Though we continue to struggle and grapple with moderate and severe malnutrition, the pendulum has swung to other extreme in over 2 decades and we are confronted with obesity in children in no small way. Which truly also is a form of malnutrition! The developed countries show a figure of 18-20%, India is fast catching up. A change in life style and eating habits has lead to this upsurge. Parents very proudly refer obese children as "Healthy"; the truth cannot be farther than this.
The first reaction of the parents is to suggest investigating an obese child is to look for some hormonal imbalance, particularly deficiency of thyroid hormone (hypothyroidism), a view shared by many general practitioners. A rule of thumb is that obesity due to internal ( read hormonal) causes is associated with lack of increase in height of the child, therefore if a child is overweight and his/her height is normal for age, it is very unlikely to be due to hormonal cause. And the best way to discern this is to follow the growth of the child on a growth chart. Many parents come with a blood report of thyroid test and the TSH level moderately high. And some body erroneously labels this as hypothyroidism. In fact, obesity causes TSH levels to rise, so a raised TSH is not the cause but the effect of obesity in these children. Obesity is an imbalance, not hormonal but of another kind. It is an imbalance between intake and expenditure. I try to explain to parents in terms of a fat bank balance, you deposit more and withdraw less, it happily grows!
What are the causes?
With the availability of play grounds getting limited in cities and children spending more time in front of television sets, the physical activity is increasingly getting limited. Tremendously increasing use of other electronic devices has further added to this problem. To cap it all, children go on munching food/snacks while watching TV, without realizing what and how much they are eating. This lack of physical activity and eating items advertised on TV is the deadliest combination.
Why are we worried?
Obesity is a definitive contributory factor to all the life style ailments past middle age. Hypertension, Heart disease, Diabetes and Joint diseases are the important ones. An obese child is more than likely to become obese adult. Obesity can have far reaching effects on child’s disposition. A risk of being mocked, teased by peers is a constant threat to self esteem; he/she may miss being part of competitive sports, distorted self image can lead to knots in the psyche.
What can we do?
- Parents should avoid the obsession regarding the food intake and habits of their children from very early on. Force feeding should be avoided at all cost. Feeding and eating should be a pleasurable experience which the child would love to repeat. Undue worry in this regard leads to trying out unhealthy non nutritive substitutes, empty calories which becomes a nidus for future eating behavior.
- Periodically monitoring the growth of the child is the surest way to discern anything amiss. A well growing child is almost a guarantee against anything significantly wrong with the child, coupled with normal activity of the child is an added assurance.
- Over anxiety of the parents and grandparents leads to employing of distraction tactics applied by them to feed an infant. We should resist the temptations to use cartoons, mobile games etc to allure child into eating. Similarly, we should assiduously try to disassociate TV viewing and eating. And the rules should be the same for adults and children.
- We are responsible for inculcating good food habits, for teaching them the disadvantage of junk food. During meals time we should refrain from substituting nourishing food with ready to eat packed snacks, fast food, and food (like sugary drinks) with empty calories.
- Limiting the screen time to a maximum of 2 hours a day is generally recommended.
- Encouraging the child for at least one hour physical activity is desirable. The foundation for healthy living is laid down in the early childhood, excessive anxiety and some times over enthusiasm become the starting point of a wrong trend which often times is incorrigible.