Overweight-related complications already established by school age in Denmark

Diet and lifestyle 25. aug 2022 3 min Clinical and Research Associate Professor Jens-Christian Holm Written by Kristian Sjøgren

Children in Denmark as young as 5 years show signs of overweight-related complications such as high blood pressure and prediabetes. According to a researcher, massive action is needed to prevent the next generation of young people from entering adulthood with overweight.

Children and adolescents today have more overweight than ever before. The same applies to adults, and a new study indicates that the problems begin before school age.

The researchers investigated the degree of overweight and overweight-related complications among children from 2 years of age.

Unfortunately, the study shows that the health effects of an increased degree of overweight emerge very early in life. Many of the children have thus already developed high blood pressure, fatty liver and prediabetes.

According to a researcher, the study provides unique insight into how early in life the problems related to unhealthy excess weight can be detected.

“I would say that our study is visionary, since we examined a group of children who would normally be apprehensive about talking to researchers and being examined in a research context. You might think that children at this age should be left alone to be children, but we can see that additional research on very young children is needed, as the seeds of obesity and all the many complications of obesity are already being sown at this age,” explains Jens-Christian Holm, Consultant, Children’s Obesity Clinic, Department of Paediatrics, Holbæk University Hospital.

The research has been published in Obesity Research & Clinical Practice.

Shockingly many children are unhealthy

The research follows up earlier studies in which Jens-Christian Holm and colleagues showed that children in Denmark averaging 11 years old have suboptimal health.

The studies showed that 50% had pre- or overt hypertension, 27% exhibited dyslipidaemia, 31% had fatty liver, 44% exhibited sleep apnoea and 14% prediabetes.

“These studies emphasised that children’s health in Denmark is much worse than we had feared. In the new study, we wanted to determine the health of even younger children,” says Jens-Christian Holm.

Nearly 1,000 children studied

The researchers obtained data through primary care municipal dental clinics and public health nurses in a cohort of 992 children aged 2.5–8 years; 335 were preschool children aged 2.5–5 years, and 657 were school-aged children aged 6–8 years.

The researchers obtained data on the children’s weight and height from municipal dental clinics and the public health nurses who visit the child’s home during infancy and see them in schools, and 392 participated in additional hospital-based examinations, including blood pressure measurement and blood samples.

The children were re-examined about 1 year later.

Things go wrong after school starts

The results show that children in Denmark have far from optimal health: 14% of both preschool children and schoolchildren exhibit overweight at baseline.

The preschool children with and without overweight had minor differences in cardiometabolic risk markers such as high blood pressure and high blood glucose but not the schoolchildren.

The research found that schoolchildren 6–8 years old with overweight had an increased risk of much higher levels of blood glucose, triglycerides and insulin. They were also more insulin resistant and had lower levels of high-density lipoprotein cholesterol.

At the follow-up after 1 year, the prevalence of overweight had not changed much among the preschool children but had increased to 17% among schoolchildren.

“We can see a continuum in which the first signs of risk factors related to overweight appear early in childhood and manifest themselves when the children start school. We can speculate that things begin to go wrong when the children transition from playing and running around all day to sitting still and being inactive for 7 hours a day. This probably contributes partly to children developing the overweight-related complications and children of normal weight developing overweight,” explains Jens-Christian Holm.

A question of upbringing

According to Jens-Christian Holm, the study indicates that very early intervention is required to avoid children developing serious complications from having overweight, leading to a lifelong struggle.

Intervention must begin before the children start school, when the problems emerge.

Jens-Christian Holm says that just talking about diet and exercise is insufficient. Much greater and broader understanding and efforts are needed to counter this dangerous trend.

“As a competent adult, and not regarding parents, you need to know that eating candy, not exercising, developing overweight and possibly also getting bullied for it is not good for children. Not taking care of our children’s health and not being critical enough in relation to how they live, eat and move has massive consequences. The insight that we bring here can and should be used for taking action instead of just observing the development. Many parents have difficulty setting limits for their children, and so Saturday candy ends up becoming candy on several days. Parents have a huge role in setting boundaries that affect children’s health that we need to consider, but also adults in schools and elsewhere are crucial,” he says.

Based on the results, the researchers have created an information and intervention study in collaboration with a school in Holbæk.

“Children consulting a public health nurse in school every 6 months or yearly seems insufficient. We need to influence them and their families with an improved understanding and help them to understand that living in the way that far too many children currently do can have serious consequences,” concludes Jens-Christian Holm.

Early detection of childhood overweight and related complications in a Danish population-based cohort aged 2–8 years” has been published in Obesity Research & Clinical Practice. Several of the researchers are affiliated with the Novo Nordisk Foundation Center for Basic Metabolic Research at the University of Copenhagen and with Steno Diabetes Center Copenhagen, which the Novo Nordisk Foundation also supports.

MD Jens-Christian Holm, PhD is a Head Consultant in Paediatrics, Clinical and Research Associate Professor, and Head of The Childrens’ Obesity Clinic,...

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