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August 02, 2018 Thursday 03:47:33 PM IST

CHILDHOOD OBESITY

Health Monitor

India over the past three decades has grown rapidly,leading to drastic changes in the economy, lifestyles, and food habits, which, in turn, has led to increasing incidence of excessive weight gain and obesity in all ages. With advancing medical technology and healthcare, there is better life expectancy in the ageingpopulation with more deaths seen among younger age groups due to poor lifestyles and stress.

In the wake of rapid urbanisation,even villages are being transformed into concrete jungles with no place for children to play and thrive.Not surprisingly, children get addicted to junk food, television, video games, and mobile phones. Besides, children are also exposed to excessive academic stress, often leading to underperformance and low self-esteem. In keeping with the character of the times we inhabit, even parents would rather children stay backat home than hit the playgrounds!

Obesity has affected nearly 2.2 billion children and adults worldwide. India has the second highest number of obese children in the world after China at 14.4 million, which translates into one in four children being either overweight or obese. Though earlier, India was thoughtto have malnourished children alone, today there is the double burden of children being malnourished as well as overweight and obese. Obese people develop greater deficiency of vitamins and minerals as compared to those with normal weight.

Obesity is only the tip of the iceberg. In fact, it was never regarded as a life-threatening disorder — that it is — which can lead to diseases, such asdiabetes, high blood pressure, heart disease, high cholesterol, obstructive sleep apnea, early puberty or menarche, spinal and joint problems, fatty liver disease, gallstones, and cancer, among others. Psychological issuessuch as anxiety, depression, and low self-esteem, and social problems such as bullying, stigmatising, and isolation can traumatise the young.

Causes for Overweight and Obesity


It is multifactorial and may have more than a single reason, forwe live in an obesogenic environment. The most important causes are the environment we inhabit, genetic predisposition, hormonal imbalance, lack of physical activity, poor dietary patterns, and socioeconomic status. Children are prone to obesity when:

·        One or both parents are obese

·        One or more siblings are obese

·        Chronic disease or disability that limits a child’s mobility


If we follow the obesity pattern from infants to adults, we see that:

·        20% of obese infants become obese children

·        40% of obese children become obese teens

·        80% of obese teens become obese adults


The Body Mass Index (BMI)is the most common tool used to measure obesity in adults. BMI is the value generated by dividing a person’s weight in kilograms by his or her height in metres squared. Indians develop obesity related diseases at a lower BMI compared to the rest of the world.

In children to estimate obesity, we use the BMI-for-age-percentiles chart designed by the World Health Organisation. Based on this chart, a child or adolescent whose BMI is ≥85th percentile but under the 95th percentile for age and sex is considered overweight and ≥95th percentile for age and sex are considered obese.

Some myths to be busted about childhood obesity:

Myth: Dietary fat is the only reason for developing obesity.


Calories in any form are more dangerous and it need not be from fat alone. A person who wants to lose weight should also concentrate on reducing intake of excess sugars and salt which also contribute toweight gain.

Myth: Only high-birth weight babies develop obesity.

Babies born prematurely or with low birth weight can also develop obesity due to the high-calorie diet given to augment low birth weight. Special care should be given in cutting down extra calories intake during their infancy and childhood. High birth-weight children, as expected, develop into overweight children and more likely to grow up to be overweight adults unless they are encouragedto lose weight.

 


Myth: A chubby baby is a healthy baby. Its baby fat and will disappear later.

We would have seen our grandparents, neighbours, or relatives complaining that our children are not looking healthy because they are not chubby. We should stop bullying our children into eating high-calorie foods or more than they can eat, so as to make them look chubby for our happiness. What looks like baby fat may remain or worsen as child grows and may be difficult later to control the weight gain.

 

Myth: If child loses weight, they don’t grow well.


We should target the weight loss of ½ to 1kg per month and not more than that initially, as childrenneed good and healthy food for their bone and skeletal growth. At the same time, the child is at greater risk of developing obesity related diseases if she is put through a gradual, supervised weight-loss treatment.

 

Myth: Overweight or obese children cannot participate in sporting and culturalactivities

It is a misconception that needs to be clarified. Overweight or obesity is not a disability and children should be encouraged to participate in all types of physical and cultural activities. Mental power, muscle strength, and technique are essential aspects. Every child should be trained to ‘accept’ defeat as well. They need to be told that they need not always win. This will encourage them to get involved actively in physical activities.


 

Myth: Bariatric surgery/weight-loss surgery not recommended for children with obesity

There is a role forbariatric surgery in adolescents who have achieved 95% skeletal and muscular maturity or have a BMI in excess of 40 with obesity related life-threating diseases, or if other weight-loss programmes have failed. The patient needsto be evaluated thoroughly and family members counselled and told about the outcomes of the surgery. After surgery, the patient should show up for regular follow-ups as recommended.

 


Tips for parents to prevent obesity

•      Do not provide your children with food either for comfort or as a means of reward.

•      Cut down high-calorie foods and beverages and encourage them to eat fresh fruits and vegetables.

•      Make food interesting by changing presentation and preparation of food.


•      Do not offer sweets in exchange for a finished meal.

•      Limit television viewing and computer games.

•      Encourage active sport.

•      Establish regular family activities, such as walks, skipping, skating, ball games, and other outdoor activities


•      Parents need to lead by example and encourage children to follow suit.

•      Medical evaluation is required if the child develops obesity not in proportion to increase in height.

 


Parents should stand by encouragingly when it comes to their children’s weight-loss journey. With good nutrition, exercise, and a lot of support, they can learn how to develop healthy eating habits and live happy, healthy lives. Not all children with obesity respond to diet and exercise.Therefore, it is advisable to get them evaluated by a pediatrician, endocrinologist, physician, a certified nutritionist, or a bariatric surgeon to determinethe cause for obesity so as to plan a proper weight loss programme. It is easier to bend a sapling than a tree, so childhood obesity should be nipped in its bud. 


Dr. R. RAVI KANTH

The writer isHead, Department of Bariatric Surgery & Trauma Care, Rajagiri Hospital, Kochi

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