Alarm Raising Situation: Childhood obesity

Today, the worldwide burden of childhood obesity has increased manifold, aftermath, associated with the rigorous changes in lifestyle at physical, mental-emotional and social levels. By 2025, India will have over 17 million obese children, and expected to stand second among 184 countries of the globe where the number of obese children is concerned.

Chubby cheeks and round tummy are not always signs of good health. This is, unfortunately, a most common myth among parents. But they are being misinformed and mislead. In fact, the obese child is at a higher risk of development of poor health at later stages of life.

How to Calculate that your Child is Overweight and Obese?

The term overweight refers to excess body weight for a particular height. Obesity is used to define excess body fat. Body mass index is calculated by dividing a person’s weight in kilograms by the square of height in meters.

In the adult population, BMI is used as a parameter for assessing obesity. However, a generalisation of BMI is not possible in case of children and teens. BMI is age- specific and sex-specific in children and is often referred to as BMI-for-age, WHO has provided reference charts for assessing childhood obesity.

11 October is celebrated as World Obesity Day

A child shall be categorised as Overweight if according to the chart, BMI is at or above the 85th percentile and below the 95th percentile for children and teens of the same age and sex.

An Obese child would have BMI at or above the 95th percentile for children and teens of the same age and sex. For Indian children between the age of 5 and 18 years revised  Indian Academy of Pediatrics ( IAP) revised 2015 growth charts (2015) are being used.

For children under 5 years, the World Health Organization (WHO) global growth standards (2006)  have been adopted by both IAP and the Indian government.Look into the link provided below to check the growth status of your kid.

https://www.iapindia.org/iap-growth-charts/

8 Causes and Risk Factors for Childhood Obesity

Obesity is a multifactorial condition, the culprit factors, directly or indirectly, act by altering energy intake and energy expenditure. For a healthy weight gain, your energy input and output needs to be in harmony. The imbalance between energy cycles leads to storage of excess fat which over time can lead to overweight.

1. Pregnancy and early life nutrition

Both Overweight and obese women and undernourished mothers have a higher risk to conceive a large-for-gestational-age (LGA) baby, which is a risk factor for the development of the child becoming overweight or obese.

Prenatal exposure to maternal smoking and absence or short duration of breastfeeding in infancy are some of the early-life determinants of overweight and obesity.

Premature complementary feeding (at aged 4 months or less) may increase the risk of the infant becoming obese in early life.

2. Lifestyle and behaviour

Lifestyle and behaviour factors play a key role in the development of childhood obesity. Most important factors responsible are diet, eating pattern, physical activity, sedentary behaviour, and psychosocial factors.

3. Diet

Excessive consumption of food laden with empty calories, refined food, junk food, sugar or salt-laden food for a sustained period of time increases the risk of obesity in kids.

4. Eating behaviours

Skipping breakfast, binge eating and frequent snacking are linked to an increased prevalence in overweight and obesity in childhood.

5. Physical activity and sedentary behaviour

The dimension of physical activity has dropped down altogether in ongoing time, will keep on diminishing further in the coming years. Commuting to school by bus or car as opposed to strolling or bicycling, the absence of spaces to play, overindulgence with TV, cell phones, PCs or PC have diminished the dimension of physical action

As per WHO recommendations, at least 60 minutes of physical activity a day for 5 to 17-year-old children, including vigorous-intensity activity that strengthens muscle and bone at least 3 times per week.

6. Sleep

School-Aged children should get between 9has 11 hours of sleep per night for rejuvenation of the body, both physically and mentally. Lack of sleep can create a state of lingering tiredness in a child, lead to increased sedentary behaviour and snacking.

Not only quantity but the quality of sleep should be adequate. However, excessive indulgence into modern gadgets and social media creates cognitive, physiological, and emotional arousal, and jeopardise the quality of sleep.

7. Psychological factors, the social environment and urbanisation

Psychological factors, such as impulsivity, depression, self-esteem, and anxiety, and the social environment, including family, social acceptance, and social functioning, have been linked to the development of childhood obesity. All the above conditions put a child into a state of stress. Stress releases hormone Cortisol in the body which increases a state in a child where child prefers to take food higher in salt and sugar.

Over protection and forced feeding by parents, false traditional beliefs about health and nutrition, low knowledge about nutrition in parents or caregiver, dietary patterns, as well as familial stress, parental mental health play an important role in the onset of childhood obesity.

8. Genetics

Obesity in the family is inherited and associated with a higher risk of childhood obesity. Several genes are responsible for obesity-increased fat-cells numbers. Fat cell theory holds that the number of fat cells in the body determines the percentage of body fat an individual carries, which in turn is partially determined by inheritance and partly by eating habits. Genetic factors are influenced by behaviour and environmental factors.

How Childhood Obesity can Affect your Child?

Childhood obesity is associated with several short-term and long-term effects, adversely affecting the physical, mental and social health of a child.

At More risk of 

• Cardiovascular diseases
• Altered lipid profile, raised cholesterol, Hypertension
• Type 2 diabetes: Overweight children have been linked twice as often to diabetes when compared to non-obese children
• None alcoholic Fatty liver disease: Too much fat can be stored in the liver can lead to health problems.
• Orthopaedic problems and musculoskeletal problems due to overloading, bones are more vulnerable to fractures
• Childhood obesity can reduce life expectancy by a 2 -5 years
• Contrary to normal belief, childhood obesity has a risk of persistence of obesity later in adulthood.
•  Obstructive sleep apnoea often occurs in obese children due to the fat tissue around the neck pressing and narrowing the airway.
• Obese children may also have an increased risk of developing asthma and asthmatic attacks.
• Increased risk of cancers (kidney cancer, colorectal cancer and oesophageal cancer)
• Hormonal disturbances, the triggering of an earlier entrance into puberty, which may be unsettling or stressful for a child.
• Low self-esteem and confidence, increased vulnerability to developing depression, social seclusion and poor performance at school.
• Low academic performance: Obese children are also more likely to miss schools. Health problems associated with Obesity decrease the other cognitive ability of the old, leading to poor grades in exams.
• Obesity is an economic burden for family, society and country.

Prevention and Treatment of Obesity in Kids

Prevention includes educating and modifying behaviour and attitude of people, directly and indirectly, influence a child and moulds his/her behaviour which includes parents, primary caregivers, teachers, decision makers, society and businesses. It is almost importance for all these people to become a role model or provide a supportive environment.

Suggestions and recommendations for parents/caregivers:

• Be a role model in front of kids. Adopt a healthy and active lifestyle yourself too.
• Never overfeed child, serve appropriate portion sizes– use smaller plates.
• Discourage excessive sugary, sweet fried or junk food outside. Instead add whole grains, fruits, vegetables in their diet. Promote healthy eating by providing balanced lunches and nutritious snacks.
• Reduce saturated dietary fat for children older than 2 years.
• Never use food as a reward for good behaviour or to satiate the emotional needs of children.
• Encourage physical activity. Take your child to park and engage them in recreational activities.
• Encourage children to try new foods, so they learn to accept and appreciate a wide range of tastes.
• Develop a supportive social environment for the child, such as family meals, no eating in front of the television, and regular (physical) activities.

Treatment of Obesity

Non-pharmacological treatment 

• Lifestyle intervention and behaviour change therapy.
• Dietary changes are important in treating childhood obesity.
• Any caloric restrictions should not be too drastic, however, as this could result in a failure to keep up with the diet, and/or with impairment of growth and development due to nutrient restriction.
•  A reduced intake of sugar-sweetened beverages and energy-dense/nutrient-poor foods are recommended.
• Reducing screen time to a maximum of 2 hours per day. (American Academy of Pediatrics).
•  Such interventions decrease sedentary behaviours and induce weight loss and reduction of body fat.
• Banning televisions and computers from the bedroom are advised.
• An example of a multi-behavioural approach is the ‘5-2-1-0’ or ‘5-2-1-almost none’ message, which stands for:
  • 5 portions of fruit/vegetable;
  • a maximum of 2 hours of screen time;
  • a minimum of 1 hour of physical activity; and
  • limited sugar-sweetened beverages per day.

Surgery to Cure Obesity

Surgery is only used in severely obese children with serious complications and after psychological examination, as bariatric surgery will result in the need for lifelong dietary and lifestyle changes and specific nutritional requirements.

Two types of bariatric surgery

1. Gastric bypass surgery

This surgery restricts food intake by reducing the size of the gastric pouch and reducing the number of nutrients absorbed.

2. Gastric Banding

It involves an adjustable band placed around the stomach, creating a small pouch and thereby restricting the amount of food that can be consumed.

Pharmacotherapy to Cure Obesity

When primary interventions comprise of behaviour and lifestyle modification fails to bring down BMI, drug therapies come to rescue.

However, drug treatment is indicated only in children above 12 years of age, and are applied in combination with lifestyle interventions. Orlistat is the only medication approved by USFDA for treatment of obesity in adolescents aged 12 years and older.