Interview | overweight and obesity
“Children struggle a lot to shed the kilos”
At least since Corona, obese children and young people have been a problem again and again. Pediatrician Jakob Maske tells in an interview how best to tackle obesity in children – and how extremely difficult it is.
rbb|24: Mr. Mask, is there a rule of thumb for when a child is overweight? Or can you just see it: if you think it, it’s like this…?
Jacob Mask: No, we always use the Body Mass Index (BMI) to see if the child is overweight. And body mass index is both age and gender dependent. So boys have different tolerance levels than girls. Respectively, male teenagers have different youngsters than female teenagers. The age limits are also very different.
What is the difference between an overweight and an obese child?
This is ultimately just a technical term. Obesity means morbidly overweight.
And when does obesity become pathological?
It again depends on the body mass index. We are actually talking about being sick above the 97th percentile. So if children have a body mass index that only three percent of other children their age exceed, then we call it pathologically overweight, i.e. obesity. There are also sources that talk about being overweight when the 90th percentile is reached. So if ten percent of the other children have the same or higher weight for their height.
The percentiles are the tables that you can also find, for example, in children’s U booklets?
Exactly. Ultimately, percentiles are curves that show where the normal path and standard deviations lie. They show us where we are at this moment – but they also show us how things are progressing. For example, if I now look at the weight all by itself, then I can also see the rate of weight gain from this curve. And I can also see if it has changed significantly. For example, in the year of the pandemic.
What should parents do and in what order if they think their child is overweight?
First of all, it is really important to take your height and weight and put them in relation – and then ideally calculate the body mass index. This, on the other hand, should best be seen on a curve together with the paediatrician. To see what the trend has been in previous years of development. And also to see if there is a problem at all or if it’s just something we feel. This is a very important point. It’s not about beauty, it’s about health.
This means that the parents are at the mercy of the individual paediatrician, his level of knowledge and awareness of the problem. Why aren’t there much clearer instructions on what to do above a certain BMI?
That’s because BMI alone doesn’t say too much. For example, if I have a BMI of 19 at the age of four, that is morbidly obese. But if I have this BMI at age 14, I’m almost back in the normal range. In this regard, one cannot make any general statements, but must look at the BMI curves individually. Anyone can do this at home too. But the help of the pediatrician is usually useful and can lead to a good consultation.
So the next step would be to seek advice?
Exactly. Counseling is also important because there are also diseases that can cause obesity, and you should talk to a doctor about that.
What should parents do if they just think the child is too fat – but the child doesn’t see a problem?
It is a more common problem in our practice that children are more likely to feel irritated when we increase weight or BMI. Because children are often not yet aware of the problem, and they often think that their appearance is being talked about. But we are talking about health. Because we know that being overweight can do things to the body that can lead to illness later in life. Be it through the manual strain or be it through influences that happen to the heart, blood vessels or brain. In this connection, you must first make it clear to the children that it is not about them not looking good. But that we care about their health. This is something that children are not ready for yet. Young people don’t even care about their health or how they will be in 20 years. It is important to them how they feel at the moment, and the children do not feel sick, but generally well.
Which age group of children are most at risk? Ten to twelve-year-olds in particular are said to have been affected during the shutdown.
In lockdown times we have noticed this in all age groups. Of course, 10-12 year olds can be particularly hard hit. But the kindergarten children were also very hard hit because they no longer had the opportunity to move. Many socially disadvantaged children no longer had the opportunity to eat one healthy meal a day. In this respect, all other age groups were also badly affected. We have seen weight gain on a scale and amount we have never seen before.
Are there and were there gender differences?
As a rule, both sexes were affected about equally.
Do you have the impression that these children are now slowly getting rid of their corona pounds?
well Most people who always have to watch their weight know that it is something that is not so easy. Unfortunately, the weight does not come off as easily as it went up. The children really struggle to shed the kilos. And also the parents. Rather, it would be enough to maintain weight during growth. This is often a goal that we state. But even that is sometimes very difficult for children.
How do you do it: keep the weight down?
First of all, it must be said very clearly that there are also diseases. Of course, you must clarify this in advance. An underactive thyroid gland or a lipid metabolism disorder can, for example, lead to pathological weight gain. You have to rule that out. Then there are three basic measures: You must work on eating, you must work on drinking, and you must work on moving. These are the three basic building blocks with which we try to work with children and young people and their parents.
Do you have any suggestions on how parents should approach their children so as not to negatively affect the children’s body image?
The best thing is actually a joint discussion with the paediatrician. Because we always make it very clear that it’s not about appearance or body image, it’s about health.
Advertising has for a while suggested that bodies that are not chubby are also beautiful and real. This also helps obese children to have a better body image. But does this also serve to raise awareness of the problem?
Of course, we are very much in favor of this image of the super slim model slowly disappearing. Of course, it shouldn’t turn out to be the opposite – but I haven’t had that feeling so far. Everyone needs to develop their body awareness. And there are very large areas in the body mass index that do not represent a slightly fuller appearance as pathological.
Back to the already overweight children and their parents: Isn’t it the latter’s task and responsibility to ensure that their children do not become overweight or even fat?
It is very easy to say. But it is actually very difficult. Especially with young people who have their own pocket money and buy things that their parents don’t agree with. And once a child has become overweight, it is actually very difficult to get out of the situation. In this connection, you can’t just leave the responsibility to the parents and say: It’s your fault. It is not like that. We must ensure that children do not even enter there as a preventive measure. This is important and parents have an important role model function – when it comes to eating, drinking and exercising. They also have an important role model function by only buying their children healthy things and only allowing a very limited amount of sweets. Parents can also regulate this. But parents can’t do it alone. Together you must find a way to get out of obesity.
Are we in a good position in Germany in this regard?
As I said at the beginning, it is extremely difficult to conduct a successful therapy. There are various options and support facilities, but it still depends on the child’s cooperation and motivation. Both factors – supply and motivation – must interact well to see rapid success. Children in particular are addicted to quick success. They often do not have an eye for long-term success. Losing half a kilo a week is not visible and quick success for them.
Thank you for the interview.
The interview was conducted by Sabine Priess.