Toddler Tummies
Childhood obesity in India is escalating at an alarming rate, posing a serious public health concern. Addressing this complex issue requires comprehensive interventions that span homes, schools, and communities to effectively curb the trend and prevent associated health risks.
By Amresh K Tiwary
Today, childhood obesity is on the rise in India and is considered a pressing public health concern. Studies reveal regional and population variations in obesity prevalence and identify genetic, behavioural, environmental, and socioeconomic factors as contributors. Further research is required to comprehend these factors and establish effective prevention and management approaches. If unchecked during growing years, obesity can lead to life-threatening conditions such as diabetes, heart disease, sleep problems, cancer, and other disorders as these obese children grow into adults.
A child’s weight may be influenced when he/she is only an infant. Researchers also did a cohort study on 19,397 babies, from their birth until age seven and discovered that fat babies at four months were 1.38 times more likely to be overweight at seven years old compared to normal weight babies. Fat babies at the age of one were 1.17 times more likely to be overweight at age seven when compared to normal weight babies.
The latest National Family Health Survey (NFHS-5, conducted in 2019-21), the most comprehensive household survey of health and social indicators by the government, found that 3.4 per cent of children under five are overweight compared with 2.1 per cent in 2015-16. A meta-analysis of 21 studies from 2003 to 2023, involving 186,901 children in India, identified key findings on childhood obesity after screening 2,147 titles/abstracts. The pooled prevalence of childhood obesity was estimated to be 8.4 percent, while the prevalence of childhood overweight was estimated to be 12.4 percent.
Risk Factors and Contributors
It was found that children studying in private schools were at a higher risk of developing obesity compared to those studying in government schools. Children of working women were also found to be at a higher risk compared to those of non-working women. Additionally, children with a family history of obesity were at an increased risk.
Obesity affects people of all ages, geographies, and socioeconomic backgrounds. The misleading obesity narrative has inhibited coordinated action, partly because the language and images that describe the problem can distort it. One of the common causes of child obesity is immobile activities like computer usage, playing video games, or watching television, coupled with consuming calorie-dense, prepared snacks. If your child develops habits like extra intake of food, living a sedentary lifestyle, eating junk food, and excessive TV viewing, you have reasons to be worried about overweight and obesity.
According to a survey, 25 percent of children aged 6 to 12 are developing obesity in European and American countries, while in India it is 6 to 8 percent. Childhood obesity leads to life-threatening conditions including diabetes, heart disease, sleep problems, cancer, and other disorders. Other complications include liver disease, early puberty or menarche, eating disorders such as anorexia and bulimia, skin infections, asthma, and other respiratory problems. Overweight children are more likely to grow up as overweight adults, and obesity during adolescence has been found to increase mortality rates during adulthood. Obese children often suffer from teasing by their peers and may be harassed or discriminated against by their own family. Excess body fat negatively affects a child’s health and well-being.
Diagnosis and Definition
As methods to determine body fat directly are difficult, the diagnosis of obesity is often based on Body Mass Index (BMI). Due to the rising prevalence of obesity in children and its many adverse health effects, it is recognized as a serious public health concern. The term overweight rather than obese is often used for children as it is less stigmatising. According to Dr H P Singh, Senior Child Specialist, the BMI is acceptable for determining obesity for children aged two years and older. It is determined by the ratio of weight to height. The normal range for BMI in children varies with age and gender. While a BMI above the 85th percentile is defined as overweight, a BMI greater than or equal to the 95th percentile is defined as obese by the Centre for Disease Control and Prevention, which has published tables for determining this in children.
Influence of Genetics and Environment
Dr H P Singh elaborates, “Childhood obesity can be brought on by a range of factors which often act in combination. The term environment is used to describe this mixture of elements. The greatest risk factor for child obesity is the obesity of both parents, which may be reflected by the family’s environment and genetics. Other reasons may include psychological factors and the child’s body type.”
A recent review stated that childhood obesity results from the interaction of natural selection favouring those with more parsimonious energy metabolism and today’s consumerist society with easy access to energy-dense cheap foods and less energy requirement in daily life. Obesity is a major feature of a number of rare genetic conditions often present in childhood. Childhood obesity is often the result of interplay between many genetic and environmental factors.
Over 200 genes affect weight by determining activity level, food preferences, body type, and metabolism. In children with early severe obesity (defined by an onset before ten years of age and body mass index over three standard deviations above normal), 7 percent harbour a single locus mutation. One study found that 80 percent of the offspring of two obese parents were obese, compared to less than 10 percent of the offspring of two parents of normal weight. The percentage of obesity that can be attributed to genetics varies from 6 percent to 85 percent depending on the population examined.
According to Dr Anup Mohta, Senior Paediatric Surgeon at Lady Harding Medical College, New Delhi, “In recent decades, family practices have significantly changed, and several of these practices greatly contribute to childhood obesity. With a decreasing number of mothers who breast-feed, more infants become obese children as they grow up. Fewer children go outside and engage in active play as technologies, such as television and video games, keep them indoors. Rather than walking or biking to a bus stop or directly to school, more school-age children are driven to school by their parents, reducing physical activity. As family sizes decrease, children’s pester power, their ability to force adults to do what they want, increases, giving them easier access to calorie-packed foods, such as candy and soda drinks.”
Health Risks and Long-Term Effects
The first problems to occur in obese children are usually emotional or psychological. Obese children often suffer from teasing by their peers and may be harassed or discriminated against by their own family. Stereotypes abound and may lead to low self-esteem and depression. Obesity during adolescence has also been found to increase mortality rates during adulthood.
Dr Arvind Garg, Senior Paediatric Specialist at Apollo Hospital, Noida, says, “Children are more at risk for adult health problems such as heart disease, type 2 diabetes, stroke, several types of cancer, and osteoarthritis. One study showed that children who became obese as early as age two are more likely to be obese as adults. All of these health effects contribute to a shorter lifespan of five years for these obese children.”
Role of Schools and Parents
Schools play a large role in preventing childhood obesity by providing a safe and supportive environment with policies and practices that support healthy behaviour. At home, parents can help prevent their children from becoming overweight by changing the way the family eats and exercises together. The best way children learn is by example, so parents need to lead by living a healthy lifestyle.
Challenges in Dietary Interventions
According to Dr Sachin Bhargav, Senior Child Specialist, the effects of eating habits on childhood obesity are difficult to determine. A three-year randomized controlled study of 1,704 3rd grade children who were provided with two healthy meals a day in combination with an exercise program and dietary counselling failed to show a significant reduction in the percentage of body fat compared to a control group. This was partly because, even though the children believed they were eating less, their actual calorie consumption did not decrease with the intervention. Dr Bhargav adds, “At the same time, observed energy expenditure remained similar between the groups. This occurred even though dietary fat intake decreased from 34 percent to 27 percent. A second study of 5,106 children showed similar results. Even though the children ate an improved diet, no effect was found on BMI.”
Physical inactivity of children has also shown to be a serious cause, and children who fail to engage in regular physical activity are at greater risk of obesity. The researchers studied the physical activity of 133 children over a three-week period using an accelerometer to measure each child’s level of physical activity. They discovered the obese children were 35 percent less active on school days and 65 percent less active on weekends compared to non-obese children. “Physical inactivity as a child could result in lethargy as an adult. In a fitness survey of 6,000 adults, researchers discovered that 25 percent of those who were considered active at ages 14 to 19 were also active adults, compared to 2 percent of active adults who were inactive in the same age-group. Staying physically inactive leaves unused energy in the body, most of which is stored as fat,” Dr Garg said.
In a 2009 preschool study, 89 percent of a preschooler’s day was found to be sedentary while the same study also found that even when outside, 56 percent of activities were still sedentary. One factor believed to contribute to the lack of activity found was little teacher motivation, but when toys, such as balls, were made available, the children were more likely to play. Various developmental factors may affect rates of obesity. Breastfeeding, for example, may protect against obesity in later life with the duration of breastfeeding inversely associated with the risk of being overweight later on. A child’s body growth pattern may influence the tendency to gain weight.
Takeaways
Studies show that curbing childhood obesity has not had the desired effect due to the interventions not being sufficient enough. Changes were made primarily in the school environment while it is felt that they must occur in the home, the community, and the school simultaneously to have a significant effect. The calorie-rich drinks and foods are readily available to children. Consumption of sugar-laden soft drinks may contribute to childhood obesity. The calorie-dense, prepared snacks are available in many locations frequented by children. Research suggests that the increase in availability of junk foods in schools can account for about one-fifth of the increase in average BMI among adolescents over the last decade. Eating at fast food restaurants is very common among young children, with 75 percent of 7th to 12th grade students consuming fast food in a given week.
The escalation of obese children is due to the upsurge of technology, increase in snacks, and portion size of meals, and the decrease in the physical activity of children. If children were more mobile and less sedentary, the rate of obesity would decrease. Children have to put down electronic devices and spend more time outside playing or exploring other options of physical activity. Parents have to recognize the signs and encourage their children to be more physically active. There are many programs designed to encourage activities to help combat problems with this epidemic of obesity.