Obesity (Children)

Childhood obesity has been a significant concern in Singapore for the past two decades. In 2010, 12.0% of primary school students and 10.5% of secondary school students were reported to be overweight or severely overweight ^[1]. In Asian populations, overweight is defined as a body mass index (BMI) ≥ 23 kg/m2 and obesity is defined as a BMI ≥ 27.5 kg/m². Comparatively, a child is considered overweight if their BMI falls between the 85^th and 95^th percentile for their age and gender, and obesity if it is at or above the ≥ 95^th percentile.

The BMI is calculated using the formula below:

BMI = weight (kg) ÷ [height (m)]²

Source: ^[1] Clinical Practice Guidelines 1/2016

Obesity results from a combination of factors, including excessive calorie intake, inadequate physical activity and genetic influences. In some children, specific diseases and medications can lead to obesity.

Immediate health concerns linked to obesity include Diabetes Mellitus, high blood pressure, hyperlipidaemia, fatty liver, obstructive sleep apnoea (OSA), irregular menstrual cycles, joint issues, depression and low self-esteem. In our clinic, healthcare professionals assess these through questioning, physical examinations and blood tests.

Long-term risks include persistent adult obesity and increased likelihood of heart disease, stroke, osteoarthritis and various cancers.

Effective weight loss involves a combination of healthy eating and regular exercise. Motivating is key to success, with support from family, friends, schools and healthcare professionals being crucial.

Our multidisciplinary weight management team comprises a paediatrician, a dietitian, an occupational therapist, a physiotherapist and a nurse clinician. This team provides comprehensive care, including monitoring and treating obesity-related complications, dietary customisation, motivational support, parenting strategies and exercise guidance.

Children and adolescents with obesity may face social pressures and experience low self-esteem, bullying and depression. As parents, it’s essential to provide encouragement, refrain from judgement and model healthy lifestyle choices. Constant criticism can be counterproductive, leading to resistance to healthy changes.

Continued clinical research is essential for advancing paediatric healthcare. Our doctors are committed to contributing to the future of child health and medicine through both clinical practice and research.

1. Lillycrop K, Murray R, Cheong C, Teh AL, Clarke-Harris R, Lee YS, . . . Godfrey KM (2017).
   ANRIL Promoter DNA Methylation: A Perinatal Marker for Later Adiposity.
   EBioMedicine, 19:60-72. doi: 10.1016/j.ebiom.2017.03.037
2. Fogel A, Goh AT, Fries LR, Sadananthan SA, Shek LP, Lee YS, . . . Forde CG (2017).
   Faster eating rates are associated with higher energy intakes during an ad libitum meal, higher BMI and greater adiposity among 4•5-year-old children: results from the Growing Up in Singapore Towards Healthy Outcomes (GUSTO) cohort.
   The British Journal of Nutrition, 117(7):1042-1051. doi: 10.1017/S0007114517000848
3. Lin X, Lim IY, Wu Y, Teh AL, Chen L, Lee YS, . . . GUSTO study group (2017).
   Developmental pathways to adiposity begin before birth and are influenced by genotype, prenatal environment and epigenome.
   BMC Medicine, 15(1):50. doi: 10.1186/s12916-017-0800-1
4. Fogel A, Goh AT, Fries LR, Sadananthan SA, Shek LP, Lee YS, . . . Forde CG (2017).
   A description of an 'obesogenic' eating style that promotes higher energy intake and is associated with greater adiposity in 4.5year-old children: Results from the GUSTO cohort.
   Physiology & Behavior, 176:107-116. doi: 10.1016/j.physbeh.2017.02.013
5. Chen LW, Aris IM, Bernard JY, Tint MT, Colega M, Shek LP, . . . Lee YS (2017).Associations of maternal macronutrient intake during pregnancy with infant BMI peak characteristics and childhood BMI.
   The American Journal of Clinical Nutrition, 105(3):705-713. doi: 10.3945/ajcn.116.148270
6. Foo JL, Ling H, Lee YS, Chang MW (2017).
   Microbiome engineering: Current applications and its future.
   Biotechnology Journal, 12(3). doi: 10.1002/biot.201600099
7. Ooi DS, Tan VM, Ong SG, Chan YH, Heng CK, Lee YS (2017).
   Differences in AMY1 Gene Copy Numbers Derived from Blood, Buccal Cells and Saliva Using Quantitative and Droplet Digital PCR Methods: Flagging the Pitfall.
   PLoS One, 12(1):e0170767. doi: 10.1371/journal.pone.0170767
8. Chen LW, Aris IM, Bernard JY, Tint MT, Chia A, Shek LP, . . . Lee YS (2016).
   Associations of Maternal Dietary Patterns during Pregnancy with Offspring Adiposity from Birth Until 54 Months of Age.
   Nutrients, 9(1). doi: 10.3390/nu9010002
9. Ooi DS, Ong SG, Heng CK, Loke KY, Lee YS (2016).
   In-vitro function of upstream visfatin polymorphisms that are associated with adverse cardiometabolic parameters in obese children.
   BMC Genomics, 17(1):974. doi: 10.1186/s12864-016-3315-9
10. Aris IM, Bernard JY, Chen LW, Tint MT, Pang WW, Lim WY, . . . Lee YS (2016).
    Infant body mass index peak and early childhood cardio-metabolic risk markers in a multi-ethnic Asian birth cohort.
    International Journal of Epidemiology. doi: 10.1093/ije/dyw232
11. Lee YS, Biddle S, Chan MF, Cheng A, Cheong M, Chong YS, . . . Wang J (2016).
    Health Promotion Board-Ministry of Health Clinical Practice Guidelines: Obesity.
    Singapore Medical Journal, 57(6):292-300. doi: 10.11622/smedj.2016103
12. Ong YL, Quah PL, Tint MT, Aris IM, Chen LW, Lee YS, . . . Foong-Fong Chong M (2016).
    The association of maternal vitamin D status with infant birth outcomes, postnatal growth and adiposity in the first 2 years of life in a multi-ethnic Asian population: the Growing Up in Singapore Towards healthy Outcomes (GUSTO) cohort study.
    The British Journal of Nutrition, 1164):621-31. doi: 10.1017/S0007114516000623
13. Chong MF, Ayob MN, Chong KJ, Tai ES, Khoo CM, Lee YS, . . . Khoo EY (2016).
    Psychometric analysis of an eating behaviour questionnaire for an overweight and obese Chinese population in Singapore.
    Appetite, 101:119-24. doi: 10.1016/j.appet.2016.03.005
14. Leow SC, Poschmann J, Too PG, Yin J, Joseph R, Lee YS, . . . Stünkel W (2016).
    The transcription factor SOX6 contributes to the developmental origins of obesity by promoting adipogenesis.
    Development (Cambridge, England), 143(6):950-61. doi: 10.1242/dev.131573
15. Aris IM, Soh SE, Tint MT, Saw SM, Rajadurai VS, Godfrey KM, . . . Lee YS (2015).
    Associations of gestational glycemia and prepregnancy adiposity with offspring growth and adiposity in an Asian population.
    The American Journal of Clinical Nutrition, 102(5):1104-12. doi: 10.3945/ajcn.115.117614
16. Parvaresh Rizi E, Teo Y, Leow MK, Khoo EY, Yeo CR, Lee YS, . . . Khoo CM (2015).
    Ethnic Differences in the Role of Adipocytokines Linking Abdominal Adiposity and Insulin Sensitivity Among Asians.
    The Journal of Clinical Endocrinology and Metabolism, 100(11):4249-56. doi: 10.1210/jc.2015-2639
17. Quah PL, Chan YH, Aris IM, Pang WW, Toh JY, Lee YS, . . . GUSTO study group (2015).
    Prospective associations of appetitive traits at 3 and 12 months of age with body mass index and weight gain in the first 2 years of life.
    BMC Pediatrics, 15(1):153. doi: 10.1186/s12887-015-0467-8
18. Lin X, Aris IM, Tint MT, Soh SE, Godfrey KM, Yeo GS, . . . Lee YS (2015).
    Ethnic differences in effects of maternal pre-pregnancy and pregnancy adiposity on offspring size and adiposity.
    The Journal of Clinical Endocrinology and Metabolism, 100(10):3641-50. doi: 10.1210/jc.2015-1728
19. Pan H, Lin X, Wu Y, Chen L, Teh AL, Lee YS, . . . GUSTO Study Group (2015).
    HIF3A association with adiposity: the story begins before birth.
    Epigenomics, 7(6):937-50. doi: 10.2217/epi.15.45
20. Ho CW, Loke KY, Lim YY, Lee YS (2014).
    Exogenous Cushing syndrome: a lesson of diaper rash cream.
    Hormone Research in Paediatrics, 82(6):415-8. doi: 10.1159/000363517
21. Tan KML, Ooi SQ, SG Ong, CS Kwan, Chan RME, Loke KY, . . . Lee YS (2014).
    Functional characterization of variants in MC4R gene promoter region found in obese children.
    The Journal of Clinical Endocrinology and Metabolism, 99(5):E931-5. doi: 10.1210/jc.2013-3711
22. Ooi SQ, Chan RM, Poh LK, Loke KY, Heng CK, Chan YH, . . . Lee YS (2014).
    Visfatin and its genetic variants are associated with obesity-related morbidities and cardiometabolic risk in severely obese children.
    Pediatric Obesity, 9(2):81-91. doi: 10.1111/j.2047-6310.2013.00149.x
23. Aris IM, Soh SE, Tint MT, Shen L, Chinnadurai A, Saw SM, . . . Lee YS (2014).
    Effect of maternal glycemia on neonatal adiposity in a multiethnic Asian birth cohort.
    The Journal of Clinical Endocrinology and Metabolism, 99(1): 240-7. doi: 10.1210/jc.2013-2738
24. Lee YS (2013).
    Genetics of nonsyndromic obesity.
    Current Opinion in Pediatrics, 25(6):666-73. doi: 10.1097/MOP.0b013e3283658fba
25. Chen YY, Chan RME, Tan MLK, Poh LKS, Loke KY, Wang JP, . . . Lee YS (2013).
    The association of a Nucleobindin 2 gene (NUCB2) variant with childhood adiposity.
    Gene, 516(1):48-52. doi: 10.1016/j.gene.2012.12.017
26. Pwint MK, Lee YS, Wong TY, Saw SM (2013).
    Prevalence of overweight and obesity in Chinese preschoolers in Singapore.
    Annals Academy of Medicine, Singapore, 42(2):66-72.
27. Lee YS (2012).
    Melanocortin 3 receptor gene and melanocortin 4 receptor gene mutations: the Asian Perspective.
    Diabetes/Metabolism Research and Reviews, 28(S2): 26-31. doi: 10.1002/dmrr.2351
28. Lee YS (2009).
    The role of leptin-melanocortin system and human weight regulation: lessons from experiments of nature.
    Annals Academy of Medicine, Singapore, 38(1):34-11.
29. Lee YS (2009).
    The role of genes in the current obesity epidemic.
    Annals Academy of Medicine, Singapore, 38(1):45-3.
30. Lee YS (2009).
    Consequences of Childhood Obesity.
    Annals Academy of Medicine, Singapore, 38(1):75-7.
31. Lee YS, So JB, Deurenberg-Yap M (2009).
    Confronting the obesity epidemic: call to arms.
    Annals Academy of Medicine, Singapore, 38(1):1-2.
32. Creemers JWM, Lee YS, Oliver RL, Bahceci M, Tuzcu A, Gokalp D, . . . Farooqi IS (2008).
    Mutations in the amino-terminal region of proopiomelanocortin (POMC) in patients with early-onset obesity impair POMC sorting to the regulated secretory pathway.
    The Journal of Clinical Endocrinology and Metabolism, 93(11):4494-9. doi: 10.1210/jc.2008-0954
33. Lee YS, Kek BLK, Poh LKS, Saw SM, Loke KY (2008).
    Association of raised liver transaminases with physical inactivity, increased waist-hip ratio, and other metabolic morbidities in severely obese children.
    Journal of Pediatric Gastroenterology and Nutrition, 47(2):172-8. doi: 10.1097/MPG.0b013e318162a0e5
34. Lee YS, Poh LKS, Kek BLK, Loke KY (2008).
    Novel Melanocortin 4 receptor gene mutations in severely obese children.
    Clinical Endocrinology, 68(4):529-35. doi: 10.1111/j.1365-2265.2007.03071.x
35. Lee YS, Poh LKS, Kek BLK, Loke KY (2007).
    The role of melanocortin 3 receptor gene in childhood obesity.
    Diabetes, 56(10):2622-30. doi: 10.2337/db07-0225
36. Lee YS, Challis B, Thompson D, Yeo G, Keogh J, Madonna M, . . . Farooqi IS (2006).
    A POMC variant implicates beta-melanocyte-stimulating hormone in the control of human energy balance.
    Cell Metabolism, 3(2):135-40. doi: 10.1016/j.cmet.2006.01.006
37. Lee YS, Poh LKS, Loke KY (2002).
    A novel melanocortin 3 receptor gene (MC3R) mutation associated with severe obesity.
    The Journal of Clinical Endocrinology and Metabolism, 87(3):1423-6. doi: 10.1210/jcem.87.3.8461
38. Lee YS, K Y Loke (2000).
    The molecular pathogenesis of obesity: An unfinished jigsaw puzzle.
    Annals Academy of Medicine, Singapore, 29(3):388-95.