Overweight children are more susceptible to a range of diseases. Can a new formula help curb this?
Doctor, is my child overweight for his age?" paediatrician Kiran Krishnamurti was asked by the parent of a two-year-old child during a routine check-up. Dr Krishnamurti, who has been practising in Hyderabad for 28 years, says this level of awareness regarding childhood obesity is a new trend. In the earlier days of her practice, parents would want their children to be chubby and seek advice on making them “healthier" (read fatter). Now, she finds that parents are increasingly weaning away from that idea, and trying to ensure that their children are growing up healthy.
And it’s important to be aware—childhood obesity has been linked to over 50 diseases, most commonly diabetes. A study published in 2007 in The National Medical Journal of India showed that childhood obesity showed a significantly increasing trend in a short period of two years.
A 2004 study inDiabetes Care says the top three countries in terms of the number of people with type 2 diabetes are India (31.7 million in 2000, with 79.4 million projected by 2030), China (20.8 million in 2000 and 42.3 million in 2030) and the US (17.7 million in 2000 and 30.3 million in 2030).
Other risks, like early-onset metabolic syndrome, increased cholesterol levels and coronary artery diseases, also loom round the corner as childhood obesity progresses into adult obesity. Nearly all the studies published on childhood obesity, like Childhood Obesity in Developing Countries: Epidemiology, Determinants, And Prevention, published in Endocrine Reviews in 2012, conclude that it will be good to have a screening mechanism and effective health education programmes to curb the increasing incidence.
A group of researchers at the Imperial College London, led by Prof. Philippe Froguel, have designed a formula that can predict at birth if a baby has the risk of turning obese later in childhood. The formula was developed using data from a 1986 Northern Finland Birth Cohort study following over 4,000 children born in Finland. It was published in the journal PLOS ONE on 28 November. Available onlinethis calculator asks for five inputs to predict obesity in a baby—the body-mass index (BMI) of the parents, the birth weight of the baby, the number of people in the household, the professional status of the mother, and whether the mother smoked during pregnancy. Originally studied on Finnish children, the formula was also tested on data from Italy and the US and was found to be accurate.
Prof. Froguel states in the study that obesity, if predicted at birth, leads to parents being more receptive to advice on early preventive measures such as breastfeeding, controlling feeding-on-demand, weaning no earlier than the sixth month with recommended meal patterns and food portions, avoiding television (more television hours mean less physical activity and mindless eating of junk food) and sugar-sweetened beverages.
According to Prof Froguel, once children become obese, it is an uphill task to change their habits and make them lose weight. This kind of awareness will ensure they stay on the right track of proper nutrition and good physical activity from early childhood, thereby giving them a good chance of not turning into obese children and adults.
Asked whether such a formula will work in India, Dr Krishnamurti says unless research is carried out on the Indian population, with a follow-up of around 20 years, it is tough to use it as an accurate predictor. “In my practice, I have seen kids extremely obese at five years turning wiry thin as teens because there are a whole lot of influencing factors that keep changing with time," she says.
The 2012 study in Endocrine Reviews by Anoop Misra (chairman, National Diabetes, Obesity and Cholesterol Foundation, New Delhi, and chairman, Fortis-CDOC Center of Excellence for Diabetes, Metabolic Diseases and Endocrinology, Fortis, New Delhi) and his team states, “Rapidly changing dietary practices and a sedentary lifestyle have led to increasing prevalence of childhood obesity (5-19 years) in developing countries, with 22% in India." The study lists a variety of reasons, mainly social triggers specific to India, such as more importance given to studies than sports, girls being restricted from playing outdoors after a certain age, not leaving any food on the plate at the end of the meal, etc. While he appreciates that screening methods help, he says, “All such algorithms should be validated on Indians before it can be widely used."
Rachna Ganguly, a Noida-based software professional with an year-old child, feels applying this statistic-based calculator on all children universally would be a little far-fetched. She would rather rely on her doctor to take a call if she sees abnormal weight gain in the course of their regular visits. Dr Krishnamurti also believes that the paediatrician is the best person to take a call on when to intervene, especially if they find that a baby is putting on much more weight than normal. “Then too, I wouldn’t be concerned about overfeeding in exclusively breastfed babies," she says. She totally rules out using the formula on newborn babies and alarming the parents with the risk of future obesity in their child.
Even Jaspreet Singh, a businessman from Delhi and father of a month-old baby, believes wrong scoring can lead to parents using measures to prevent obesity in the child, causing unnecessary stress. “While being forewarned is good, needless stress is not," he says.
Yoni Freedhoff, an obesity medicine doctor, founder and medical director of the Bariatric Medical Institute, Ottawa, Canada, has a strong viewpoint on formula-based predictions. “When practising medicine, we have to see the person in front of us and not blindly believe fancy statistics," he said in an email interview. While it is tough to summarize in a few words how to keep children healthy and prevent obesity, he goes on to share his top three suggestions—“Cook the vast majority of meals using fresh whole ingredients and involve your family in their preparation to pass on the life skill of home cooking. Eat out truly rarely, and don’t drink your calories."
Dr Misra’s study gives much weightage to effective interventions starting in early childhood to reverse anticipated trends. He concludes in the study, “High-risk screening and effective health educational programmes are urgently needed in developing countries."
It may be wise to set down the benchmarks for an India-specific screening criteria.