Problem statement

There has been a greater presence of overweight children in pediatric consultations.

this becomes worrying. Childhood obesity is a topic that concerns
health-related organizations, both in our country and around the world, today in
It is increasingly common to see overweight children, and over time, this leads them to
suffer from serious health problems.

I have been able to observe that today's children engage in little physical activity, except for what
What is the school subject 'Physical Education' in schools or colleges?
from the Dominican Republic. The use of tablets, cell phones, laptops is more common,
smart televisions as a form of entertainment. Similarly, they are consumed.
the so-called junk foods that provide fats and calorie content to the body
children and adults. The problem of overweight and obesity in children is not only
it is found in developing countries but is also observed in societies
subdesarrolladas, en la cuales se ingieren alimentos con poco contenido nutricional.

In the last 20 years, the prevalence of obesity in children has increased.

abruptly, especially in the more developed countries. It is estimated that today,
In many countries, 1 in 10 children is obese by the age of 10. The Organization
The World Health Organization categorizes childhood obesity as one of the most significant problems.
greats of the 21st century.

En República Dominicana, este problema está avanzando con rapidez pues según una
statistics presented by Public Health, in the last 20 years, the increase in cases
childhood obesity has risen from 5% to 20% currently. This increase leads to
pediatricians are expressing concern about the health of Dominican children, as in their
consultations receive significant cases of children and adolescents with health problems
characteristic of adults.

Among the consequent problems of childhood obesity are: problems of

health issues such as hypertension, type 2 diabetes, metabolic disorders with high levels of
cholesterol and triglycerides, risks of cardiovascular diseases, difficulties
respiratory issues, problems in bones and joints, developmental disorders
(premature maturity, in girls irregular menstrual cycles); physical problems
such as fatigue, discouragement, low physical performance capacity; disorders
nutritional; cognitive disorders (low academic performance capacity);
personality and social disorders (depression, low self-esteem, insecurity,
social and school discrimination, etc.) and even, sleep disorders.

This problem has basically been occurring due to poor nutrition (intake
of foods high in polyunsaturated fats and sugar), a sedentary lifestyle
of today's children and the long hours that many parents must

1
dedicating in their work and with the little time they have, does not allow them to carry out
healthier foods and/or involve your children in recreational activities that
allow for greater movement and energy consumption.

It can also be present due to genetic assignment and/or obese parents who can influence it.
the health of their children.

All of the above leads children towards a life of overweight or obesity,

The aim of this work is to determine whether we should be concerned about...
increasingly high indices of the problem we present, if we are in the
ability to determine where we drink strengthen the knowledge we have about
the issue, where we should direct corrective measures so that obesity
childish behavior should be corrected before it becomes a situation that gets out of our hands
hands as a country.

Importance of the problem

In the Dominican Republic, it is currently more common to see both fathers and mothers involved.
from the same home working long shifts and hardly having any time left
to properly care for their children in all aspects, especially in the
nutrition, what they eat, when, etc., hence the importance of researching about this
theme.

Research subjects
In this work, we want to select children of school age as the study population.
school-age children, between 3 and 8 years old, who attend pediatric consultations for health problems
at the Robert Reid Cabral Hospital.

Geographical delimitation
Dicho hospital está ubicado en el sector La Feria, de Santo Domingo, Distrito Nacional,
Dominican Republic.

Temporal delimitation
Period January–December 2017

Proposed methodology
Observation of the pediatric room, surveys to parents and doctors about ailments
most common in the consultation, if there are many problems of childhood obesity. Review
records from previous months (January to date), in Public Health and in the same hospital.

Reason or usefulness of the study

A study on childhood obesity in the Dominican Republic will help determine whether
the children of our country are heading towards this problem in the short term and
will allow us to take measures that help correct or prevent new cases. Also
will help promote child health.

2
 Research Questions

Are technological advances promoting sedentary behavior in people?

especially in children, which in turn leads to cases of obesity
Are childhood cases increasing in our country?

2. Are there currently programs that promote awareness about the

negative consequences of childhood obesity?

3. Are the hours that they have enough to prevent childhood obesity?
dedicate the children in the subject of Physical Education?

Is insecurity at the societal level a driver that leads parents to have

Your children at home and indirectly this promotes a sedentary lifestyle?

5. Can socioeconomic development be indirectly encouraging that

parents who work long hours offer their children low meals
nutritional content but high in fats and sugars?

6. What are the elements that allow us to detect obesity at first glance?
in a child?

Objectives
1. Determine if technology and its advancements encourage sedentary behavior in
children, causing them to be overweight or obese.

2. Determine whether the lack of knowledge about the negative consequences that
childhood obesity allows for an increase in cases in the country.

3. Verify if the physical education programs in schools prevent children from

suffer from obesity or overweight.

4. Determine if the levels of insecurity in Dominican society are

related to the decrease in physical activity among school-aged children.
5. Investigate whether the long hours that parents work with overweight children
are related to the intake of high-calorie foods in
school-age children.

6. Identify the traits that allow determining if a child is overweight or

obesity.

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 Theoretical Framework

What are overweight and obesity?

Overweight and obesity are defined as "an abnormal or excessive accumulation of

fat that poses a health risk.

Measurement of overweight and obesity

It is difficult to find a simple way to measure overweight and obesity in children.

and adolescents because their bodies undergo a series of physiological changes as they grow
that are growing. Depending on the age, there are several methods to determine
what is a healthy body weight:

Between 0 and 5 years

The WHO growth standards for children, presented in April 2006, include
measurements of overweight and obesity in infants and children up to 5 years old.

Between 5 and 19 years

The WHO has developed reference data on growth between the ages of 5 and 19.
This is a reconstruction of the 1977 reference from the National Center for
Health Statistics (NCHS)/WHO and complemented with sample data from
children under 5 years used to develop child growth patterns of the
WHO. (7. [Link]

The most commonly used parameter to measure overweight and obesity is the body mass index.
corporal (BMI), whose determination is simple and allows for the identification of overweight and
obesity in adults, both at the individual and population level. BMI is defined as
the weight in kilograms divided by the square of the height in meters (kg/m2). The BMI is
the same for both sexes and all ages (in adults). However, it must
to be considered as a not very precise orientation, because it may not correspond
with the same body fat percentage in different individuals. The BMI still does not
it is usable in children.

Obesity can be defined as the excessive accumulation of adipose tissue. In children

fat deposits occur mainly at the subcutaneous level, while in
young people and adolescents, just like adults, are also formed
intra-abdominal fat deposits, a pattern that is associated with a higher risk of
metabolic disorders.

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The adverse effects and health risks of obesity in the early stages of
life includes both physical and psychosocial problems in the short term. Studies
Longitudinal studies suggest that childhood obesity, after the age of 3, is associated
in the long term with a higher risk of obesity in adulthood and with an increase in
morbidity and mortality; persistence of associated metabolic disorders, a
increased cardiovascular risk and some types of cancer.

According to the book Overweight and Obesity in Children from European Countries (2000) (1): The
childhood obesity is associated with an increased risk of cardiovascular disease, with
hyperinsulinemia and lower glucose tolerance, and with alterations in the lipid profile
in blood and even high blood pressure. The metabolic changes observed in children
Obese adolescents are also known as premetabolic syndrome and can
are related to the endocrine disorders observed in obesity, such as
growth hormone deficiency or hyperleptinemia.

Orthopedic problems that are accompanied by alterations have also been described.
physical mobility and inactivity; disorders in the immune response with an increase in
susceptibility to infections; skin alterations that reduce the capacity of
wound healing and infections and nighttime respiratory problems and even
sleep apnea (2. Maffeis C., 2000)

The psychosocial consequences of body image distortion for the obese child
they can be as important and even more than physical ones. Low self-esteem, isolation
social, discrimination, and abnormal patterns of behavior are some consequences
frequent (3. Phillips RG, Hill, 1998)

There is still no solid epidemiological evidence regarding the long-term effects.

the duration and persistence of childhood obesity into adulthood. Considering the
possible limitations in the existing data, it seems that children are more likely to
obese adults are compared to normal weight children, although
Paradoxically, most adults who are obese today do not
they were obese children.

Childhood obesity in the second decade of life is a predictive factor of

adult obesity increasingly consistent (4. Influence of diet, physical activity, and obesity
in childhood obesity, 1998). If one or both parents are obese, the likelihood of
that childhood obesity persists into adulthood is even greater. Some studies
prospective studies have shown that there are many confounding factors that
they act as tools to determine the role of diet and physical exercise
in the genesis of childhood obesity, for example, the obesity of the parents
B, 2000)

Although to date there has been a greater emphasis on total energy intake with the
diet, today voices emerge that point to the importance of energy density8 and

5
the frequency of consumption and the energy distribution. Regarding the role of the activity
In physics, the importance of physical exercise has been analyzed in greater detail.
vigorous; however, today it is accepted that the fact of dedicating many hours to watching the
television or video games configure a lifestyle in itself that goes beyond the
sedentary lifestyle (6. Television as a Cause of the Increase in Obesity among Children in the United States
Unidos, 1996)

The analysis of the interaction between genetics and the environment will be of special interest.
to detect high-risk individuals in the near future. The early assessment of the
childhood obesity is important because it is the best time to try to prevent it.
progression of the disease and the associated morbidity. School age and the
Adolescence is a crucial stage for the formation of eating habits.
and other lifestyles that will persist in later stages, with repercussions, not only
at this stage regarding the possible impact as a risk factor, but also in the
adult age and even in old age.

The WHO (World Health Organization) has classified obesity as a global epidemic,
and estimates that by the year 2015 there will be 2.3 billion adults with overweight
more than 700 million obese people. The WHO defines obesity as 'an accumulation
abnormal or excessive fat that can be harmful to health," and that affects "to
all ages and socioeconomic groups.

Experts estimate that 80% of obese children and adolescents will continue
becoming so when they reach adulthood if the appropriate measures are not taken. In the
in the last 40 years, childhood obesity has doubled in the United States, while,
In Spain, more than half of adults are obese or overweight, disorders
that affect 28% of Spanish children, who could see their hope diminished
life for it.

It is important to distinguish between overweight and obesity. A person is overweight when their
weight is above the recommended level in relation to size, and this is calculated with the BMI
the body mass index. It is considered that there is overweight when the BMI is
finds between 25 and 29.9, while from a BMI of 30 it is considered that the
the person is obese.

Various studies have linked childhood overweight with obesity in adulthood.

reach adulthood, and medical professionals warn that prevention is needed
and address weight issues from childhood to prevent these disorders and the
diseases associated with them reduce the quality of life of the population and
overwhelm the health system (almost 30% of the adult population in Spain suffers
obesity.

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What are the causes?

The fundamental cause of overweight and childhood obesity is the imbalance between the
caloric intake and caloric expenditure. The global increase in overweight and obesity
infantile is attributable to several factors, such as:

The global dietary shift towards an increase in the intake of hypercaloric foods
with abundant fats and sugars, but with scarce vitamins, minerals, and others
healthy micronutrients.
The trend towards decreased physical activity due to the increase in nature
sedentary from many recreational activities, the change in modes of transport and
the growing urbanization.
Social causes of the childhood obesity epidemic

The WHO recognizes that the increasing prevalence of childhood obesity is due to changes
social issues. Childhood obesity is primarily associated with an unhealthy diet and
little physical activity, but it is not solely related to behavior of the
child, but also, increasingly with social and economic development and policies in
subject of agriculture, transportation, urban planning, environment, education and
processing, distribution, and marketing of food.

The problem is social and therefore requires a population-based, multisectoral approach.

multidisciplinary and adapted to cultural circumstances.

Unlike most adults, children and adolescents cannot choose the

environment in which they live nor the food they consume. Likewise, they have a capacity
limited in understanding the long-term consequences of their behavior. By
consequently, they need special attention in the fight against the epidemic of
obesity.

What does emotional eating mean?

Emotional eating is the use of food as a way to cope with

emotions instead of as a way to calm hunger. We've all experienced this at some point.
Sometimes, we have finished an entire bag of chips just out of boredom.
or we have devoured one cookie after another while we leaned on our elbows in front of a
important exam. But when it is done habitually —especially without being
aware of it —emotional eating can affect weight, health and
general well-being.

There aren't many people who make the connection between eating and emotions. But understanding
what triggers emotional eating behavior can help to continue the
necessary steps to stop doing it.

7
One of the main myths about emotional eating is that it is triggered by
negative emotions. Yes, it is true that people often turn to food when
is stressed, feels alone, sad, anxious or bored. But emotional eating
it can also be associated with positive emotions, such as the romanticism of sharing a
dessert on Valentine's Day or the celebration of a banquet on a holiday.

Sometimes emotional eating is associated with significant life events, such as

a death or a divorce. But more often it is the countless and small stresses.
daily those that make people seek comfort or distraction in food.

The patterns of emotional eating can be learned: a child who is always

a sweet is given after an important achievement, it can grow using sweets as
reward for a job well done. A child who receives cookies for stopping crying
puede aprender a asociar las galletas al consuelo.

Risk factors

Childhood obesity, although it may be caused by a genetic disease

endocrine, in 99% of cases it occurs as a result of the combination of a
a series of environmental factors (an inadequate diet and sedentary lifestyle), genetic (the
children whose parents are obese have a higher risk of suffering from the disorder) and
psychological (when food is used to compensate for emotional problems, stress
or boredom).

Environmental factors

A high-calorie diet, with an excess of foods rich in fats and sugars, and that
suppose an energy intake higher than actual needs for long
periods of time, has as a consequence a significant increase in fat
Watching television is an important risk factor for developing obesity.
because, in addition to being a sedentary activity that replaces others in which
Yes, energy is consumed, it facilitates continued eating, and even characters are imitated with
bad eating habits (the influence of television is considered so important
about the smallest ones who, in the United States, the diet of the Monster was modified.
the Sesame Street Cookies, turning him into a great fan of vegetables). The
computer and consoles add hours to children's sedentary behavior, especially from
from seven or eight years old, and they have replaced other activities like games and sports
outdoor activities that helped maintain the balance between calorie intake and expenditure
of energy.

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Genetic factors

Inheritance also largely determines a person's metabolism: the

process by which the body converts the nutrients from our food into
energy (calories). The basal metabolic rate (BMR) is the rate at
that we burn energy while we are at rest. From sixty to seventy-five percent
One hundred of our total energy is spent in this state to maintain the functions
vital functions such as breathing, circulation, body temperature, digestion, and the
glandular activity.

A person's metabolic 'rhythm' can be up to 20 percent faster or

slower than someone else's. This amounts to a difference of four hundred.
calories a day. So two teenagers can go cycling and eat the same
caloric amount, but the one with the lowest BMR will burn fewer calories. When
more calories are consumed than are burned, the excess is stored in the form of
body fat for future use. Obese teenagers often had
lower resting metabolic rates when they were children, before becoming overweight.
([Link]://[Link]/health-issues/conditions/obesity/pages/organic-causes-
[Link]

However, other organic factors are what partly determine which children
they can eat whatever they want and they don't seem to gain an ounce, and what children face
a lifelong struggle to keep their weight under control.

The risk of a child being obese increases considerably when their parents do
son (has four times more chances of developing obesity if one of their parents
he is obese, and eight times more likely if both parents are obese). However, in this equation
not only does genetic inheritance intervene (ease of gaining weight, inadequate
distribution of body fat...), but the family's lifestyle such as the
preference for certain foods or ways of cooking them that increase the
caloric intake, as well as low energy expenditure due to little or no activity
Physics. The child will normally follow the same family habits, which will favor the
weight gain already during childhood.

Psychological factors

Sometimes, both children and adults seek a reward in food, a

a way to mitigate their shortcomings and frustrations. They may eat when they feel sad
the insecure, to forget their problems, due to stress or boredom. The foods
selected foods usually provide little nutritional value and many calories (sweets and candies,
snacks such as industrial fries and similar...). In these cases, also the
Children may be imitating the behaviors they have observed in their elders.

9
Why are childhood overweight and obesity important?

Childhood obesity is associated with a higher likelihood of death and disability.

premature issues in adulthood. Children who are overweight or obese have greater
probabilities of remaining obese in adulthood and suffering at older ages
early non-communicable diseases such as diabetes or diseases
cardiovascular.

The risk of most non-communicable diseases resulting from obesity

it partly depends on the age of onset and the duration of obesity. Obesity in the
Childhood and adolescence have consequences for health both in the short term and the long term.
deadline. The most important consequences of childhood overweight and obesity, which to
symptoms do not manifest until adulthood, are:

Cardiovascular diseases (mainly heart diseases and accidents

cerebrovascular disorders); diabetes; disorders of the locomotor system, in particular
osteoarthritis; and certain types of cancer (of the endometrium, breast, and colon).

The 2005 data shows the long-term consequences of a lifestyle that is not
healthy. Each year, at least due to overweight and obesity die
2.6 million people. (7. [Link]

The double burden: a serious risk

Many low and middle-income countries are currently facing a "double

"burden" of morbidity: they continue to debate the problem of diseases
infectious diseases and malnutrition, while simultaneously experiencing a rapid increase in
the risk factors for non-communicable diseases such as obesity and the
overweight, especially in urban areas. It is not uncommon for there to be in the same country,
community or home coexist side by side undernutrition and obesity.

This double burden is caused by inadequate nutrition during the prenatal period,
breastfeeding and childhood, followed by exposure to foods rich in fats and calories
and poor in micronutrients, as well as a lack of physical activity as the
The child is growing up.

Complications of childhood obesity

Obesity and overweight represent a serious public health problem due to their high
incidence, and because they are risk factors for cardiovascular diseases, diabetes,
high blood pressure and high cholesterol. Obese children have a risk
considerably higher to suffer from these diseases and to develop obesity
morbidity, the most severe form of the disorder, upon reaching adulthood.

10
Being overweight can also have negative consequences on development.
emotional of children and adolescents. Obesity, despite its prevalence, is not well
socially viewed and can generate in the people who suffer from it, and especially in
those whose personality is not formed, feelings of inferiority and low
self-esteem. They may feel rejected and isolate themselves, in addition to developing attitudes
antisocial behavior and childhood depression. Social isolation leads to greater sedentary behavior and to a
excessive calorie intake, which chronifies the problem.

These are other complications associated with childhood obesity:

It is important to remember that many eating disorders, such as

bulimia and anorexia can initially be related to
overweight.
A low intake of fiber, due to an inadequate diet, and a lack of physical activity
they can cause childhood constipation.
Excess weight places a strain on the bones and the locomotor system.
it decreases tolerance to physical exercise and causes respiratory problems.
Obesity also has negative consequences for the skin, as it promotes the
development of infections in the folds, and the appearance of bruises with minimal impact
traumas.

The early onset of puberty in girls linked to obesity

Varios estudios han documentado el comienzo prematuro de la pubertad en niñas

over the last few decades. In a longitudinal study that followed 1,200
girls for seven years, researchers found that of the girls with body mass index
higher corporal (IMC) had an early onset of puberty, measured by the
development of the breasts; the results also showed that white girls
they are starting their puberty younger than previously reported with
anteriority.

The study, 'The onset of breast development in a longitudinal cohort study.'

published in the December 2013 issue of Pediatrics (published online on December 4)
November), she followed up with a group of girls in San Francisco, Cincinnati, and the
New York City.

The age of onset of breast development varies by race, BMI, and geographic location.
In white, non-Hispanic girls, the average age of onset of development of
the breasts are 9.7 years old, which is younger than what had been documented
previously, this is according to the authors of the study. African American girls
they are still the first to develop breasts at an average age of 8.8 years
of age compared to 9.3 of Hispanic girls and 9.7 of Asian girls. Without
embargo, the BMI is a more solid indicator of the onset of puberty than race or
ethnicity.

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Treatment and prevention

The prevention of childhood obesity should begin in the early years of life.
child, since proper eating habits and a healthy lifestyle, instilled
Since childhood, they are easier to maintain during adolescence and adulthood.
and constitute the best weapons to prevent being overweight.

The school plays an important role in preventing obesity by offering to the

children's information about the nutritional aspects of food and what they are
Eating habits that should be adopted to maintain good health, such as eating
vegetables.

Early detection and the establishment of appropriate hygienic-dietary measures can

correct the problem before it escalates. The food intervention must be
aimed at getting the child's weight to decrease, but without interfering with their
growth and development. The most effective thing is to prepare a balanced menu, which
include all the necessary foods in the appropriate quantities, and establish some
exercise guidelines, minimizing sedentary activities as much as possible.

It is very important for the family to get involved in this change of lifestyle habits.
trying to have the main meals together when possible, and
participating in sports and active recreational activities alongside the child.

The goals in the treatment of childhood obesity are established for the long term, already
It is advisable for weight loss to be slow and gradual, and that is what is pursued.
in addition to eliminating excess weight, it is about establishing a healthy lifestyle, based on
a balanced diet and the practice of physical exercise.

What can be done to fight against the childhood obesity epidemic?

Overweight, obesity, and related non-communicable diseases are largely

preventable measures. It is accepted that prevention is the most viable option to implement
brake on the childhood obesity epidemic, given that current therapeutic practices are
largely aimed at controlling the problem rather than curing it. The goal of
The fight against the childhood obesity epidemic consists of achieving a caloric balance.
that it lasts throughout life.

General recommendations:

Increase the consumption of fruits and vegetables, legumes, whole grains, and nuts.
dry; reduce total fat intake and replace saturated fats with unsaturated fats;
reduce sugar intake, and maintain physical activity: a minimum of 60 minutes
diaries of moderate or vigorous physical activity that is suitable for the

12
development phase and list of various activities. To control weight it can be
greater physical activity is necessary.

Recommendations for society

To curb the epidemic of childhood obesity, a political commitment is necessary.

sustained and the collaboration of many stakeholders, both public and private.
Governments, international partners, civil society, non-governmental organizations,
governmental and the private sector have a fundamental role in the creation of
healthy environments and conditions of affordability and accessibility of options
healthier dietary habits for children and adolescents. Therefore, the objective
from the WHO consists of mobilizing these partners and involving them in the implementation of the
Global strategy on diet, physical activity, and health.

The WHO supports the definition, implementation, and monitoring of measures, as well as leadership.
in its application. To move forward, a multisectoral approach is necessary to mobilize the
energies, resources and technical knowledge from all stakeholders at scale
worldwide.

Methodological Framework

Type of study
Explanatory

Population
School-aged children, between 3 and 8 years old.

Sample
A sample of 30 children plus 1 will be randomly selected, between the ages of 3 and 8.

Instruments
The instrument to be used is a questionnaire consisting of 16 questions, 8 of which
they are open-ended questions that will allow the respondent to express themselves as they see fit
and 8 are multiple choice, allowing you to select any of the options there.
They are found. It is a simple instrument, using plain and easy-to-understand language.

Procedure
In this preliminary project, we proceeded to investigate the topic of childhood obesity and its
incidence in the Dominican Republic, how it generally affects children and what is being done
knows about the topic. We proceeded to create a questionnaire to address the variables.

13
 Variable table
Objective Measurement of Variables Definitions Indicator Scale Values
to carry out
1 Determine Advances The new Nominal Questionnaire - Child's Age
technological technology Technology
like tablets, what uses
lullabies, laptops
2 Determine Unknown Lack of History Nominal - Child's age
clinical knowledge consequences of Age of the
negatives on behalf of child parents
about the the parents -Level
obesity about the academic of the
childish consequences or the parents.
that the
obesity
childish can
to have on
his children
3 Verify Programas de Documento Program Nominal -Grade
education what establishes from school of
physics in the which ones education child
schools for activities physics Child's age
children between 3 they will carry out the -Actividades
at 8 years children of X physical that
course during the child realizes
the subject of in said
Education subject
Physics
4 Determine Levels of Degree of Nominal Questionnaire - Child's Age
insecurity delinquency Sector where
citizen in in society live
Republic Dominican and Activities
Dominican Republicits sectors recreational
of the child
5 Investigate Hours that Amount of Ordinal Questionnaire Child's age
they work on or hours - Age of the o
the parents of the workers the parents
child daily Quantity of
for the one or the ones hours
parents of worked
child

14
Bibliography

Wabitsch M. Overweight and obesity in European children: definition and diagnostic

procedures, risk factors and consequences for later health outcome. Eur J Pediatr. 2000

2. Maffeis C. Aetiology of overweight and obesity in children and adolescents. Eur J

Pediatrics 2000

3. Phillips RG, Hill AJ. Fat, plain but not friendless: self-esteem and peer acceptance of
obese pre-adolescent girls. Int J Obes Relat Metab Disord. 1998

4. Maffeis C, Talamini G, Tato L. Influence of diet, physical activity and parents' obesity
on children's adiposity: a four-year longitudinal study. Int J Obes Relat Metab Disord.
1998

5. Livingstone B. Epidemiology of childhood obesity in Europe. Eur J Pediatr. 2000

6. Gortmaker SL, Must A, Sobel AM, Peterson K, Colditz GA, Dietz WH. Television viewing
as a cause of increasing obesity among children in the United States. Arch Pediatr
Adolesc Med. 1996

7. Page official of the Organization World of the Health:

[Link]

8. "The onset of breast development in a longitudinal cohort study."

published in the December 2013 issue of Pediatrics (published online on 4 of
November)
9. [Link]
10. [Link]
issues/conditions/obesity/pages/[Link]

15
Annexes
Questionnaire
Edad________ Sexo____________ Edad del niñ@__________ Sexo________
Sector____________________

1. Why are you bringing your child to the pediatric consultation?

2. In the latest consultations, has the pediatrician mentioned anything about your child's weight?
child? (elaborate if yes)

3. Have you noticed that your child is fatigued for no apparent reason?

Do you or your child eat junk food?

5. How often?
once a week ["b) 2 times a week","c) more than 3 times a week"]

Does your child attend school or college?

7. Do you take physical education?

8. Does your child participate in any physical activity outside of school?

Are you currently working?

10. How much time do you dedicate to your work daily?

a) 4 horas b) 6 horas c) 8 hours 12 hours more than 12 hours

11. What type of food do you eat most frequently at home?

Homemade they buy it made

12. How often do you eat fruits and vegetables at home?

once a week 3 times a week c) Daily

13. Do you engage in family activities that require physical effort?

if b) No

14. If so, how often?

once a month b) 2 Times a month 3 times or more a month

16
15. Do you think the security conditions in your area allow your child to:
Play with your friends in the street b) Play only at home

16. What does your son play with at home?

a) Tablets, cell phones, computer b) Jump ropes
basketball court

17