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!
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
– 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
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.