Tackling childhood obesity in India

Should you be concerned about your child being obese? In Indian context, we have always heard of malnutrition and deficiency diseases as being the major focus of health programs. But recent statistics show an alarming reversal. According to a study published in Lancet, India is third in the list of having highest number of obese people after US and China and finds its name in the top 10 global hazard list.

The study also notes an alarming trend of obesity among children and adolescents in India, with abdominal obesity being a key concern.

A recent study conducted among urban school children in South India showed an increase in number of obese children demonstrating the time trend of this rapidly growing epidemic.

The reasons are obvious – Fast food, lack of exercise, or games periods in schools, increased stress on academics which leaves little time for any other outdoor activity,  addiction to gadgets (TV, mobile, gaming, and so on) all contribute to this menace.

Schools should mandatorily increase outdoor games and competitive sports, apart from lowering stress on academics and homework.

Some reversible causes of obesity include:

• Genetic susceptibility
• Circadian rhythms
• Sleep
• Medications
• Stress
• Psycho-social
• Sedentary behaviors
• Physical activity
• Exercise
• Dietary behaviors

Obesity can lead to many complications, even in childhood. Some consequences are:

Cardiovascular: Dyslipidemia, hypertension.

Endocrine: Impaired oral glucose tolerance test, type 2 diabetes, polycystic ovary syndrome.

Gastrointestinal: Anemia, constipation, fecal soiling, gastroesophogeal reflux disease, non-alcoholic fatty liver disease.

Orthopedic:  Slipped disc, brittle bones, weak knees.

Neuropsychiatric: Binge eating, compulsive eating, night eating, depression, anxiety, weight teasing, sleep disturbances.

Pulmonary: Asthma, sleep apnea.

Dermatologic: Acanthosis nigricans.

Tackling obesity before it gets too late is of primary importance. Parents, teachers, primary healthcare providers, expert nutritionists, all need to integrate their efforts in bringing about a behavior and lifestyle modification in the obese child.

Dietary recommendations

Limit sugar-sweetened beverages with the goal of eliminating them entirely.

Increase the consumption of vegetables and fruits, particularly non-starchy vegetables such as greens and carrots (caution needed with starchy vegetables such as potatoes, corn, peas).

Eat breakfast every day.

Limit meals eaten at restaurants as they tend to be more calorically dense.

Cook and eat family meals together, emphasizing family time and not just food.

Limit portion sizes.

Avoid storing sugar-sweetened beverages at home.

Focus on high-fiber, low-calorie foods by making ½ plate vegetables and fruits at lunch and dinner.

When there is no time to have breakfast, blend a fruit, some almonds and walnuts with low fat milk into a smooth milkshake.  If possible, add a boiled egg white. This ensures a protein rich, filling breakfast which reduces the tendency of the child to overeat during later hours.

A serving of lean meat or non-veg should be the size of a child’s palm and a serving of starch should be the size of a child’s fist.

Offer meals and snacks at set times daily – this way kids know when to expect food.

Never allow “grazing” between meals; instead offer meals and snacks consistently every 2-4 hours.

Engage in family meals as often as possible. Parents and children should sit together at the table and engage in a pleasant mealtime conversation. Parents should model healthy eating behaviors.

Children should not be forced to eat certain foods or certain amounts of foods. Healthy kids know when they are hungry and when they are full.

Food should never be used as a reward, bribe, or punishment. Rewards can be in the form of stickers or a trip to a park, but not food.

Physical activity recommendations

The Indian Council of Medical Research recommends at least 90 minutes of vigorous physical activity every day for children.

Tips to enhance physical activity levels

• Enroll in physical activity programs if possible
• Set up an active play group with the child’s peers – kids like to be active with other kids. They need to have fun and not work out
• Use local parks and playgrounds
• Join a local community/recreation center
• Encourage activities such as dancing, exercise videos, yoga at home
• Take homework/study breaks
• Walk to get to places as much as possible.

Preventing obesity and getting the obese child back to ideal weight is very critical for ensuring great health for the rest of their lives. Parents and other caregivers need to address this on a war footing. The first step is finding a certified dietitian to plan your child’s meals and a physical trainer to formulate a workout regime to complement that very plan!