not eating too well, precisely because they are not eating well and are not balanced. "
    Obesity is mainly divided into simple obesity without disease factors and secondary obesity with disease factors (pathological obesity). Secondary obesity is caused by pituitary dysfunction, hypothyroidism or drugs. Simple obesity is caused by the interaction of genetic factors and environmental factors, including unbalanced diet, too little exercise, too little sleep and emotional neglect.
    According to Xia Lulu, 95% of obese children in outpatient clinics are simple obese. Excessive total energy intake and unreasonable diet structure are the important reasons leading to overweight and obesity in children.
    Simply put, most children’s obesity comes from eating, not eating too well, but eating too much and unbalanced nutrition.
    Xia Lulu’s feeling in outpatient service is supported by the data of scientific research papers. According to the results of "Status and Evaluation of Main Food Intake of Children Aged 6-17 in China in 2016-2017", most children aged 6-17 in China have sufficient or even excessive intake of grain, livestock and poultry meat; Insufficient intake of whole grains and miscellaneous beans, fresh vegetables, fresh fruits, fish and shrimp, milk and its products, nuts and soybeans. In other words, most school-age children in China eat too much staple food and meat.
    Children’s nutritional imbalance is mostly due to the unreasonable family diet structure. Most of these families have the following problems in their diet: skipping breakfast, irregular meals, often eating high-energy-intensive foods such as meat, sugary drinks and fried foods, and insufficient food diversity in their diet.
    Children can’t lose weight without the supervision of their parents. "The child itself is a blank sheet of paper. The key depends on how you teach. Through daily outpatient contact with patients, you can find that parents teach well and children lose weight quickly; If parents don’t teach well, children can’t lose weight at all. "
    Three years ago, by chance, Yan Qiushi took his child to the hospital and was told by the doctor that the child was overweight, and being overweight was likely to affect his future performance. This parent who has always advocated "stocking" children is indifferent to this, and even laughs at himself as a mountain on the road to losing weight. At the beginning of this year, because of his work, Yan Qiushi came into contact with a child nutrition expert, and only then did he realize that childhood obesity has so many hazards. Yan Qiushi, who made up her mind, took her children to the nutrition department of the hospital to customize the exclusive weight loss plan. Within one month, the child lost nearly 10 pounds.
   Waist-to-height ratio, body mass index and body fat rate comprehensively judge whether obesity is present or not.
    When talking about the parents of children who come to the nutrition department for registration, Xia Lulu thinks that a common problem is: "They have never been able to correctly judge their children’s current physical condition and nutritional health, and they are either too anxious or too careless." Xia Lulu said, "When it comes to obesity, many people think of weight, and think that weight is the main basis for judging obesity. In fact, it is not possible to judge whether children are obese only by naked eye observation. "
    Correctly judging whether a child is overweight or obese is the first step to help children achieve a scientific and nutritious diet and maintain a healthy weight.
    The determination of children’s obesity should refer to the scientific basis, and at least three factors should be considered when judging: the ratio of waist circumference to height, body mass index and body fat rate.
    Body mass index (BMI) is widely used in the world to judge whether a person is lean, normal or obese. The calculation formula of BMI is: weight (kg)÷ the square of height (m). If the BMI is greater than the 95th percentile of children of the same age and sex, it belongs to obesity. That is to say, if the BMI index of 100 children of the same age and sex is arranged from high to low, the top five are obese.
    In addition, we can also refer to waist-to-height ratio and body fat rate to judge whether a child is obese. For children over 6 years old, the ideal waist-to-height (cm) value should be less than 0.46. The body fat rate of boys and girls under 12 years old should be less than 20%, and the body fat rate of girls over 12 years old should be less than 25%. If it exceeds the above range, it belongs to obesity.
    For overweight and obese children, weight loss should be "shut up" and "open your legs" like adults.
    When Haoyu and his parents came to the Nutrition Department, they were similar in size and wore two layers of "swimming rings" on their bellies. Xia Lulu told the reporter of China Youth Daily and China Youth Network, "This is very common. What parents usually eat, children will follow. In the long run, children will grow into a body shape with their parents."
    After Haoyu was diagnosed with obesity, Xia Lulu recommended the weight loss training camp to Haoyu’s parents, but Haoyu’s father refused. Afterwards, Haoyu’s father said: "This kind of weight-loss summer camp is to throw children in and starve. I can’t bear to part with it. Besides, it is also hungry. We are hungry for our children at home and lose weight. "
    Xia Lulu said, this is another common misunderstanding of parents of obese children. "Children can’t just rely on hunger to lose weight. It is very unscientific to rely solely on dieting to lose weight. Dieting will have a very bad effect on children during their growth and development. "
   The cultivation of health concept should start with dolls.
    Xia Lulu said that children who need to lose weight should first change their eating habits and slow down their eating. In the daily diet, the staple food should pay attention to the collocation of thickness, and coarse grains can account for 1/3 of the staple food intake; Mix meat and vegetables, try to choose high quality and high protein meat, and eat more vegetables every meal; Yogurt, nuts, beans, raw vegetables, fruits, etc. can be used as children’s snacks, but it should be noted that the number of snacks should not exceed 3 times a day, and the amount should not be too much; Try not to eat foods high in oil, sugar and calories. At the same time, scientific weight loss is definitely not achieved overnight, and the diet structure should be improved according to the law of decreasing.
    Moderate-intensity aerobic exercise such as long-distance running, swimming, skipping rope and kicking the ball is very beneficial to control children’s obesity. Studies show that adhering to a healthy lifestyle at the age of 4 will reduce the risk of overweight, obesity and abdominal obesity at the age of 7, and lifestyle intervention can improve the cardiovascular outcome of obesity in children and adolescents.
    To achieve the goal of Healthy China 2030, to prevent and control the occurrence and development of obesity-related chronic diseases in China, such as diabetes, cardiovascular disease and hypertension, and to reduce the premature death caused by chronic diseases, we must start from controlling the obesity of children and adolescents.
    Every time a child over 7 years old suffers from malnutrition in outpatient service, Xia Lulu will not only answer the parents’ doubts, but also take pains to explain the dangers of malnutrition and how to do it correctly and scientifically in sentences that children can understand.
    "Children are very reasonable and most receptive to new ideas. Healthy living is actually the result of the influence of ideas on behavior. The indoctrination of health concept awareness needs to start from the doll. " Xia Lulu said. (In order to protect the privacy of minors, Wen Huihui, Qiu Qiu and Hao Yu are all pseudonyms) (trainee reporter Tan Sijing)
