Obesity in children has increased considerably. Moderate estimates are that 15% of children between 6 – 19 years are obese and more than 10 % of children aging between 4-5 years suffer from obesity. Many obese children grow up to be obese adults. This is also age related. Chances are that 11-year-old children are likely to be obese in adolescence, while 7- year-olds have less chances of becoming obese as they grow older. Obesity has a genetic predisposition and it runs in families. It is also influenced by surrounding environment. Is there a way to measure obesity? Obesity is an excess in body fat, weighing 20 percent above the desired weight. There is no way to measure all the fat in a body. Basal metabolic index is a yard stick of measuring obesity and serves as a screening tool; this measurement is age and gender specific. Special charts known as Percentile Charts are available from 2 – 20 years for assessment. For Basal Metabolic index percentile, a child scoring between 5 -85 is normal, while 85 -95 percentile is at risk of being overweight. A child exceeding the 95th percentile is over weight. Is obesity harmful? Obesity affects virtually every major organ system and leads to a large number of complications that maybe psycho-social, growth related, brain related or respiratory. These complications include sudden death, heart problems, vascular diseases, skeletal diseases, metabolic-diabetes mellitus and increased blood lipids. Obesity is also associated with a large number of genetically predisposed syndromes. Can we tell who's fat and who's not? Yes, by routine examination in a clinic and calculation of basal metabolic index, putting the child in the requisite percentile. A dietary history is very important and must be taken in order to know the effect of the child's feeding patterns. Such a pattern plays a cardinal role in determining weight, habits like eating in front of TV or the amount and frequency of food and beverages consumed can affect weight gravely. Assessment of activity; How many hours does your child spend watching TV or playing computer games and surfing the web? How many hours of exercise and sports does your child's day include? Parents' activity can also be important. Are any laboratory tests needed? Only in children with a percentile higher than 95 and who have evidence of disease. Fasting blood sugar, insulin level, lipids and thyroid function tests are required. What advice can be given to an obese child? In deciding treatment, age, percentile and whether or not the child is suffering from any diseases must be taken in consideration. The aim of treatment in 7 years old or younger children is to maintain a base line weight, allowing the child to grow in height so that the weight is normalized. In children more than 7 years old with a percentile higher than 95, who are suffering of a disease, weight loss is still needed. Half a kilogram per month is recommended until they are within the 85 – 95 percentile range and then weight is maintained. Obesity treatment programs can be very helpful in these situations. In order to sustain treatment and target behavioral changes in the whole family, the obese child's entire family should be encouraged to switch to healthier eating habits. Physical activity and exercise should be encouraged as well, decreasing the time spent on TV or Internet to a maximum of two hours daily. The treatment of obesity is a challenging process. Awareness must be developed regarding many issues that are closely related to this problem. Breast feeding, diet, exercise and avoiding sedentary life are important concepts that must be delivered to parents. Families should be approached as one inseparable unit in such cases, joining their children in their treatment programs and implementing the necessary changes for their children to live a healthy life. The writer is a Pediatrician at My Care Medical Center, Jeddah, with an M.B.B.S, D.C.H (Dublin) __
