MetroHealthy Living: Fighting Childhood Obesity and Fatty Liver Disease

by Dr. Reema Gulati, MD
Division Director, Pediatric Gastroenterology, MetroHealth Medical Center

I am worried about our children because they are developing fatty liver disease at an incredible rate, and fatty liver disease is entirely preventable.  I encourage you all to help foster a culture of healthy living, healthy eating and physical activity, and set examples for your children.

As a gastroenterologist and a liver specialist I see a lot of children with liver diseases and I would just like my audience to know that, unfortunately, we are seeing a lot of fatty liver disease in children nowadays something that was almost unheard of, say, 20 years ago.  To a large extent, this is because our children now are much heavier – to the point of being classified as obese – as compared to children say 20 years ago.

So, there is an epidemic of childhood obesity which is affecting not only their hearts, their risk of developing diabetes, but unfortunately, similar to (for example) what happens when people consume alcohol over years and develop cirrhosis of the liver:  now this fat is accumulating in the liver and has the potential to hurt and damage our children’s livers in the same way as alcohol does.  This condition is called non-alcoholic fatty liver disease. It is linked directly to a child’s body mass index, which is a crude measure of how overweight or obese a child is.

So, I think it’s important for us to understand that it is necessary that we learn – and teach our children to lead – a healthy lifestyle by eating healthy and also staying active so that we can control excessive accumulation of fat in the body.  We can keep their weight in check and prevent conditions like fatty liver disease.

Food is the biggest source of nutrition, and not only does it provide fuel for our children’s bodies to stay active and to grow, but it also prevents chronic diseases like diabetes, heart disease and fatty liver disease if it is properly selected.  So, we should encourage our children to eat a well-balanced diet.

A well-balanced diet consists of the appropriate amount of carbohydrates, which provide fuel to our bodies; protein, which provides amino acids that are necessary for growth; and fats, also, to some extent, to help with the functioning of the brain, the eyes and the different body membranes.  Along with that come the minerals and vitamins that we mostly get from our fruits and vegetables; and then we need some dairy in our diet to get the calcium and vitamin D for bones to stay strong.

In the end, body weight is a balance of energy intake versus energy expenditure.  So, the next thing in the equation that we need to consider is how much energy our children are expending.  The American Academy of Pediatrics recommends that all children, starting from the age of two years onwards, should get at least an hour of moderate-intensity physical activity in a day.

An activity is classified as moderate if it leads to mild sweating, if it leads to you feeling your heart pounding, so a lot of activities like swimming, biking, informal sports or formal sports, as long as they are played out for a period of at least an hour every day.  That’s the amount of energy expenditure we need to incorporate in our children’s daily routine to keep their weight in check as well.

So, healthy eating, staying active will prevent over accumulation of calories.  Bad calories (or excess energy) are converted into fat, and that fat goes and deposits itself throughout the body, in our arteries, in our liver and also predisposes us to metabolic diseases.

Once again, I encourage our parents to understand that children, unfortunately nowadays, are becoming heavier primarily because of the fast food culture, the relative inactivity because of increased screen time, and that is then leading to all these adult died diseases that we had never heard in children up until two decades ago which is now affecting our children.

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