Published in B Positive Magazine – June 2009
 
As I walked into my son’s school to attend an annual celebration, I could immediately notice that a significant portion of the children there were overweight. This trend of weight changes in school children across most of the urban schools, and the so called ‘premier league schools’ in India, is a standing testimony of our times. It is now an acceptable norm to have kids overweight in the higher socio-economic class. Unfortunately, while some children in our country are struggling with hunger and poor nutrition, we have another emerging problem: The problem of plenty.

Some time back, a hefty child used to mean a healthy well-fed child. But actually, even this could be just another form of malnutrition.

Some Sobering Facts:
It is very likely that overweight children will become overweight adults.
Probability of childhood obesity continuing into adulthood is estimated to increase from approximately 20 percent, if they are obese at age four, to almost 80 percent by the teen years.
Pediatric (childhood) obesity is increasing at an alarming rate making it a major concern for today's youth. Approximately, 15 percent of children in India, from ages six to18 years old, are considered obese.

Causes of Obesity in Children:
Causes of pediatric obesity differ from child to child and are still not fully understood. Factors such as Genetics, Environment and behaviorseem to be the main causes. Overweight children are at increased risk of developing

• High blood cholesterol
• High blood pressure
• Type 2 diabetes
• Sleep apnea
• Asthma
• Orthopedic complications

 
Recently, at my practice, I was shocked to see a 14-year-old boy with a weight of 93 kgs and severely hypertensive. Parents of this child approached for a possible weight loss procedure to help his overweight and hypertension. It is only a matter of time that he would develop type2 diabetes and other conditions mentioned above, if nothing is done.
 
The Parent’s Role
It has been shown that children with overweight parents are more likely to be obese. Experts believe that this is a leading cause for childhood obesity. Regardless of how big a role genetics plays, one thing remains very clear:

“Parents are responsible for a child's genes, diet and behavioral patterns”

The goal for obese children should be to maintain weight or reduce the rate of gain. Excessive calorie consumption and lack of physical activity are two of the major culprits and are controllable risk factors. Parents should take a proactive role by asking their health care provider or school authorities to monitor their child's BMI periodically (at least once a year). [Obesity is measured in terms of Body mass index (BMI), a ratio of weight (in kilograms) divided by height (in meters squared)]
At home, remember that parents and caregivers are a child's best role model. If you are staying active and eating a balanced diet, your children are more likely to follow your lead.

Things to do

• Keep healthier foods in the house, like fruits, vegetables, whole grains and low fat dairy foods, so they begin to consider it ‘the norm.’
• Encourage moderation of portion sizes and set limits on how much high fat and high sugar foods are eaten each day.
• Teach moderation and limit fast food meals to no more than a couple of times a month
• Limit television and video time to no more than two hours a day and encourage activities like bike riding, playing outdoors and participating in sports. One can also start programs at home such as ‘no TV week’ and encourage children to participate. Use the additional time created to play sports and interactive games.The advertisements on food products have a significant impact on what your kids prefer to eat.
• Action and reaction:Remember,your actions can help your child develop healthy eating and exercise habits that will last a lifetime.
• Force feeding: Watch for your child's internal hunger cues, and listen when he says, "I'm full”.
• Being part of the "clean plate club" and asking the child to finish the food in his plate, may not send the right message.
• Focus on "5-A-Day" for fruits and vegetables and "3-A-Day" for milk.
• Liquid Calories: Watch out for the extra calories in drinks. Discourage soda and sugared beverages. Dilute juices with water.

Children are still growing, which works much to their advantage since it's possible for them to ‘grow into’ their weight. As they grow in height, their weight may ‘decrease’ in percentiles according to growth charts. Hence, weight maintenance is as important to an overweight child as weight loss is to an overweight adult.

Professional Help

• Physical education: place children in a structured exrecise or sports activity.
  n Dietary modification – with a nutritionist who can customize the diet in terms of quality and quantity.
• Psychological evaluation – to rule out any eating disorders or underlying depression.
• Medical therapeutics – usage of medications to reduce fat absorption or to reduce appetite.
• Surgical intervention – should be considered when conservative measures fail or, if the child develops obesity associated conditions such as hypertention, diabetes etc. When such interventions are sought, a reversible procedure such as a gastric band procedure is better recommended. BMI can be calculated from several sources on the internet. BMI more than 25 shoud be monitored closelywith conservative weightloss mesures. BMI above 32, with associated conditions may be considered for surgery. One with BMI more than 37 will definitely benefit from weight loss surgical procedures.

Children tend to be very sensitive to their weight problems. They tend to fall an easy prey to rude and insensitive remarks from their peers. This issue must be approached in a very gentle and personal manner. This will avoid permanant emotional scarring in such kids.
Let us protect our children from obesity. Children are our contributions to the society, and, we will be identified though their success stories in future.