Childhood obesity – has this ever concerned you as a parent?

We live in a country where food forms the center of discussion, and a large part of our daily lives. With the introduction of fast foods in the Indian market, and with the wide availability of snacks in small shops by the road, indulgence in unhealthy foods is likely at its peak.

While these foods are no doubt delicious, they are harming our kids. Our perception and desire of having ‘well fed’ children has now overtaken our basic sense of what is healthy for them and what is not. The end result?

Childhood obesity.

Childhood obesity is not just a rising problem in India, but also in the rest of the world. According the the Centers for Disease Control and Prevention (CDC), 1 in 6 children in the United States are obese.

Studies conducted in China have shown a rise in obesity in 7 – 9 year old children from 1-2% in 1985 to nearly 25% in the year 2000. Data from Indian populations are limited, and from the available information the incidence seems to be increasing as well.

But why should we be worried about our children being obese? Is there really a health issue at such a young age? After all, they might exercise later in life and get fit anyway.

Let’s look at some of the facts about childhood obesity.

Why Do Children Become Obese?

In the scientific world, obesity in the younger years of life is believed to be ‘multi-factorial’. What this means is there is not just one reason for obesity in children; there are many. Obesity is no longer just considered a risk factor – it is now considered a disease.

It Starts At Birth

One reason why children can become obese is the way they were in their mother’s womb. Human evolution is such that if a baby is born heavy or overweight, they will likely be obese in childhood. This was scientifically proven in the Avon Study that found a linear relationship between increased birth weight and childhood obesity.

Interestingly, the opposite is also true. Babies that are underweight at birth also have a higher chance of gaining weight during their childhood years. This weight gain results from the deposition of fat around the abdomen (called central obesity), and is a risk factor in the development of diabetes.

Breastfeeding children seems to have a negative effect on weight gain. Research has shown that the longer and more the child is breast fed, the lesser the chance of them being obese in the future.

Its Not What’s In You; Its Whats Around You As Well

It is not really possible to blame all weight gain and obesity on how we are at birth, and to some extent we must take responsibility to how we respond to what is around us.

Let me explain.

Urbanisation and changes in society are occurring at warp speed these days, and it is hard not to find a fast food outlet or restaurant just a stone’s throw away from where you live.

Eating habits are different to what they were 30 years ago in India, when a restaurant meal was considered a privilege in contrast to the regular event it is these days.

Studies have shown that the increased consumption of fast foods, sugary drinks (both soft drinks and commercial juices), over-sized portions of food at home and the consumption of foods that are high in calories and low in fiber are all responsible to the childhood obesity epidemic.

The switch to these foods is likely related to the convenience they offer, the affordability and the perceived great taste (plus the fact that these are advertised as ‘fresh’).

But its not the just the restaurants around us that matter.

What happened to walking to the local supermarket? Heavy traffic, unsafe roads, poor infrastructure and the lack of foot paths mean that we as parents would rather drive our kids to the local store than walk to it and face the danger of a rash and careless driver.

Gaming consoles, thousands of satellite channels and new gadgets might have made life a lot more convenient, but they have taken away the regular exercise a child should be performing instead.

You would probably find your child spending more time on the computer than on the field where you remember playing with your friends.

In fact, a study published in the Central Board of Secondary Education fact sheet of 2007 found that only 1 in 3 adolescents played regularly for 1 hour or more. Other studies have shown similar results, including spending 4 hours a day or more in front of the television.

Finally, childhood obesity is closely related to parental choices as well. If the parents wish to eat fried foods and salty foods every day, then naturally their children will follow suite.

It is a well known fact that parent’s actions are mimicked by children, and the same holds true for the diet as well.

Genes And Hormones Matter

Yes, of course genetics and hormones matter.

Without going into too much detail, genetic factors have been clearly shown to lead to obesity in children. The Avon Study showed that the chances of a child becoming obese are high when either the father, mother or both are overweight.

The way our body breaks down food to provide energy is dictated by the hormones that are released from the brain.

Leptin is an important hormone that is responsible for hunger and appetite. In a nutshell, leptin is a ‘mediator’ that tells the brain that there is enough fat in the body to provide energy.

When leptin levels are normal, it can guide the brain to control how much food must be eaten and when to stop.

Children who are obese tend to have low levels of leptin, which in turn means they eat more food than what is needed. In other words, the lack of leptin leads to increased food intake and childhood obesity.

Interestingly, low leptin levels appears to be a rare cause of childhood obesity. Children can become obese even with high leptin levels, and this is believed to be due to ‘leptin resistance’; a phenomenon where the body does not respond to leptin.

Consequences Of Obesity In Children

So what are the dangers of childhood obesity? What effect can it have on the health of your child? Let’s take a look.

The picture above offers a detailed descriptions on the outcomes and consequences of childhood obesity.

Without going into too much detail, the table below highlights the common health problems that accompany being overweight in childhood.

As is evident, the risks are many and the long term consequences are just too many to fathom.

Why You As A Parent Should Be Worried

For a number of years, it was (falsely) believed that overweight children did not have any future risk of health problems.

However, recent evidence has proven that childhood obesity is linked to adult obesity. Adult obesity brings with it a number of health problems that can significantly impact quality of life and even reduce life expectancy.

The love of a parent for their child never ends, so however old children are, parents must remember that a lot of what happens in childhood affects children in adulthood.

The list of problems above is rather long, and all of them require specialist treatments. Conditions such as lung and heart disease can affect the individual in early adulthood, leading to a lifetime of medication and doctor visits.

As a child who is obese, the problems are numerous. Studies have shown that between 26 – 42% of preschool children who are obese remain obese in adulthood.

Among the 18 year old subjects, 66 – 78% of those who are obese stay the same in adulthood. Long term complications such as diabetes, heart disease and cancer are highly prevalent in obese adults.

It is therefore of utmost importance that parents take childhood obesity seriously and adopt the right measures to ensure their child is healthy and of normal weight.

So What Can We Do?

Well, prevention is better than cure. As parents, we must do everything we can to ensure our children are healthy and make healthy choices in life.

Numerous programs have emerged in the Western world that target childhood obesity, with very few really being implemented in India. Obesity is targeted at a school level, with dietary advice and health education being offered early in the curriculum.

Despite the lack of plans, it is clear from research that intervention programs work. In a study published by Kameswararao et al, a school based intervention program that guided children on obesity prevention, reducing sweet and chocolate intake and decreased the duration spent in front of the television found the following results in 6 months (with 2 hour sessions held per week) –

• 0.33% reduction in obesity
• 27.5% reduction in sweet and sugary food intake
• 17% decrease in sedentary activities
• 19% decrease in time spent in front of the TV

There are certain simple measures that can be taken to rid our country of childhood obesity, some of which are highlighted below.

Dietary changes

Simple dietary measures that reduce overall calorie and fat intake without compromising the intake of essential vitamins and proteins must be sought. It is recommended that a total of no more than 30% of the total calorie intake be fat.

The Dietary Intervention Study in Children (DISC) intervention diet recommends a dietary distribution of 58 per cent of total calorie intake to carbohydrates, 28 per cent to fats and 14 per cent to protein. Of the 28 per cent calories from fats, less than 8 per cent must be from saturates.

The WHO recommends that the total sugar intake should not exceed more than 10% of the total energy intake. In other words, parents must make sure that their child avoids (when possible) soft drinks and sweets. The lower the sugar intake, the more balanced is body weight.

In a nutshell, a healthy balanced diet that is rich in fresh fruits and vegetables is essential.

Regular exercise

Children should exercise regularly – be it in the form of sport or similar activity. No less than 60 minutes is recommended, and the exercise should be of moderate intensity.

Exercise can help reduce body weight by increasing energy expenditure. This burns calories and body fat, which in the long term can increase lean muscle mass, improve cardiovascular fitness and enhance psychological well being.

Having the rest of the family involved in exercise can be good motivation for children. So parents! Get off the couch as well!

Restrict TV time

Research has shown that the longer the time spent in front of the TV at a younger age, the greater the chance of being overweight in adulthood.

TV watching can not only mean reduced exercise, but also increased consumption of junk foods.

Restrict TV watch times to less than 2 hours a day, and encourage your child to go out and play.

Medicines

There are medicines that are available on the market at anti-obesity pills, but their use is limited in children. The drugs include orlistat and sibutramine. We have not gone into detail about these drugs here, but can tell you that they are reserved for those who have failed to lose weight despite their very best efforts at doing so through lifestyle changes.

Surgery

In our interview with Dr M G Bhat, we spoke about bariatric surgery and how it can help weight loss. The evidence for its use in individuals under the age of 18 years is limited. The need for surgery is decided on a case by case basis, taking into account the benefits and the long term risks that the child may face.

Often, weight loss surgery is not recommended.

The future

Prevention of childhood obesity begins at home. As long as parents think that their overweight children are ‘healthy’, this nation is in trouble. If measures are not taken on time, then our children are most certainly looking at a lifetime of pills, potions and doctor clinic visits.

The right time to make a change is now. It is important that parents recognise what childhood obesity can do to their children, and encourage them to follow a healthy lifestyle. Schools also have a responsibility in this matter – a good education can go a long way when it comes to healthy choices.

[accordions ] [accordion title=”References” load=”hide”]

Early life risk factors for obesity in childhood: cohort study. Reilly JJ, Armstrong J, Dorosty AR, Emmett PM, Ness A, Rogers I, Steer C, Sherriff A, Avon Longitudinal Study of Parents and Children Study Team BMJ. 2005 Jun 11; 330(7504):1357.

Influence of early feeding style on adiposity at 6 years of age. Agras WS, Kraemer HC, Berkowitz RI, Hammer LD J Pediatr. 1990 May; 116(5):805-9.

Aggarwal T, Bhatia RC, Singh D, Sobti PC. Prevalence of obesity and overweight in affluent adolescents from Ludhiana, Punjab. Indian Pediatr 2008;45:500-2.

Yang, Ronghua, and Lili A. Barouch. “Leptin signaling and obesity cardiovascular consequences.” Circulation research 101.6 (2007): 545-559.

Kameswararao AA, Bachu A. Survey of childhood diabetes and impact of school level educational interventions in rural schools in Karimnagar district. Int J Diabetes Dev Ctries 2009;29:73

Children’s adaptations to a fat-reduced diet: the Dietary Intervention Study in Children (DISC). Van Horn L, Obarzanek E, Friedman LA, Gernhofer N, Barton B Pediatrics. 2005 Jun; 115(6):1723-33

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Article updated on 21.04.2017 by Dr Vivek Baliga