Obesity in childhood can be defined as a weight of more than 20 percent above that expected for age, gender and height on the National Center for Health Statistics (NCHS) weight for height tables.
Various factors determine infant obesity. These include genetic predisposition, excessive feeding, poor intake regulation, underactivity, maternal attitudes toward infant feeding.
Genetic predisposition:
growth is influenced by genetics (tall people often have tall children and obese people often have obese children).
Excessive feeding:
overfeeding of milk and the early introduction of solids leads to increased energy intake.
Poor intake regulation:
the ability to regulate food intake from birth to four weeks may not be fully developed.
Initially food consumption is controlled mainly by gastric filling and subsequently by additional regulatory mechanisms.
Underactivity:
infants use some of their energy from food during physical activity.
At birth the energy used for physical activity is 28 percent and at 12 months it is 50 percent of the total energy intake.
A study relating infant activity levels to obesity demonstrated that heavier infants tend to be less active than lighter ones.
From birth to three months, infants use 27 percent of their energy intake for growth, 45 percent for metabolic activity and 28 percent for physical activity.
Between four to six months, 11 percent of energy intake is used for growth, 45 percent for metabolic activity and 44 percent for physical activity.
Between 7 - 12 months, infants use 5 percent of their total energy intake for growth, 45 percent for metabolic activity and 50 percent for physical activity.
Maternal attitudes towards infant feeding:
maternal attitude towards feeding plays a very important role. In diverse cultures, mothers make different food choices for their babies.
If the culture sees "fat babies", as "healthy babies" mothers will be less inclined to be concerned about the baby's weight.
If the culture is Westernised, mothers may give a lot of refined carbohydrates and luxuries such as sweets and biscuits.
Management
In the past, doctors believed that early infant overfeeding and therefore overweight babies would lead to an increase in the number of fat cells and to an adult life of obesity.
Today the emphasis is on promoting eating healthy foods during childhood to establish healthy eating later in life and not on anatomical changes.
The infant or child should be given enough food to fulfil his energy, protein, fat, vitamin and mineral requirements for growth and development.
Thirty percent of the energy intake during the first three to four months of life is used for growth.
This decreases by the age of one to two years.
Breast-milk is the single food source for the first four to six months of life.
Feeding should be in response to the baby's appetite. Solids should be introduced when the baby is developmentally and physiologically ready.
Development cues:
baby can sit with support and can hold its head up when lying on its stomach.
Physiological cues:
extrusion reflex is relaxed, the gut is mature and the kidneys can handle extra renal solute load.
Restricted fat diets and low-fat foods are not appropriate for infants under the age of two.
Infants have limited stomach capacity, therefore they require energy-dense foods to support their rapid growth and metabolism rate.
Fat is an excellent source of energy (1g of fat provides 38kj as compared to 17kj per 1g of protein or carbohydrates).
Fat also helps the brain and nervous system to develop and provides insulation around vital organs like kidneys.
Sugar is a readily metabolizable source of energy for active, rapidly growing infants. Sugar should be given in moderation.
Because of the deleterious effects of kilojoule restriction on growth, resistance to infection, and central nervous system development, specific caloric restriction is not recommended.
Parent education is important to prevent obesity later in life.
Advice on sensible feeding practices is clearly the key to prevention in families with characteristics that are risk factors for the development of childhood obesity. - Purity