The Emerging Epidemic

TOI, 22nd July, Mumbai edition, carried on front page a report on “One of youngest to undergo Bariatric Surgery” for a morbid obesity caused by being fed on rich diet!

The Emerging Epidemic - Childhood Obesity - Overfeeding A Baby - Kids

Alas! a child penalised for life full of morbidity and may be early mortality.

In this case father at least owned up to the error, that since she was a precious child they over pampered her by (over)feeding a very rich diet.

In my 36 years of practice, I have not had a single mother come worried about child’s overweight! Contrary to this most mothers will lament, “Doc., do something. She is not eating at all! I am so worried!” In most cases, child is above 90th percentile in weight (if not overweight) and the worried mother is beaming! They overlook the fact that he is outgrowing his clothes with a lightening speed. By the time they accept that their healthy (cho chweet) baby is really overweight/obese it is too late and needs drastic control which the pampered child is not willing to obey.

All of us know Childhood Obesity is becoming a major medical problem. We cannot take solace in the fact that obesity is on the rise in adults as well. Adult obesity has tripled in the past 20 years, and is still rising. Obesity in children, has doubled in six-year-olds and trebled among 15-year-olds (and in a decade only). And like bad behaviour, bad manners, etc. parents play a key role in childhood obesity.

What is shocking is that for most mothers an overweight child is just a healthy child.

Why childhood obesity?

–      Majority is due to overeating, the child eating (fed) more than the body needs, leads to an imbalance between intake and output. Most mothers decide how much the child should eat and when. Most fat children have developed the sweet eating habit and gobble potato wafers, icecreams, chocolates, etc. very commonly.

–      Most mothers argue that the child is so big and needs a lot to fill him and they are generally proud of his marvelous appetite.

–      There are often important emotional factors like sibling rivalry that leads to overeating. More commonly it is emotional weakness of a mother (uska bachha mere bachhe se healthy kaise?)

–      Obesity may develop because of inactivity, an important factor can be today’s addiction of television, video games and the Internet.

–      In most cases it is a combination of 2-3 factors

Health issues:

–      The most frightening is diabetes. Every one knows there is Juvenile diabetes (life time of insulin) and there is maturity onset (Type 2) diabetes, which was seen in patients in their late 40s or early 50s – Truly a Maturity Onset! With passing times, this age kept getting younger and it forced a NEW nomenclature – MODY (Maturity Onset Diabetes of the Youth)!… Now we are seeing Type 2 diabetes in grossly obese kids of 12-13 years! Amazing!

–      Early onset (in early 20s) of high blood pressure

–      Calcaneal apophysitis – a heel pain, non-responsive to conventional therapy

–      Skin folds – treatment resistant fungal infection, largely because skin in the folds just can not breathe

–      For the girl child – PCOS, Infertility, hirsutism

–      Backache/joint pains

–      Difficulty in breathing

–      Loss of self esteem/stress

The important aspects of obesity management are:

–      Start a serious weight-management program; not only to say “Ok, I will try and control”

–      Eating habits have to be changed (train your child to eat slowly and not gobble). No distractions like TV while eating

–      Food selections have to include less fatty foods; avoid junk food

–      Calories must be recorded; inculcate the habit of “Diet recall” in your child

–      Increase physical activity (especially walking, cycling, swimming)

–      Do not provide snacks while watching television or working at the computer

–      Should not use food as a reward; take a vaccine shot – get a chocolate!

–      Limit in between snacking – mothers NEVER remember snacking when complaining to a doctor ‘My child does not eat at all’  for a child with a BMI of 30+

A very small percentage of mothers do realise the potential problems an overweight child will face in later life and are willing to discuss the problems and discipline the child.

If your child is more than 25 % of his expected weight, it is time to seek an opinion and act accordingly. If there is a positive family history of diabetes (parents/grand parents) take that as a incessant wake up call alarm!

Dr Chander Asrani, father to three daughters and grand father to one, is a post-graduate in Family Medicine. He has over 35 years in clinical practice, launched www.growingwell.com in 2000 and since then has been writing on various subjects. Know more about him at about.me/drasrani.

  • Thanks Doc, for that reminder and the wonderful tips that you have provided in your post. Although I was aware that childhood obesity was an issue, I was honestly shocked that it is widely prevalent in India as well.

    Given that we belong to a country and a culture where ‘plenty’ is considered good, I truly am not surprised when mothers complain of their children not eating enough. As long as quantity is given priority over quality, especially when it comes to food, I believe we will continue to face this problem.

    • Yes, Jairam.
      In India, indulgence is taken as expression of love. Over indulgence is more love!
      WIth both parents taking time to live their own life, maybe guilt leads to chocolates, outings to Mac etc,,,

  • Another great post by you Dr. Asrani. I think it is one of the biggest fights we have as parents. Healthy diet and lifestyle is one area we have to lead every single day by example in front of our kids.

  • I am very particular about food/diet. Chocolates, junk food etc are not part of our daily food habits. I have seen so many moms taking their children for stroll and handing them chocolates everyday. Obviously, when they don’t, children throw tantrums. I have stopped many people – friends and family-from giving chocolates to my son. My child does not even know what chocolates are. He has tasted of course. Why introduce such habits. He is anyway going to pick it up once he steps out of our cocoon.
    Moreover, we don’t watch TV. And if by chance, somebody is watching, it has to be turned off while eating. I will admit that I have worried about my son not eating enough solid food earlier but now I have accepted that if he is active and energetic, and not asking for food, he isn’t hungry. Even when I feed him, I ask him if he is done or would like to eat more. I have seen he is more keen on food when he eats himself.
    Recently, my nephew visited us. He has the habit of eating snacks while watching TV. I had to go out of my way to guard my son from picking those habits. When he would eat biscuits, I would deviate my son’s attention by offering him dry fruits (which he absolutely loves). It had become almost funny. But at 2, he is at an impressionable age. It is easy for him to pick up habits, and I have to ensure they better be good 🙂

    • Reema
      I wish more parents were willing to rebel against the so called norms. Even my grand daughter at 2 and 1/2 does not know what a chocolate is. But has been trained to fight for ‘Dahi’ before she finished her meals. Most parents suffer from a dangerous ‘bcozothersaredoingit’ syndrome!
      Keep up your controls! You will need your wits around you as he grows up.

  • Dr. Asrani, I cannot say anything beyond a big thank you for this post. I will be making a print-out and circulating it around in my Punjabi community who live to eat, and feed their kids, only. If only such words of advice were heeded by those who think everything should be dipped in ghee before giving it to a baby, obesity in children due to over-feeding would be wiped off. Perhaps, social appearances which make you a good mother if your child is chubby drive mothers to make the 7 kg bundles of joy eat eat eat. Lovely post!

    • Thanks, Sakshi
      Not lagaoning ‘Nazar’, I was watching the current singing competition for kids on one of the channels and was shocked to see only 2-3 of 20 could be called as thin or averagely built and as the programme has progressed, they have actually become chubbier.
      Kahan ja rahen hain hum??
      Your attempts at changing Punjabi mother’s behaviour – I have tried and the response in most cases is “Doctor saab, tussi te peeche hi pad jaate ho. Hun Baccha nahin khayega te ki assi khayenge?”. This coming from a 100 kg mother.
      Habits continue – an adult will not give up sugar/ ghee even if diagnosed with diabetes or dyslipidaemia.
      Anyways, if they don’t change, why should we give up our attempts?

  • Thank you Dr. Asrani for this timely and much-needed post. Here is a related one that readers may find useful: http://parentedge.in/monitor-the-junk-in-your-childs-diet/

    Kritika Srinivasan

  • Thanks, Kritika. I am sure parents will find it useful

  • One more good eye opener article Dr. Asrani.
    The biggest criticism I get in raising my kid is that she is “toooooooo” thin, the equivalent to being sick, they tell me! and it is always followed by advice that I should feed her more. She being very active, with good stamina and good immunity(at the age of 4) is of zero consideration to people making such comments!! She is thin and small because her parents are of small build is obviously ignored !! Its like being a good mother is directly proportional to how “fat” your kid is!! Its crazy out there!

    • Dr Chander Asrani

      I know Divya, what you are going thru. Sad that healthy kids are compared to tall/ fat kids. Time parents realized the difference

  • Dr SNRao

    Doctor,
    This is a precious article.I wish the message reaches many readers! Giving the child a healthy eating habit is definitely the parent’s responsiblity.

    • Dr Chander Asrani

      Thanks, Dr Rao
      Coming from a doctor makes it more satisfying