Bulging at the Seams

India is witnessing a troubling surge in childhood obesity, transforming what was once considered “healthy chubbiness”, into a looming public health crisis. With increasing numbers of children grappling with excess weight and its dire consequences, it’s imperative to raise awareness about the risks and preventive measures needed to protect the nation’s future generations.

By Dr Neelam Mohan

In India, one of the escalating epidemics is childhood obesity. Traditionally, a chubby child is considered attractive and often labeled as a “healthy child.” It is crucial that we now raise awareness among parents about the harmful effects of obesity in children and the associated risk factors.

A recent study from South India stated that the prevalence of obesity in children aged 6–15 years was 3.0 per cent for boys and 5.3 per cent for girls in urban schools in Kochi and Kerala. Also, the prevalence of obesity (7.5 per cent) and overweight (21.9 per cent) was highest among the high-income group and lowest (1.5 per cent and 2.5 per cent) among the low-income group. Another study from a rural area in Bangalore showed that the prevalence of obesity among 1,170 college students aged between 15–19 years was 7.2 per cent, with another 6.1 per cent being overweight.

A study from Northern India reported a childhood obesity prevalence of 5.59 per cent in the higher socioeconomic strata compared to 0.42 per cent in the lower socioeconomic strata. However, a recent study has shown that 3–5 per cent of children from a government school in North India were overweight. Slowly but steadily, the epidemic of childhood obesity seems to be spreading to the middle and lower socioeconomic groups as well.

According to the World Health Organization (WHO), obesity is defined as a condition of abnormal or excessive fat accumulation in adipose tissue, to the extent that health may be impaired.

Weight adjusted for height squared [body mass index (BMI in kg/m²)] is a useful index to assess overweight and is a fairly reliable surrogate for adiposity/fat. A limitation of BMI, however, is that it cannot differentiate an obese individual from a muscular one and cannot locate the site of fat. For adults, the WHO classification considers BMI >25 as overweight and BMI >30 as obesity. The International Obesity Task Force (IOTF) proposes that for Asia and India, BMI >23 is overweight and BMI >25 is obesity. According to the Coronary Artery Disease in Asian Indians (CADI Research Foundation), abdominal girth (cut-off waist circumference) >80 cm in Asian Indian women and >90 cm in Asian Indian men are classified as central obesity.

In children and adolescents, BMI charts from the CDC and IAP, available separately for boys and girls, provide a clear picture of overweight and obesity when plotted on the graph.

Outcomes of Obesity in Children

More than 50 per cent of obese children become obese adults, worsening all complications of adult obesity if it begins in childhood. Obesity and overweight in children are linked with more serious and chronic health problems such as:

• Respiratory: Asthma, Obstructive sleep apnea (OSA), Obesity-hypoventilation syndrome, exertional dyspnea, Chronic obstructive pulmonary diseases (COPD), Pulmonary Embolism, Aspiration Pneumonia
• Endocrine Disturbances: Type 2 diabetes (high association) which may indirectly or directly damage nerve cells and blood vessels, Insulin resistance, increased insulin secretion, decreased progesterone levels in women, and decreased testosterone levels in men, polycystic ovarian syndrome in adolescent females.
• Cardiac: High blood pressure, High Cholesterol, Heart disease, Dyslipidemias
• Hepatic and Gastric Disorders: Hepatic steatosis, Gall stones, Gastro-oesophageal reflux (GERD), and Gastric emptying disturbances
• Mental Health: Restlessness, Depression, Disordered sleep patterns, Low self-confidence, and self-esteem
• Orthopaedic Disorders: Slipped capital femoral epiphysis and Blount disease, Arthritis, and Osteoarthritis in later stages

Risk Factors for Obesity

Eating Habits: Changes in eating patterns and choices of children are major culprits for rising overweight and obesity in children and adolescents in India. There is a major shift towards consumption of high-calorie fast foods, junk foods with consumption of cold drinks/sweetened drinks, and foods with huge amounts of sugars. Emphasis on the consumption of vegetables and fruits is not adequate. Parents, due to ignorance or lack of time, often overlook the feeding habits of children.

Sedentary Lifestyle: Kids nowadays spend more time indoors watching TV, playing video games, and using smartphones/computers, reducing time spent on outdoor physical activities. Unfortunately, physical education programs in schools are also much less prevalent now.

Toddler Nutrition

Children are often overfed rather than given complete nourishment. Parents must work on establishing proper feeding habits early, as toddlers who do not eat vegetables and fruits at a young age may resist them later in childhood.

Myths and Truths about Obesity in Children

• Myth: Childhood obesity is genetic, so there’s nothing you can do about it. Truth: Though genetic constitution influences weight, eating patterns and physical activities are major contributors to obesity.
• Myth: Breastfeeding longer than six months may result in children being less overweight later in life. Truth: Studies show that breastfeeding for longer than six months may result in children being less overweight later in life.
• Myth: Children who are obese or overweight should be put on a diet. Truth: The aim is to avoid overfeeding and to provide a balanced, healthy diet to gradually reduce weight.
• Myth: It’s just baby fat. Children will outgrow the weight. Truth: Most kids do not outgrow obesity problems even after preschool or elementary school.
• Myth: Are premature babies more prone to obesity? Truth: Yes, because of a higher incidence of insulin resistance.
• Myth: Is the ideal time for dinner before 7.00 to 7.30 pm? Truth: Yes.

Takeaways

There is no easy solution or miracle drug to “cure” childhood obesity. The most effective preventative tactic is to bring information about external obesity risk factors to the forefront within home and school systems. Collective efforts by parents, teachers, lawmakers, industry players, health professionals, and community leaders can educate themselves and others on the importance of establishing healthy eating habits for children from their earliest years. Promoting and applying breastfeeding, lifestyle, and nutrition education programs are absolutely necessary to effectively combat the rapidly increasing rates of childhood obesity.

(The author is Director, Department of Paediatric Gastroenterology, Hepatology & Liver Transplantation, Medanta – The Medicity Hospital, Gurgaon)