(1) Hunger therapy: fasting/semi-starvation and disguised hunger therapy are prohibited.
(2) Fast weight loss method: short-term fast "weight loss" or "weight loss" is prohibited.
(3) Diet pills: It is forbidden to use "diet pills" or "diet foods".
(4) Surgical treatment: It is forbidden to use surgical treatment or so-called "physical therapy", such as oscillation.
2. The concept of childhood treatment, the treatment of obesity is based on weight control, and the so-called "weight loss" or "weight loss" treatment with the goal of reducing weight is not carried out. Weight control refers to a comprehensive physiological-psychological regulation theory with the contents of promoting growth, maintaining moderate fat growth and improving physical and mental health.
3. The first-line goal of childhood weight control is to promote growth and development, enhance aerobic capacity and improve physical health. physical education class gets a high score or a perfect score to control the body fat growth within the normal rate. It is the long-term goal of weight control in childhood to cultivate scientific, correct and good living habits, maintain healthy physical and mental development and cultivate a new generation of healthy people without cardiovascular risk factors.
4. The treatment plan is based on exercise prescription, behavior correction is the key technology, and health education (including diet adjustment) is always implemented; Pay attention to obese children, with the participation of teachers, parents and medical staff; A comprehensive treatment scheme with daily family life as the main regulation and implementation place and concentrated life training in winter and summer vacations.
5. Exercise prescription tests the individual's maximum oxygen consumption, and takes 50% of the individual's maximum aerobic capacity as the average training intensity to make a training plan. Training 1 ~ 2 hours a day, 5 days a week, l2 weeks as a course of treatment. The purpose of sports training is to make sports training a habit in daily life, and to keep and insist on physical exercise frequently; Master training techniques, self-protection knowledge and methods, and adhere to correct and scientific exercise. When choosing exercise form, we should pay attention to the effectiveness of reducing fat, the feasibility of children's long-term participation and their interest in participating.
6. Behavior correction project conducts behavior analysis through personal interviews, family visits/parent-teacher conferences and school visits (teachers and classmates). Making a behavior correction plan includes baseline behavior, intermediary behavior and target behavior. Positive/negative induction for making reward/punishment rules. Select relevant parameters/indicators. Special emphasis on parents' participation has a great influence on the weight control effect and consolidation of obese children in China. Psychotherapy should be carried out, especially for children with psychological burden, to enhance their confidence. Once the child loses weight, his spirit will improve.
7. Diet adjustment should pay attention to the following principles:
(1) Children's basic nutrition and nutrition needed for growth and development must be guaranteed.
(2) It is not advisable to lose weight suddenly. At first, it is only required to stop the rapid weight gain, and then it can be gradually reduced to about 10% beyond the normal weight range of this age group, that is, there is no need to strictly restrict food.
(3) Try to satisfy the child's appetite so as not to go hungry.
(4) The daily supply of protein should not be less than 1 ~ 2g/kg. Some people even advocate a high-protein diet, and the daily supply of protein is 3 ~ 4g/kg.
(5) With sugar as the staple food, fat should be restricted and sweets should be restricted appropriately.
(6) Vitamins and minerals are indispensable. According to the above principles, food should be mainly vegetables, fruits and rice. , plus the right amount of protein including lean meat, fish, eggs, beans and so on. The control of calories should fully consider the needs of children's growth and development. Generally, the heat energy under 5 years old is 2500 ~ 3330 kJ/d (600 ~ 800 kcal/d); 6 ~ 10 years old, 3330 ~ 4 167 kj/day (800 ~ 1000 kcal/day); 10 ~ 14 years old 4 167 ~ 5000 kilojoules/day (1000 ~ 1200 kilocalories/day). Strictly calculate and control the daily calorie intake, and selectively eat or avoid eating certain foods. At the same time, with behavior correction, let children establish correct eating habits. The content of the diet adjustment plan is formulated according to the obesity situation. For young people who are only slightly or moderately obese, they can be treated according to a less strict diet adjustment plan. For those with mild to moderate obesity whose intervention effect is not obvious, we should further limit the types of food we eat, and teach children how to correctly choose the food suitable for healthy search and how to replace it among different foods. The dietary guidance plan includes two kinds of food, which are encouraged to eat more and discouraged to eat more. They are expressed in different colors, namely, red light food is forbidden/eaten less, and green light food is edible. Mainly limit some high-calorie foods, or finely processed carbohydrates, such as refined white flour, potato with starch, fat, fried food, sugar and chocolate, cream products and so on. Any sweet drink should be restricted. Eat less or no food with high calorie and small size. The contents of this plan include asking obese people to eat more foods containing cellulose or unrefined processing, and asking their parents to help obese children eat dregs. The food for children should be cut to the right size, not too big, mainly in small pieces. Don't lick dishes and bowls every time you eat, and eat less sweets. The daily intake of protein, vitamins, minerals and trace elements should be kept above the lower limit, and the calories should be supplied according to the maintenance period after the weight control is satisfactory (table 1).
8. Drug therapy
(1) Amphetamine: It has been introduced that the application of amphetamine can reduce appetite, and the dosage is 2.5 ~ 5 mg, twice a day, 0.5h before meals, and the course of treatment is about 6 ~ 8 weeks. However, drug therapy is rarely used in children. On the one hand, it is easy to produce drug dependence, on the other hand, if you don't pay attention to diet control, the drug effect is not obvious.
(2) Gene product therapy: The animal experiment of protein expression product (leptin) of obesity gene has been basically completed, and the clinical experiment has begun. Leptin seems to be effective in reducing weight, but it is not specific. Only 5% ~ 10% obese patients are sensitive to leptin. The regulation of adipose tissue apoptosis and the use of related products will be a promising field in obesity control.
(3) Treatment of hypoxemia: In addition to the low-calorie diet of 2500 ~ 3330 kJ/d (600 ~ 800 kcal/d), cardiotonic, diuretic and low-concentration oxygen should be given, and excessive oxygen should be used to inhibit breathing. Anticoagulation therapy can limit thrombosis. Prognosis: 1. Obesity lasts until adulthood. Whether obesity can last until adulthood depends on lifestyle. The relative risk of weight control is between 1.5 ~ 1.6 and 0.69 ~ 0.73. The relative risk of those who do not accept weight control can rise to 1.88 ~ 2.34.
2. The risk factors of cardiovascular disease in adults depend not only on how many cockroaches are overweight, but also on the location of fat distribution. Waist-hip ratio is an important predictor of risk factors of ischemic heart disease, infarction and sudden death. When boys are higher than 1.0, and girls are higher than 0.8, the risk increases sharply. Childhood obesity is a high risk factor for adult atherosclerosis. Every overweight 1 kg of adult body weight increases cholesterol by 20 ~ 22 mg/dl. Blood cholesterol, blood pressure and weight/height index are clustered, which is seen in school-age children. The survey of simple obesity in China shows that the blood pressure of 60% obese children is higher than 95% percentile.
3. Risk factors for cancer in adulthood: colon, rectum and prostate, as well as endometrium, cervix, ovary, gallbladder and breast in women. When overweight is 40% or more, the cancer virus rate of male is 1.33/65438+ million, and that of female is 1.5/65438+ million.