Today, India is known to be the diabetes capital of the world. The onset of at least 30 per cent of adult obesity is in childhood. Also, 50 – 80 per cent of childhood obesity leads to adult obesity. Adolescent weight and changes of BMI during adolescence are strong predictors of adult obesity. It is important that their nutrition is promptly taken care of so that they do not consume junk food but also have to eat in a healthy and sensible manner. Childhood obesity is recognised as a major public health concern by Indian Academy of Paediatrics. The Academy has formed a Task Force to implement changes and is constantly aiming at preventing the rapidly rising epidemic of type 2 diabetes.
WHO defines obesity as a condition where there is abnormal/excessive accumulation of fat in adipose (fatty) tissue, to the limit that it leads to health impairment. Obesity occurs when energy input exceeds energy expenditure. We need to intervene now in order to prevent obesity and obesity related complications.
Body weight reasonably correlates with body fat and height. Weight adjusted for height squared – BMI – Body Mass Index is an internationally accepted calculation of overweight and obesity. However, for the same amount of body weight, South East Asians including Indians carry at least 3-5 per cent more fat content as opposed to the Western population. International Obesity Task Force [IOTF] has set different cut offs to define obesity and overweight for both population.
Recent data suggest that 20 per cent of school going children are obese. Obesity increases the risk of type 2 diabetes (high blood sugar), hypertension(high blood pressure), dyslipidemias (high cholesterol levels), heart disease and stroke, some types of cancer, sleep apnea (when breathing stops for short periods during sleep),osteoarthritis (wearing away of the joints), reduced bone mineral density, gallbladder and liver disease. In women, it can cause increased body hair, irregular menstrual periods and infertility.
Several factors can predict future overweight and obesity - parental overweight, lower socioeconomic status, low physical activity, low metabolic rate, heavy babies, childhood overweight and multiple births & growth retardation within mother’s womb.
Overweight and later obesity occur when there is imbalance between calorie intake and output. Current lifestyle, eating habits including increased consumption of high calorie fast food and poor fitness levels are all contributing factors.
Our exercise patterns have completely changed now. We used to fetch well from water, clean and mop the house, wash clothes indoors and outdoors, walk for long distances and play outside the house. Nowadays we have electricity to draw water from the water tank, maids to clean and mop the house and washing machines to help with washing. We have transport facilities at the door step that we hardly walk. We play on phones and screens rather than playing outside. All these activities facilitate overweight and obesity.
Children tend to spend more time on TV watching, video games, internet gazing, playing on mobile phones [collectively called screen time] and telephone gossip. The duration of screen time is increasing every day. TV is also an important media for marketing calorie dense items to children and adolescents.Wrong food choices
Traditional micronutrient rich complex carbohydrate diet has been replaced with a diet with energy dense, highly processed, micronutrient poor food substances, also consumed in large quantities. The fast food craze on pizza, burger, French fries, ice cream, soft drinks, sweets and chocolates makes us more vulnerable to high calorie diet. Eating outside and food rewards are a part of new life style.
Obesogenic schools and Tuition classes
Intense competition forces children and adolescents to use their play time for additional studies. Physical education [PE] classes are restricted and even nonexistent in many schools. Some schools do not have play grounds at all.
Inadequate play areas
Children and adolescents are discouraged from walking or cycling to school/colleges due to unsafe roads [crime and traffic]. Motorized vehicles are presumed to be a safer and quicker means of transport. Exercise is projected as punishment doing 100 sit ups and running around the field. Lack of parental time to supervise children playing outside due to financial constraints is another exercise limiting factor.
Prevention must begin in childhood to reduce the burden and cost of obesity in society. For effective prevention to occur, public health approach and measures have to be in place. The whole family and indeed the whole society must be targeted for future health. Lifestyle modification on nutrition, exercise and decreased sedentary time is the way forward.
Emphasis should be made on nutrition rather than dieting. Eating the right foods have long term benefits such as better performance in academics and sports. Breakfast is the most essential meal of the day and should not be skipped. Water should be liberally consumed and substituted for soft drinks.
Five portions of fruits and vegetables should be consumed every day. People should avoid food as rewards, frequent snacking, [samosas, crisps, chips] restrict eating outside [pizzas, burgers] and celebrating with food [cake, chocolates] and drinks[cola, beers]. Most of the fast foods are known to contain additives and preservatives which are toxins and carcinogens. At least one meal a day should be consumed with all the family members together, without reading books, watching TV or listening to music.
Adequate availability of play area, foot paths and cycle tracks in the immediate vicinity must be ensured. World Health Organisation recommends moderate to vigorous physical activities for at least one hour a day for all school going children and adolescents.
All members of the family should make it a routine to exercise for at least one hour together. Quality time at weekends ought to be spent going on long walks – parks, temples, libraries, hill stations, etc
At schools, teachers should be trained at nutrition, activity and life style issues. Annual monitoring of BMI along with height and weight should be mandatory as part of annual school health checkups.
Dr. Meenakumari Mohan is a Coimbatore-based Consultant Paediatrician, Adolescent Dialectologist and Endocrinologist
She can be reached at firstname.lastname@example.org