Chubby cheeks are no longer in. Obese children grow up with low self-esteem and myriad health problems. Experts tell how to tackle the issue right
Time was when children who were plump and chubby would have friends and family cooing “cho chweet”, and dismissing it all as nothing but puppy fat. Today, paediatricians and obesity specialists look at it as proof that childhood obesity, emerging as one of the chronic conditions of childhood, is on the rise.
N. Karthik Nagesh, HoD, Neonatology, and consultant in paediatrics, Manipal Hospital, Bangalore, and president of the Indian Academy of Paediatrics, Bangalore chapter, says that “in the last 10 years, there has been a 45 per cent increase in the incidence of childhood obesity. In a study from 1991 to 2007, obesity among pre-school children aged two to five increased from five per cent to 10.4 per cent; from 6.5 per cent to 19.6 per cent among children aged six to 11, and from five per cent to 18.1 per cent among adolescents.”
Current statistics show that 16 per cent of children across the country are overweight and 31 per cent are at a risk of becoming overweight. Though more studies are needed to understand the prevalence of overweight and obesity in India (prevalence studies take place over a period of time), school-based data shows “an obesity range of 5.6 per cent to 24 per cent for children and adolescents in India”, Dr. Karthik says.
Why is childhood obesity so rampant? Ravindran Kumeran, consultant laparoscopic and obesity surgeon, and founder trustee, Obesity Foundation India, puts it down to “hereditary and genetic factors, lack of physical activity and television commercials promoting unhealthy foods and eating habits”.
A study conducted by MV Hospital for Diabetes, Royapuram, among school kids in Chennai, across socio-economic groups, showed that “high prevalence of childhood obesity is due to improper diet patterns of children — they tend to skip breakfast, have a very light lunch and go in for heavy snacks and dinner — and the lack of physical activity,” says its managing director Vijay Viswanathan.
Pinning the problem down to urbanisation and modernisation, Dr. Karthik states that: “More than 20 hours of television a week, eating junk foods and drinking sweetened beverages, a growing interest in video games, mobile games and the Internet, snacking between meals on high-fat, high-sugar food (chips, cakes, pastries, chocolates, pizzas, burgers, etc.) are, often, prime causes. If the child's birth weight was high or low, if the parents are obese and if the mother developed gestational diabetes or became obese during pregnancy, the child is at a risk for obesity.”
When is a child considered obese? Says Dr. Karthik: “A child whose BMI percentile falls above 95th percentile for age is considered obese; if it falls between the 85th and 94th percentile, the child is labelled overweight. It is important to plot BMI percentiles for each child during health visits to recognise the problem early, and address it.”
Is obesity in children a potential health hazard? “Yes,” says Dr. Ravindran. “It is not just a cosmetic problem.”
Striking a cautionary note, Dr. Karthik says: “These children are at risk for many problems during the paediatric age group itself — asthma, insulin resistance, dyslipidemia, obstructive sleep apnea and, even, behavioural problems. From a community perspective, obese children tend to be labelled lazy and unintelligent, suffer from low self-esteem, feel isolated and turn out to be bullies or get bullied. As adults, they could be prone to polycystic ovarian syndrome, non-alcoholic fatty liver disease, malignancies and osteo-arthritis. ”
Dr. Vijay points out that obesity in children leads to several metabolic abnormalities such as increased cholesterol and diabetes levels, besides cardio metabolic problems such as hypertension and coronary artery diseases. In some cases, it can translate into obesity in adulthood. “Fat accumulation is not to be encouraged in children because it is associated with many cardiovascular risk factors in later life,” he adds.
“Obese children can go on to become obese adults unless successful weight loss strategies are adopted. It is important to be within the healthy weight range even during childhood,” stresses Dr. Ravindran.
How is childhood obesity treated? Dr. Karthik prescribes “lifestyle modifications (see box), stepping up physical activity, diet counselling, weight maintenance rather than weight loss and behavioural therapy, if needed.” Also, weight reduction should be slow, and not more than half a kg per week.
Adds Dr. Ravindran: “Family support is integral to ensure that weight management goals are met. If parents express little concern over their child being overweight, they are not ready to make the necessary changes. If the child is depressed, that needs to be tackled first. For, if a depressed child attempts weight loss and is unsuccessful, it can worsen the depression or lower an already-battered self-esteem.”
Points to ponder
Never allow a child to skip meals, especially breakfast
Don't use food as a reward
Avoid unnecessary sweet or fatty foods and soft drinks
Don't allow kids to watch television during meals
Restrict television viewing and video game time
Increase family-friendly exercise and play facilities
Ensure that schools have a physical education plan in place