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Overweight and obesity have become one of the major public health issues affecting the health of primary and secondary school students, and urgently need the attention of the whole society. Recently, the National Center for Disease Control and Prevention, together with the Ministry of Education, the National Health Commission and the General Administration of Sports, formulated the "Technical Guidelines for Comprehensive Public Health Prevention and Control of Overweight and Obesity among Primary and Secondary School Students" (hereinafter referred to as the "Guidelines"). The "Guidelines" for the first time proposed a comprehensive prevention and control of overweight and obesity among primary and secondary school students.Three-level preventionIntervention techniques.

▲Screenshot of the National Center for Disease Control and Prevention's Guidelines

Regarding the main content and innovations of the "Guidelines", such as at what level of weight a child needs to see a doctor and how to avoid becoming a "little fat boy", the reporter interviewed the participants in the formulation of the "Guidelines", Zhang Qian, director of the Student Nutrition Office of the Institute of Nutrition and Health, Chinese Center for Disease Control and Prevention, and researcher, and Gao Shan, professor of the Department of Endocrinology, Xuanwu Hospital, Capital Medical University, for authoritative analysis and interpretation.

Why are there more and more “little fat kids”?

The "Report on the Nutrition and Chronic Disease Status of Chinese Residents (2020)" shows that the obesity rate among children under 6 years old in my country is 3.6%, and the obesity rate among children and adolescents aged 6-17 is 7.9%; while in 1982, the obesity rate among children and adolescents aged 7-17 in my country was only 0.2%.

Obesity is an important risk factor for many diseases. It not only affects the motor ability, skeletal muscle development and cognitive development of children and adolescents, but also has adverse effects on mental health, cardiovascular, endocrine, respiratory, digestive and other systems. In addition, obesity in children and adolescents can persist into adulthood, increasing the risk of various chronic diseases and increasing the medical and socioeconomic burden.

(Image source: Doubao AI)

The Guidelines point out that the factors affecting overweight and obesity among primary and secondary school students mainly include genetic, behavioral, environmental and social factors, and are jointly influenced and acted upon by the above multiple factors. Among them, dietary nutrition, physical activity, lifestyle, mental health, etc. are key individual-level factors; food systems, urban planning and living environment, public policies and management, etc. are important environmental and social determinants.

As one of the people who participated in the formulation of the Guidelines, Zhang Qian introduced that "the formulation of the Guidelines is based on the rapid increase in the proportion of overweight and obesity among children and adolescents in my country in recent years, and to prevent chronic diseases caused by overweight and obesity among children and adolescents from continuing to cause further health problems in adulthood. It aims to strengthen multi-departmental coordination from a public health perspective, take active intervention measures, and avoid greater health risks."

When talking about the reasons for the rapid increase in the proportion of overweight and obesity among children and adolescents in my country in recent years, Zhang Qian believes that it is mainly due to "imbalance in eating and moving". "In recent years, we have emphasized the influencing factors of the social environment, such as over-processed food, more and more sugary drinks, and more and more fried foods. People pursue delicious food, so their dietary intake leads to overweight and obesity. In addition, as the size of cities expands, the distance between study/work and residence increases, which also causes a decline in overall activity levels. Changes in leisure methods, such as the increase in the frequency of mobile phone use, are also important factors that cannot be ignored."

"From a medical perspective, the root cause of obesity is that energy intake is greater than energy expenditure," said Gao Shan. "Some unhealthy cooking methods, such as adding too much sugar, oil, or thickening when cooking, can lead to excessive calories in food, which is also a major cause of overweight and obesity in children and adolescents."

The child is getting fatter.

Medical guidance is needed in due course

In traditional concepts, many parents believe that their children are obese and overweight because they absorb food well and are well fed. As they grow taller, they will naturally become thinner. However, as a doctor in an obesity clinic, Gao Shan strongly calls for medical help and guidance in controlling overweight and obesity in children and adolescents.

"Many children and adolescent patients who come to the outpatient clinic have adopted incorrect weight loss methods or blindly copied the weight loss model of adults, which leads to hypoglycemia, anorexia nervosa, etc., which seriously affects their study and life." Gao Shan introduced.

So, how do you tell whether your child should see a doctor?

Gao Shan provided two suggestions: one is that overweight and obesity have not been alleviated through self-weight loss for two years; the other is that if any abnormality is found in the child's blood pressure, blood sugar, or blood lipids (even if slightly elevated), in addition, if the child has severe sleep apnea, etc., a medical evaluation is needed, and the doctor should provide a scientific weight loss plan.

"Children are in a period of rapid growth before they reach 18, especially before they reach sexual maturity," Gao Shan said. "Different growth stages have corresponding growth requirements, and sometimes if parents fail to pay attention in time, it may lead to unexpected consequences."

Gao Shan remembers a patient who left a deep impression on her. "His mother brought him to see a doctor. As a 13-year-old child, the patient looked short and obviously shorter than his age. After calculation, he was indeed 5 cm shorter than the normal value. In his recollection, the parents mentioned that the child had grown 2.8 cm shorter for two years, but they did not pay attention to it at the time, which resulted in the child's height being lower than that of his age and he might not grow any more in the future."

In this regard, Gao Shan emphasized that once a special situation occurs, parents should attach importance to cooperation with medical institutions, and if measures are taken, they should also be evaluated by medical institutions. In addition, Gao Shan also emphasized that attention should be paid to children's body mass index and growth curve. "However, differences in body shape and other factors will cause about 5% of children to fail to follow the general growth curve. Therefore, once an abnormality is encountered, at least a medical institution should be evaluated before taking corresponding measures for the child."

▲Use the cutoff values ​​in Table 1 to judge overweight/obesity: Those with a BMI greater than or equal to the "overweight" cutoff point for the corresponding gender and age group and less than the "obesity" cutoff point are considered overweight; those with a BMI greater than or equal to the "obesity" cutoff point for the corresponding gender and age group are considered obese. Excerpted from the standard "Screening for Overweight and Obesity in School-Age Children and Adolescents" (WS/T 586-2018) issued by the National Health and Family Planning Commission

In view of the fact that parents and children may lack scientific self-assessment methods for overweight and obesity risks, the Guidelines provide a Self-Assessment Form for Overweight and Obesity Risks among Primary and Secondary School Students. "This is a major innovation of the Guidelines, which can not only help the public self-assess, strengthen risk prediction and prevention, but also provide a basis for professional assessments by CDCs, schools and other institutions," Zhang Qian added.

"Self-assessment form for overweight and obesity risk among primary and secondary school students"

Parents or students are requested to read the following content carefully, determine which description the student meets, and mark “√” in the corresponding position, and assess the risk of overweight or obesity based on the total score.

Note:

1. "Yes" counts as 0 points, "No" counts as 1 point. If the cumulative total score is less than 5 points, the risk of overweight or obesity is low; if the cumulative total score is 5-7 points, the risk of overweight or obesity is medium; if the cumulative total score is greater than or equal to 8 points, the risk of overweight or obesity is high.

2. *Moderate-intensity physical activity: During exercise, you feel shortness of breath and increased heart rate, but you can communicate verbally, but you feel a little effort. High-intensity physical activity: During exercise, your breathing deepens and speeds up, your heart rate increases significantly, verbal communication becomes difficult, and you feel a little effort.

(Source: "Technical Guidelines for Comprehensive Public Health Prevention and Control of Overweight and Obesity among Primary and Secondary School Students")

Scientific "eating + moving",

Prevent your child from being a fat boy

Diet is an important individual factor causing overweight and obesity in children and adolescents. Many parents or children will intervene through dieting and other methods when they become overweight or obese. In this regard, Zhang Qian pointed out that "adult weight loss methods such as light fasting and eating only vegetable salads are not applicable to children and adolescents." Children and adolescents need to meet their growth and development needs, and should adopt scientific weight loss methods that are in line with their age. It is generally recommended to appropriately reduce the intake of energy and elements, such as reducing it to about 80%. In terms of dietary structure, you should eat more fresh vegetables, soybeans and their products, and drink more milk; the daily staple food should appropriately increase whole grains and miscellaneous beans, and match them with refined white rice/noodles; eat more aquatic products such as fish and shrimp, or poultry such as chickens and ducks, and eat less fat-rich livestock such as pigs, cattle and sheep; in addition, foods with high oil, high salt and high sugar should be eaten as little as possible.

▲Examples of three meals a day recipes for primary and secondary school students (Source: Zhang Qian, Illustration: Jia Shuorong)

"We encourage everyone to buy two scales at home. One is an ordinary weight scale, which can timely understand the height and weight level of the child; the other is a scale for weighing food. You can weigh all kinds of food before eating, so you can have a more intuitive understanding of daily intake." Zhang Qian added.

In addition to promoting healthy eating, the Guidelines also emphasize the importance of physical activity. Zhang Qian said, "Primary and secondary school students should engage in medium to high intensity activities for more than one hour a day, such as ball games, running and other sports that can speed up breathing and heartbeats; schools are also encouraged to arrange daily physical education classes when arranging the curriculum. In addition, parents should cultivate the habit of exercising with their children."

"Sports play a greater role in weight loss for children and adolescents than for adults. Encouraging children to engage in various types of sports, which can be any form of play, a combination of various sports, or even going out as a family for a quick chase after dinner are very effective methods," Gao Shan added.

In addition, regarding the content of "carrying out health examinations for students" proposed in the Guidelines, Zhang Qian emphasized that parents should take their children for regular physical examinations. For overweight and obese children, not only should their height and weight be measured, but also their blood pressure, blood lipids, blood sugar, uric acid and other indicators should be regularly tested. Once an indicator is abnormal, clinical treatment measures should be taken in a timely manner.

Collaboration between home, school and society,

Preventing and controlling overweight and obesity among primary and secondary school students

"The three-level prevention and intervention technology proposed in the Guidelines, especially strengthening school education and publicity and advocacy, is of great significance," said Gao Shan.

The Guidelines proposePrimary preventionIntervention technology aims to control risk factors and improve protection levels before overweight and obesity occur, so as to prevent overweight and obesity among primary and secondary school students; secondary technology refers to conducting screening and early intervention for overweight and obesity among primary and secondary school students, so as to achieve early detection and early intervention, control the occurrence and development of overweight and obesity, and prevent related diseases; the third level is to carry out joint intervention such as medical care, diet, exercise, psychology and behavior correction for students with severe obesity and obesity with clinical risk factors according to relevant guidelines and specifications.

"This is another innovation. The Guidelines propose for the first time a three-level prevention and intervention technology for overweight and obesity among primary and secondary school students. It changes the previous concept of horizontal prevention and control, and is conducive to all levels and departments to better play their relevant roles and give play to the synergy between families, schools and communities," said Zhang Qian.

"Primary and secondary school students are more influenced by schools and teachers. It is an effective measure to encourage parents through schools and then encourage students to take the initiative in prevention and control." In Gao Shan's view, in order to promote the better role of the Guidelines, the correction and management methods led by medical units should be vigorously promoted in the three-level prevention and control to avoid mistakes caused by lack of scientific knowledge and professional guidance. In addition, the construction of multidisciplinary clinics for childhood obesity should be further improved, and medical institutions at all levels should be encouraged to train specialized doctors, including community doctors, to better deal with the problem of overweight and obesity in children and adolescents.

Written by: Reporter Jia Shuorong

Interview experts:

Zhang Qian Director and Researcher of Student Nutrition Office, Institute of Nutrition and Health, Chinese Center for Disease Control and Prevention

Gao Shan Professor of Endocrinology, Xuanwu Hospital, Capital Medical University

Editor: David Duan