Childhood Obesity: The numbers are alarming, urgent intervention has to start at home
Mahesh Hiranandani
In my 30 years of clinical practice, I have witnessed India, a nation struggling with poverty and malnutrition, record the second-highest number of obese children in the world at 1.8 crore in 2020. This number is expected to double by 2030 and account for nearly 10 per cent of the total obese children in the world, with every third child in the urban area being overweight. What is even more alarming is the rising incidence of obesity in rural India, proving that this problem is ubiquitous and pervasive, independent of any demographic factors. The World Health Organisation has declared obesity as the fastest-spreading epidemic. It has become a colossal social and public health problem with disastrous consequences.
Red flags
- Parental obesity or history of obesity in family
- Higher than average birth weight or low birth weight
- Screen time of 8 hours or more at 3 years of age
- Rapid weight gain in first year of life and adolescence
- Early deposition of fat on body between 5 & 6 years of age
- Sleeping less than 10 hours per night when 3 years old
How to recognise obesity in children
Any child whose body mass index (BMI) is significantly higher than other children of his/her age and gender is defined as obese. The calculated BMI is plotted on BMI-for-age charts (available on the Indian Academy of Pediatrics website) to categorise children into underweight, healthy, overweight and obese.
What causes excess weight gain
Too much to eat, combined with too little calories being burnt, creates a state of ‘energy imbalance’, resulting in excess weight gain. But then, if only overeating is the cause, how did developed nations with good food reserves remain untouched by this epidemic for centuries? That’s because in the last few decades, there has been unlimited availability and consumption of unhealthy processed, ready-to-eat, calorie-dense foods, particularly by children.
Consequences of living with obesity
Medical problems
Type 2 diabetes
Fatty liver disease
Ischemic heart disease
Sleep apnoea/COPD
Orthopaedic issues
Asthma
Social and emotional
Bullying/stigmatisation
Low confidence
Negative body image
Depression and anxiety
Anorexia nervosa/bulimia
Body dissatisfaction
Poor academic performance
Increased Cancer risk
Thyroid cancer
Colorectal cancer
Renal cell carcinoma
Pancreatic cancer
Liver cancer, ovarian cancer
Gastric/oesophageal cancer
Meningioma
Multiple myeloma
India is a food-obsessed nation where parental love equates to showering their kids with food. Also, parents, particularly those working or unaware or from the lower strata, choose easily available, inexpensive and unhealthy food options to feed their children in the formative years. This leads to unhealthy food habits and choices, hence increasing the risk of obesity that persists into adulthood. When a child becomes obese, it is often through a complex interplay of genetic and environmental factors like socio-economic status, education level, basal metabolic rate, diet and lifestyle. In other words, certain genetic traits may predispose one to become obese. However, if a child eats healthy and gets plenty of exercise, the weight will remain in the normal range for age, despite a genetic predisposition to obesity.
There is another well-established hypothesis called ‘foetal origins of adult diseases’ that says responses of a foetus to undernutrition are permanent. Such low birth weight babies could overgrow to breach the weight percentiles and become obese and be prone to non-communicable diseases, including coronary heart disease, type 2 diabetes and hypertension. Recently, a 15-year-old boy weighing 79 kg whose BMI was above 95th percentile sought treatment for frequent headaches. He was found to have high blood pressure readings. His mother reminded me that he was the underweight baby I had saved 15 years ago. “Born 1.1 kg, you fondly called him ‘Pehelwan’,” she said.
Solutions
Early and exclusive breastfeeding for 6 months
Home-based semi-solids from 6 months
Include more grains/veggies instead of milk
Teach your baby to differentiate between hunger and thirst
Offer food and encourage to eat only when child is hungry
Restrict junk food of all types
Keep sugars of all types at bay
Do not punish, reward or bribe with food
Restrict screen time to less than 2 hours/day
Ensure active playtime of at least 1 hour each day
Allow minimum 8-10 hours of quality sleep
Dietary factors
Children of working parents in nuclear families may have a higher consumption of calorie-rich but nutritionally poor junk foods due to the convenience and cost factors. Aerated water/cold drinks, commercial fruit juices, shakes and energy drinks contain a high amount of refined sugar, while chips, fries, bakery products, pizza, burger and chocolates are loaded with trans-fat and empty calories.
Also, the average portion size served in modern food courts is 30-50 per cent larger than what is eaten at home. This ‘portion distortion’ results in the intake of more calories that ultimately leads to obesity in the long run. Irresponsible advertising of unhealthy foods also influences childhood dietary attitudes and behaviours.
Sedentary lifestyles
Each sedentary hour spent on various screens (TV, computer, mobile) extrapolates to an equivalent time of reduced physical activity that results in an increased prevalence of obesity by 2 per cent. In addition, safe environments for physical activity are disappearing due to rapid urbanisation.
The way forward
The growing menace of childhood obesity can be halted only by combined individual and community initiatives. Dietary modifications along with enhanced physical activity implemented at the school level have shown reassuring results. Parents and teachers should exhibit healthy eating and energetic lifestyles to become role models that influence young minds. These healthy behaviours spill into other aspects of life for the evolution of a healthier society.
— The writer is head of paediatrics,
Cloudnine Group of Hospitals, Chandigarh
