Eleven-year-old Rahul, the only son of his doting parents, looks much older than his age. He weighs more than 48kg and his big paunch makes him the butt of jokes among his classmates. But Rahul couldn’t care less. He loves potato chips, chocolates and colas more than the idlis and tomato chutney his schoolteacher mother makes for breakfast. He loathes the idea of going to the neighbourhood park in the evening to play with his friends. Once back from school in the afternoon, Rahul refuses to take his eyes off the TV, at least till it is time to do homework, have his dinner and go off to sleep.
Rahul’s mother knows the problem is serious. Obesity among children, doctors have told her, is a serious condition stalking urban India and her son is a victim. Says Sushil Sanghi, a child specialist from Jaipur: “Obesity in childhood will lead to diabetes and heart-related problems as adults.” Other doctors add to this list: hypertension, high cholesterol levels, sleep apnea and bone problems.
Some doctors also opine that social and psychological problems are the most significant consequences of obesity in children. Recent studies have indicated that more than 80% of obese children end up as obese adults, with all the accompanying ailments.
Doctors say that obesity in children, described as a modern epidemic, is caused by two simple factors: an unhealthy diet (typically, too rich in sugar and fats) and a complete lack of exercise that could help burn off excess calories (see Treadmill on this page). The changing nature of diets is a major cause of concern. Most of what children eat these days seems to consist of junk food, fried stuff and items made of refined flour such as biscuits, cakes, pastries and noodles—which badly affect the intestines.
Says Vinod Jacob Cherian, consultant paediatrician, West Fort Hospital, Thrissur: “Overfeeding by anxious mothers is the principal cause of obesity among children. Mothers associate love with food. We do not even let our children experience hunger. Therefore, children end up eating even when they don’t need to. The excess, fat-enriched food does not get burnt up and the result is there for all of us to see and regret later in life. Children today are being brought up like broiled chicken. What we have in the end is just a confused mass of protoplasm.”
The first two years of a baby’s life, doctors say, are the most critical. This is the time when fat cells are created and, if there are too many of these, the chances of gaining excessive weight right through adulthood increase. Adds Dr Cherian: “For the first five to six months, the baby should be breastfed every three hours or so, which works out to about eight feeds a day. However, mothers today, unaware of the needs of the child, overfeed them. Crying need not always imply hunger. A baby will suckle even if it is not hungry.”
And then, parents are over eager to wean their children from breastfeeding: Even before the baby is a couple of months old, they start giving him/her cereals, bananas and even ghee. Being fat and chubby does not necessarily spell health, warn doctors.
However, the problem need not always be due to unhealthy food or faulty lifestyles. Hormonal imbalances such as thyroid or growth hormone deficiencies, and Cushing’s Syndrome, where there is more natural production of steroids in the body, could also lead to excess weight.
According to recent studies, children with inherent insulin resistance, which is genetically determined, have also shown a tendency to put on excessive weight. Says Arvind Taneja, director, paediatrics, Max Healthcare, New Delhi: “There are insulin receptors, especially on fat body cells, that allow the entry of glucose into the cell for its metabolism. If these insulin receptors do not bind the insulin because of genetic factors, then the pancreas, which produces insulin, has to work overtime. Such children will have high insulin levels and high glucose levels in the bloodstream. The excess glucose gets converted into fat, making them obese. These children are also likely to develop heart disease and cerebral stroke. They may also get Type 2 diabetes.”
Doctors suggest that parents can play a very active role in avoiding obesity in children. Says Dr Taneja: “Parental obesity has a big role to play in a child gaining excessive weight. If parents love fat-rich food and follow a lifestyle that includes little physical activity, their children will follow suit.”
Arbitrarily putting your child on a diet is a short-term route to losing weight. Instead, what is most important is to wean the child away from unhealthy food by inculcating in him/her a liking for healthy, home-cooked food that is high on nutrients and roughage and low on calories. On an average, a one-year-old child needs approximately 1,100 calories per day while a five-year-old needs about 1,500 calories.
It is also important to build in a regular exercise regime. Parents need to join their children for walks, swimming or biking, making it a family activity. Making children do every thing on their own is unlikely to yield positive results. Responsible parenting involves lifestyle modification, too, and is an important element of losing weight. Parents themselves must live an active life and involve their children in activities that keep them outdoors.” Doctors suggest at least half an hour of daily physical exercise.
There are no short-cut solutions to this problem. Doctors warn against medicines that claim to curb appetite. These, they say, can have many harmful side effects. Appetite suppressants, such as Sibutramine, induce a feeling of a full stomach. And, then, there is Orlistat, which is a reversible inhibitor of gastrointestinal enzymes that digest fat. Doctors say both should be avoided as they stop the absorption of vitamins A and D.
Anju Virmani, paediatric endocrinologist at Indraprastha Apollo Hospital, New Delhi, says that genetically, Indians tend to have more fat. “Many of us moan that obesity runs in the family. Instead, we should focus more on exercise.”
Parents should, she says, be more concerned about the fact that their children run the risk of diabetes, hypertension and polycystic ovarian disease if their weight is not kept under control. In addition, she says, boys may develop large breasts—this affects their self-esteem. The skin in the armpits, nape of the neck and several other parts of the body darkens unnaturally with increased insulin levels in the blood.
Paediatricians say the only way out is to ensure that parents are fully aware of the causes behind their child’s weight problem and of the ill effects it could have in future. Only then will they take remedial steps.
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