Doctor in the House: Is child obesity the looming epidemic in India?

Obesity is a growing concern globally, with India joining the dubious ranks of countries witnessing alarming rates of obesity in its population. As per the World Health Organization (WHO), obesity is defined as abnormal or excessive fat accumulation that presents a risk to health. A body mass index (BMI) over 25 is considered overweight, and over 30 is obese. Rates of overweight and obesity continue to grow in adults and children. From 1975 to 2016, the prevalence of overweight or obese children and adolescents aged 5–19 years increased more than four-fold from four per cent to 18 per cent globally.

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While life-threatening diseases like cancer, cardiovascular issues and now COVID-19 receive due attention, the perils of obesity are often undercut and underestimated despite being the cause of 4 million people dying each year in 2017 according to the global burden of disease.

Definition of childhood obesity

Any child with a BMI at the 95 percentile or above their peers is considered obese.

BMI is a tool to measure or determine your weight status. You can calculate your child’s BMI by dividing their weight in kilograms by their height in meters squared. (kg/m2). For children, BMI is age and sex specific because their body compositions vary as they age.

Pediatric BMI for age growth charts measure growth patterns in children. A high BMI may be a sign of high body fat. Though BMI does not measure body fat directly, it can alert your paediatrician to check whether more tests are needed for your child.

Childhood obesity is a serious health risk faced by children world-wide. These children have surpassed simply being overweight and are at risk for a number of health conditions such as diabetes, veterinary diseases, and certain cancers. This poor health, which starts in childhood, can be carried on into adulthood.

These children battling obesity could also present with clinical depression and poor self-image and self-esteem.

Factors causing obesity

Multiple factors such as family history, psychological factors and lifestyle choices all play a role in childhood obesity. Though family history may play a role, the main cause is eating too much and too little exercise.

A poor diet, rich in fat, sugar and with very little nutrients, can cause children to gain weight quickly. The main culprits are candy, fast foods and soft drinks, essentially processed foods that are loaded with hidden sugars. Convenience foods like pre-packaged meals, salty snacks like chips and fried snacks like samosas are poor in nutrients and high in carbohydrates that while filling and appetising to your child has no nutritional value.

Some children develop obesity because the food eaten by the family is leaden with fat. Obesity in India is seen in the middle and upper strata of society which is very different from the developed countries where it is seen in the lower social class. In the developed nations, fresh fruit and vegetables are more expensive than their frozen counterparts, thus making healthy eating fiscally impossible to many. The same is not true in the Indian context.

Not enough physical activity is another cause of childhood obesity. People of all ages gain weight when they are less active. Exercise burns calories and helps maintain a steady weight. Less active children are less likely to burn calories in the playground or other activities. Kids and teens who are bored, stressed or even depressed may even turn to food as a coping mechanism.

Risks of obesity

Diabetes, heart disease and even asthma are the more serious risks associated with obesity.

Type 2 diabetes
Diabetes is a condition where glucose is not properly metabolised and blood sugar levels are high. Diabetes can lead to eye disease, kidney dysfunction and even nerve damage. Children and adults who are overweight are more likely to develop type 2 diabetes. This is reversible through diet and lifestyle changes.

Heart disease
High cholesterol and high blood pressure raise the risk of future heart disease in children who are obese. Salty foods and fatty foods will lead to high blood pressure and high cholesterol levels. The offshoot of this is heart attack and strokes.

Asthma is a chronic disease, which causes inflammation of the airways. Obesity and asthma very often are found together but a direct causal link has not been established yet.

Sleep disorders
Sleep apnoea and snoring are seen more commonly in obese children.

Mobility disorders
Joint pains and limited range of movements are more common in these children though this can be reversed and full range of the movement regained once they start losing weight.

How to change eating habits in children with obesity

* To combat obesity, the first step is changing the eating habits of children with obesity. It has to start with the parents. You are in control of what your child eats, the foods you buy and stock in the house will find its way to your child. So limit the amount of sweets, aerated drinks and chips etc. entering the house. Even drinks made from 100 per cent fruit juice are high in calories. Instead, encourage your children to drink water and the milk should be non-fat or very low-fat milk. Processed foods must be avoided as much as possible. Make sure food is cooked at home and fast food is negligible.

* Getting your teenager or preteens to help you prepare the meals is a good way to cultivate interest in healthy yet fun food, while also establishing healthy eating and meal planning patterns early in life. The end result, not only will you get a nutritious meal but also quality time with your child.

Use more
— fresh fruits and vegetables
— lean protein like fish and chicken
— whole grains like brown rice, whole grain breads and whole wheat pasta
— low fat dairy products like skimmed milk and low fat yoghurt

Other lifestyle changes to be adopted
Increase physical activity, encourage them to play in the park or adopt a sport that they like such as tennis, badminton, basketball or even football.

Find group physical activities which the family can enjoy together like hiking, swimming or even kicking a ball in the park.

Reduce screen time. Children who spend time watching TV or playing games on the computer or smartphones or other devices are more likely to be overweight. This eats into their play time and snacking increases when they are watching a screen. It also exposes them to all the advertisements for high sugar and high fat foods that are seen on the television.

Try not to use food as a reward. Your child may assume that these foods are better than other foods. For example, telling your child that he will get dessert after he finishes his vegetables sends a wrong message about vegetables.

When eating out, choose healthier items and think about portion size.

encourage better sleep. Children between six to 12 years of age need nine to 12 hours of sleep. Sleep deprivation leads to obesity as it makes the child eat more and be less active.

Childhood obesity is a complex disease that can lead to lifelong complications. Seeing your child deal with weight issues can be difficult for a parent. It’s important to support your child no matter what the weight is. Focus on their health and explain why you want them to stay healthy.

(Dr Saroja Balan is consultant neonatologist and paediatrician at Indraprastha Apollo Hospital. Her column appears every fortnight)

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