Too fat by far
Your Health
DR GITA MATHAI
It is difficult to convince parents that their child is overweight even if you prove it by measuring the weight in kg and dividing it by the height in metre squared. (The normal value is around 23). Parents are disbelieving even when faced with values higher than 30. Perhaps this is because we tend to equate prosperity with a “well-fed look” and look admiringly at plump parents accompanied by children with pot bellies. Generations of coping with famine, want, the unavailability and unaffordability of food have taken their toll. As the money rolls in, parents abandon their traditional healthy life style and adopt a western approach to food and leisure.
Our tradition of breast-feeding infants provided them with the correct amount of calories for the first six months of life. A “let down” reflex controls the production of milk; as the baby sucks, more milk is produced. This ensures that the baby gets enough for its requirement, and doubles its birth weight by the end of the fifth month and triples it by the end of the first year. A baby that starts life at 2 kg will be normal if it weighs 6 kg on its first birthday. Its appearance will be a stark contrast to the baby that was 4 kg at birth and 12 kg on its first birthday. Both are normal, but cannot be compared as they represent two ends of a normal spectrum.
Unhappy with small but normal babies, parents often supplement breast milk with powdered formula or cow’s milk, a practice that should be avoided as far as possible. There really is no superior or adequate substitute for the “real thing,” that ensures healthy, adequate and normal growth.
Traditional weaning is with home-cooked cereals such rice, ragi and wheat with added milk and sugar. Today parents opt for ready-made sodium-rich, precooked, packaged weaning foods, or “milk biscuits” with disastrous results. These changed child-rearing practices have resulted in an epidemic of childhood obesity: 30 per cent of urban children are obese. Tragically, 70 per cent will go on to become obese adolescents and adults.
With cartoons, television serials, computer games, homework and tuition, children spend more than three hours a day almost motionless. Added to this is snacking on fat-laden packaged food and drinking calorie-high sugar-dense aerated bottled drinks. There is practically no physical activity at all.
Busy parents prefer these sedentary activities as they require minimum parental participation. For activity and sports, parents have to take the children to a place where they can play. There is a shortage of parks and open spaces. Children cannot be left unsupervised as there are the problems of safety, and social crimes like abuse and abduction (This used to be true only for girls but now both sexes are equally in danger).
The problem is compounded by the fact that life in India is very competitive. Only a few sportspeople succeed, but academic excellence ensures “good jobs”. Parents are under the misconception that children who “play” will be too tired to study.
Gradually caloric intake overtakes expenditure and obesity sets in. It also causes many psychological problems. Children develop a negative self image and either withdraw into themselves or become bullies. By the early twenties many are already exhibiting signs of syndrome X or insulin resistance, their blood sugar and lipid profile become abnormal. They develop diabetes, hypertension and heart disease. Girls may develop the polycystic ovarian syndrome (PCOS) with irregular periods and eventually, fertility problems. Indians are genetically prone to these abnormalities.
Studies have shown that children over the age of two need an hour of physical activity a day. This can be a single one-hour session or split into two 30-minute one. Even six 10-minute sessions are effective. It can be running, cycling, playing structured games, skipping or swimming.
Exercise helps children maintain an ideal body weight, feel less stressed and angry, improve concentration in school and sleep well at night. Objective studies using MRI scans demonstrated that exercise in children increases brain activity in the prefrontal cortex of the brain. This is the area associated with cognitive skills, complex thinking, decision making and correct social behaviour. Also the IQ (intelligence quotient) of these children improves by almost four points.
Children all over the world are becoming obese for the same reasons. Parents have a crucial role to play in making children healthy. They should exercise and lead by example. TV viewing should be limited. Oily, ready-to-eat snacks should be avoided.
Other governments (the UK, the US, Japan, China) have woken up to the fact that obese children grow into unhealthy unproductive adults, with medical problems that are a burden on the national exchequer. They have begun to tackle the problem on a war footing. We have not, and this means that India may eventually be a country where the life expectancy starts to fall.
Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in
Showing posts with label childhood obesity. Show all posts
Showing posts with label childhood obesity. Show all posts
Monday, June 6, 2011
Tuesday, July 13, 2010
fat children
Catch them early
Your Health
--------------------------------------------------------------------------------
DR GITA MATHAI
When I was a medical student (so long back that it was actually in the last century), two of the cases placed before us as “spotters” (look and diagnose, don’t touch or question) in an examination were children with kwashiorkor (lethargic and disproportionately swollen with fluid) and marasmus (wizened, wasted and looking like a wise elder). Both were common conditions, the result of malnutrition.
Such diseases are rare today. In fact, now doctors have to spot diagnose children at the opposite end of the spectrum. About 20 per cent of children (some less than a year old) and teenagers in India can be defined as overweight, obese or morbidly obese. Their weights exceed that expected for their heights by 20 per cent, 50 per cent, and even 80-100 per cent. The BMI (body mass index, calculated as weight divided by height in meter squared) which should be 23 is often well above 30. Many of these children maintain their obese status into adult life.
In addition to having a paunch, big hips, knock knees and a double chin, such children have a peculiar velvety black discolouration of the skin — called acanthosis nigricans — on the nape of the neck. No amount of scrubbing will remove it, nor talcum powder conceal it. It is a marker for obesity that is likely to progress in diabetes.
This unhealthy state of over nutrition starts in infancy. Babies are breast fed for less than a year and weaned early. They are often force fed high energy, ready-to-eat carbohydrate substitutes instead of healthy, home cooked weaning foods. Older children gorge on unhealthy packaged snacks that often serve as a substitute for meals.
The children also have limited outdoor activity. Schools do not encourage physical training or games, as academics takes precedence over sports. In the evenings, tuition, homework and television usurp their time. Many parents do not have the time, inclination or space to take the children out.
Energy intake soon overtakes energy expenditure. In children, the waistline expands and fat is deposited in the abdominal regions. A paunch develops and pushes up the stomach and other abdominal contents against the diaphragm (a muscle that separates the abdomen from the chest). The chest is unable to expand fully and breathing becomes shallow, noisy and inefficient. Infections are frequent.
The excess fat is also deposited in muscles and liver tissue. The fat makes the body resistant to the actions of its own insulin. Even young children develop relative “insulin resistance”. Glucose intolerance and hypertriglyceridemia begin to develop in them. Fat gets deposited in the blood vessels. And this can cause the blood pressure to rise and result in premature coronary artery disease.
Adolescent obesity causes hormonal imbalances. In obese girls, androgens are present in excess. They develop unsightly facial hair and menstrual irregularities. This may result in PCOS (polycystic ovarian syndrome). In men, estrogen levels rise and gynacomastia develops. Eventually, these obese adolescents become subfertile adults. Pregnancy occurs only after expensive and frustrating treatment.
Obese children are also prone to numerous orthopedic problems. They may develop bowlegs. The ends of the growing bones may slip causing deformities. All this results in the early onset of arthritis.
Moreover, children are psychologically affected by their obesity. They are often the brunt of jokes. They are often excluded from sports and cultural events.
Quite often, the overweight children appear to have a familial obesity. This correlation is likely to be due to the environment with excessive food intake, limited exercise and almost compulsive television viewing. In these children, the obesity is not genetic but a result of the upbringing.
Boys (not girls) who are obese in childhood and adolescence are at risk for sudden death from coronary artery disease (CAD) as adults. They are also at increased risk for gout and colorectal cancer. This risk remains constant even if they manage to lose weight as adults. Girls who are obese become women at high risk for arthritis.
Television viewing should be restricted to a minimum. If the parents watch television for many hours every day, children too get hooked on to it. It is better to enroll them in coaching classes for activities like cricket, swimming, tennis, football or basketball. The Sports Authority of India conducts camps during summer vacations. Children who attend these camps should be encouraged to maintain the momentum even after school re-opens. Daily running or jogging for 20-40 minutes will help them keep up their stamina and maintain weight till the next round of coaching starts.
As parents and elders, we have to keep our children fit and not fat.
Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in
Your Health
--------------------------------------------------------------------------------
DR GITA MATHAI
When I was a medical student (so long back that it was actually in the last century), two of the cases placed before us as “spotters” (look and diagnose, don’t touch or question) in an examination were children with kwashiorkor (lethargic and disproportionately swollen with fluid) and marasmus (wizened, wasted and looking like a wise elder). Both were common conditions, the result of malnutrition.
Such diseases are rare today. In fact, now doctors have to spot diagnose children at the opposite end of the spectrum. About 20 per cent of children (some less than a year old) and teenagers in India can be defined as overweight, obese or morbidly obese. Their weights exceed that expected for their heights by 20 per cent, 50 per cent, and even 80-100 per cent. The BMI (body mass index, calculated as weight divided by height in meter squared) which should be 23 is often well above 30. Many of these children maintain their obese status into adult life.
In addition to having a paunch, big hips, knock knees and a double chin, such children have a peculiar velvety black discolouration of the skin — called acanthosis nigricans — on the nape of the neck. No amount of scrubbing will remove it, nor talcum powder conceal it. It is a marker for obesity that is likely to progress in diabetes.
This unhealthy state of over nutrition starts in infancy. Babies are breast fed for less than a year and weaned early. They are often force fed high energy, ready-to-eat carbohydrate substitutes instead of healthy, home cooked weaning foods. Older children gorge on unhealthy packaged snacks that often serve as a substitute for meals.
The children also have limited outdoor activity. Schools do not encourage physical training or games, as academics takes precedence over sports. In the evenings, tuition, homework and television usurp their time. Many parents do not have the time, inclination or space to take the children out.
Energy intake soon overtakes energy expenditure. In children, the waistline expands and fat is deposited in the abdominal regions. A paunch develops and pushes up the stomach and other abdominal contents against the diaphragm (a muscle that separates the abdomen from the chest). The chest is unable to expand fully and breathing becomes shallow, noisy and inefficient. Infections are frequent.
The excess fat is also deposited in muscles and liver tissue. The fat makes the body resistant to the actions of its own insulin. Even young children develop relative “insulin resistance”. Glucose intolerance and hypertriglyceridemia begin to develop in them. Fat gets deposited in the blood vessels. And this can cause the blood pressure to rise and result in premature coronary artery disease.
Adolescent obesity causes hormonal imbalances. In obese girls, androgens are present in excess. They develop unsightly facial hair and menstrual irregularities. This may result in PCOS (polycystic ovarian syndrome). In men, estrogen levels rise and gynacomastia develops. Eventually, these obese adolescents become subfertile adults. Pregnancy occurs only after expensive and frustrating treatment.
Obese children are also prone to numerous orthopedic problems. They may develop bowlegs. The ends of the growing bones may slip causing deformities. All this results in the early onset of arthritis.
Moreover, children are psychologically affected by their obesity. They are often the brunt of jokes. They are often excluded from sports and cultural events.
Quite often, the overweight children appear to have a familial obesity. This correlation is likely to be due to the environment with excessive food intake, limited exercise and almost compulsive television viewing. In these children, the obesity is not genetic but a result of the upbringing.
Boys (not girls) who are obese in childhood and adolescence are at risk for sudden death from coronary artery disease (CAD) as adults. They are also at increased risk for gout and colorectal cancer. This risk remains constant even if they manage to lose weight as adults. Girls who are obese become women at high risk for arthritis.
Television viewing should be restricted to a minimum. If the parents watch television for many hours every day, children too get hooked on to it. It is better to enroll them in coaching classes for activities like cricket, swimming, tennis, football or basketball. The Sports Authority of India conducts camps during summer vacations. Children who attend these camps should be encouraged to maintain the momentum even after school re-opens. Daily running or jogging for 20-40 minutes will help them keep up their stamina and maintain weight till the next round of coaching starts.
As parents and elders, we have to keep our children fit and not fat.
Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in
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