The genes are not the only reason…


Dr. Rayna Stoyanova graduated medicine in Sofia in 2011. Later she had residency in gastroenterology in a capital hospital. She is currently assistant professor in the Department of Metabolic and Endocrine Diseases in University Hospital “ISUL – Tsaritsa Yoanna”. talked to her about the consequences of improper nutrition and the sedentary lifestyle, as well as about obesity in children and the fight with this increasingly occurring disease.

Q: Dr. Stoyanova, is the number of children with overweight increasing?

Globally, for the past 33 years the number of children with overweight and obesity has increased by 47%. Nearly 27% of the boys and 26% of the girls in Bulgaria up to 20 years of age are with overweight, as about 7% of the children suffer from morbid obesity. The World Health Organization even claims that the obesity among children and adolescents in Europe is so widespread that it may require a change in the criteria for “normal” weight.

Q: What are the most common causes of obesity in children?

Although the heredity is one of the factors, the alarming increase in the number of children suffering from obesity in the last 20-30 years clearly shows that the genes are not the only reason. It is believed that the vector of this outbreak is predominantly the fast food and the culture that accompanies this lifestyle.

The lack of enough physical activity, standing in front of the computer and the few games outside also determine the reduced energy consumption against the background of systematic overfeeding. The children are true “parrots” and do what their parents and everybody who bring them up do every day. The parents and mentors should be a role model with their nutrition and habits in the everyday life.


Q: What measures should be taken?

The treatment of overweight in children should be complex, no matter its degree – proper nutrition, medications if needed, physical activity. It won’t be enough effective without any of these parts. The problem is that overweight comes back again when the improper nutrition starts again. In children with overweight up to 7 years of age we should provide nutrition that keeps the kilograms close to the norm – it is important they to be reduced gradually and slowly. The food intake should be 5-6 times a day in moderate amounts, consistent with the taste, age and the health status of the child.

The diet should include the consumption of fish at least two times a week, lean meat 3-4 times, eggs 3-4 times, everyday consumption of low-fat dairy products which lead to faster absorption of the necessary for them calcium, fruits and vegetables daily, enough water and liquids. Always emphasize on the active daily exercise of the child – according to his health and age. The nutritional and physical activity habits are formed at this age. The children learn much easier than leaving off the bad habits.

The reduction of kilograms for kids from 7 to 12 years of age should be moderate as well, about 3 kg per month. It is important to keep the weight and its further reduction to continue in the next stage. This happens by providing proper nutrition of the children both at home and school. This depends on the parents as well. It is wrong to reward the kids with chips, pasta, chocolate and other sweets. Do not teach them or break them of drinking carbonated drinks, replace them with fresh juices and water. To protect them from overweight, everybody in the family must help unanimously. Do not insist on eating at all cost everything you have filled his plate with. Also do not leave him to eat as long as he want. Insist on daily exercise or enroll him to practice his favorite sport.

There is increasing trend of sedentary lifestyle of the children – computers, TV. The age from 13 to 17-18 years is a difficult age from physiological, physical and psychological aspect. It is an important period of the children development. It is very difficult to accomplish healthy nutrition especially if the child hasn’t eaten that way so far. Junk food is preferred – pizzas, hamburgers, pastries, croissants, snacks, chips, pretzels, broths, packaged soups, etc. So, it is very important to be properly consulted and adequately managed.

Q: How should the young people be encouraged to lead an active lifestyle?

It’s a fact that the battle between the TV and computer and the game outside is getting really quite fierce. And having all these possibilities for entertainment without movement, the time and desire for free play becomes less. The parents, concerned about the health and development of their children, should provide them enough variety of options with which to distract their attention from the screen and to secure them enough movement every day. Up to 5 years of age for example, the child is already prepared to ride a bike on two wheels and it is important to build this own skill at this moment.

Even if you have the possibility, it is better to leave aside the toys with batteries in which the child is having a ride without effort on his part. Yet, we are talking about physical development and exercise above all. The ball games, among the other things, improve and develop hand-eye coordination (throwing and catching) and include a lot of running and jumping. The children are encouraged mostly by personal example and mutual sports. Be an example for your children. Active parents have more active children. Present some of the activities that you like to your child and take part in those which he likes.

Q: What are the basic rules that must be followed in order the people to eat healthy?

Avoid semi-cooked and canned foods on first place – they contain a lot of preservatives and salt. Eat wholesome foods, rich in minerals, vitamins and cellulose. Increase the consumption of wholegrain legumes, brown rice, wholegrain pasta and bread up to 50-70% of your daily calories. Eat more fresh fruits, salads and vegetables, about half a kilo a day is best. Reduce the amount of fat in your food, especially the saturated. They should be no more than 30% of the daily calories. This means about 75g a day for males.

Use more olive oil for cooking and salads. Reduce the amount of red meat in your food. Eat it in one-two servings per week. Eat more fish. The fish, and especially the fat one, influences positively on blood cholesterol. Increase the consumption of nuts and seeds. The World Health Organization recommends eating 30g nuts and seeds per day. Reduce the amount of sugar and sugar products in your menu. They are absorbed very fast and sharply raise blood glucose. This increases the risk of diabetes and atherosclerosis. Reduce the amount of salt you intake. This will lower the risk of high blood pressure and coronary artery disease. To improve the taste quality of food, use herbs, spices and black pepper.

Q: What is the influence of medications for weight loss, do they really help?

Childhood obesity is difficult to cure, the success is unsatisfactory and the results are not lasting. Only 25% of the kids achieve long-term weight reduction, there is no change in about 25% and in 50% obesity progresses despite the treatment. The treatment is a combination of diet and increased physical activity. The most suitable is the balanced diet with a reduction of the calories to 800 a day in preschool age and to 1000-1200 calories a day at school age. To ensure normal growth, sufficient complete proteins should be consumed. Extreme diets with rapid weight loss are not recommended in children. Drugs for weight reduction are forbidden in the childhood. The physical activity should be appropriate to the child’s age. The exercises should be gradual, systematic and with gradual increase of the load.

Q: What advice would you give to the parents and young people?

Eat healthy. Many of the young people are not interested in what they eat. For them, it doesn’t matter if they eat healthy or junk food, they are always feeling good. But the impact will come after years when if you have eaten junk food, you will gain weight or you’ll get sick of different diseases associated with the food. It is best to control your nutrition while you are young.

Another personal advice is to entertain truly and sincerely whenever they can. This doesn’t mean that they should only have fun, but don’t spend your youth at home and over the textbooks. Get sleep. Many young people underestimate the sleep and do not get enough of it. This may lead to different health problems in the future. That’s why it is good after a few nights of entertainment several nights of good sleep to follow. Also don’t study all night when you have exams, this may lead to depression.

Remove carbonated drinks. It doesn’t matter if you are 10-20 or 60, carbonated beverages are bad in all ages. They will not only make you swell and gain weight, but also may lead to various diseases, including cancer. So it is good to quit early these drinks.

Do exercise. It is important to create a routine to exercise while you are young. Make the training part of your life. This will help you feel better in your entire life. Choose a sport that you like and have a talent in it, and have fun with it.

Go for a walk. Don’t spend the whole day at home, but go for a walk, look around new places, use all the possibilities of youth.