- Obesity, a form of malnutrition can stem from causes right from birth
- Monitor consumption of fats, salt, sugar: Ritika Samaddar, Max Hospitals
- Children should indulge in some physical activity for 60 minutes a day: WHO
New Delhi: In 2020, globally, 38.9 million children (5.7 per cent) under the age of 5 years of age were overweight as opposed to 33.3 million in 2000, shows the key findings of the UNICEF, WHO and The World Bank Group joint child malnutrition estimates. As per the report, about half of all countries have experienced no progress or are worsening when it comes to the percentage of overweight children. If we talk specifically about India, a drastic rise in obesity among children under five years of age was seen in 20 of the 22 states surveyed under the National Family Health Survey-5 (NFHS), conducted in the year 2019-20.
According to Dr Khan Amir Maroof, Medical Director and Professor at Department of Community Medicine, University College of Medical Sciences, non-communicable diseases can develop among obese children earlier than others. There are higher chances for them being bullied in schools, neglected or shamed by peers, which lead to mental health problems as well among them, he added.
While obesity is a big issue, we need to understand the cause behind it and also how it can be managed from the early years of life. Here’s what the experts have to say.
What Is Obesity?
The WHO defines overweight and obesity as abnormal or excessive fat accumulation that may impair health. Body mass index (BMI) is a simple index of weight-for-height that is commonly used to classify overweight and obesity. It is defined as a person’s weight in kilograms divided by the square of his height in meters (kg/m2). In children, along with weight and height, gender and age is also considered as during the initial years, children grow differently, said Dr Chetan R Mundada, Senior Consultant Pediatrician and Lead Pediatric Intensivist at Yashoda Hospitals in Hyderabad.
According to Ritika Samaddar, Regional Head, Department of Clinical Nutrition & Dietetics, Max Hospitals, Saket, there is no parameter in India to measure obesity among children, but it is usually assessed on the basis of BMI only.
As per WHO, we map child’s growth that is measure height and weight. BMI between 5 percentile and 85 percentile is considered as a benchmark for a healthy child. Anything below 5 is considered undernourished, above 85 is overweight and over 95 is obese, said Ms Samaddar.
What Causes Obesity In Children?
Dr Mundada said the two main causes of obesity among children and adults are an imbalance of physical activity and dietary needs. In some cases, there are certain hormonal and metabolic causes and also genetic issues, he added.
Adding to this, Ms Samaddar said, obesity in children can start in the womb itself because of the mother’s health and nutrition. She explained,
The reason the first 1,000 days of a child (from the time a child is conceived till 2 years of age) are important is because it’s a critical phase of development and if managed well, it can reduce the risk of malnutrition. During pregnancy, if a mother is undernourished or overnourished, that will directly impact the health of a child. Also, a lot depends on what a mother eats and how much she eats during pregnancy. Similarly, till six months after the birth, exclusive breastfeeding is recommended because the breastmilk protects a child from numerous diseases including malnutrition.
After six months, breastfeeding is supported with complementary feeding and the kind of food given at that stage also shapes the growth of a child. If food rich in carbohydrates and high in sugar is given to children, it can result in the early onset of obesity, she said.
Post two years, exercise, lifestyle, the proportion of junk food in a child’s diet, and portion size also play a role in a child’s growth and development. Ms Samaddar also added that if a child is inactive, unhealthy or gets unwell often, it’s a sign that they may be malnourished.
Adding to this, Dr Mundada said,
If a child is growing at a rapid pace then that’s also a cause of concern. A child between 2 and 8 years of age usually gains 2-3.5 kgs of weight and 6-9 cm of height every year. This is called a normal gain. If it’s more than that, we should definitely examine the child. If the child’s appetite has suddenly increased and there is a constant craving of packaged food or junk food, parents should be alarmed.
Managing Obesity Among Children Through Diet And Physical Exercise
A Variety Of Food Groups
Ms Samaddar believes that food habits are inculcated at a very young age which a child grows up to follow. Both the quality and quantity of food are important but initially, at a young age, quality is of utmost importance.
Three major food items which you have to monitor are fats, sugar and salt. There are healthy fats like ghee and malai and there are unhealthy fats like trans-fat. When we say sugar, it’s majorly the hidden sugar which is refined carbohydrates we get in pizza, bread, biscuits and other such items. Salt is equally important because we know young adults are falling prone to high blood pressure, said Ms Samaddar.
To ensure a child eats well, experts recommend including a variety of food items in the diet. This means, including all five food groups – protein, fats, carbohydrates, minerals and vitamins.
Go Local, Go Regional
Additionally, it’s also recommended to eat local and regional food. Explaining the reason behind it, Ms Samaddar said,
When we say local food, it has two meanings. Firstly, consume food which is locally available in your region. For instance, Sattu is majorly found in Bihar. Locals and their palette are aware of the food; it’s easy to digest for them; widely acceptable; financially it’s cheap. The second aspect of going local is to have kitchen gardens in urban spaces.
Avoid Content Consumption While Eating
Dr Mundada is of the opinion that now it has become a habit of people to use some or the other gadget while eating. While doing so, one fails to focus on what they are eating and how much they are eating. He added,
Meal time is often distracted with TV or phone. We don’t understand our dietary requirements and tend to overeat. If we are watching something exciting, we will keep on munching beyond our capacity.
For the same, Dr Mundada recommends parents to lead by example and say no to calls and texts especially when eating with family. Parents have to be an inspiration for their children in two fields – diet and eating habits, he said.
Snack Time Or Junk Food Time?
It is advised to have three major meals and two snacks in between. Often, the two snack times end up being junk food time, however, experts recommend munching on healthy food like fruits, nuts and calorie dense items like chikki, soybean and lentils. The same applies when eating while watching something during leisure time.
Junk or processed food like chips, Bhujiya, and biscuits only give us calories instead of any micronutrient like protein. We have to use snack time wisely. For children, aged 3 and above, we suggest a handful of nuts as their snack meal. Avoid giving nuts to younger children as it can lead to choking. Also, treat snack meal as snack, which means keep a check on portion size, said Ms Samaddar.
Physical Activity As Important As Diet
Dr Mundada believes that diet is not the only way to control obesity. A balance is needed between diet and physical activity. Due to the COVID-19 pandemic and restrictions, almost everyone is confined within their homes, and we don’t know for how long this will continue. However, that doesn’t mean one cannot move in the house. As per WHO, children should do some sort of physical activity for at least 60 minutes a day. Dr Mundada suggests going to a park at times when there is less crowd, playing inside the house, dancing and doing other such activities to ensure physical movement and well-being. Here also parents have to lead by example.
Tackling The Rise In Obesity In Children
According to the NFHS-5 conducted in 2019-20, several states and Union Territories, including the bigger states/UTs like Maharashtra, Gujarat, Mizoram, Tripura, Lakshadweep, Jammu and Kashmir, and Ladakh, have shown a several-fold increase in the percentage of overweight children below five years of age in comparison to NFHS-4 conducted between 2015 and 2016. For instance, in Maharashtra, the percentage of overweight children in the state has increased by 115 per cent – from 1.9 per cent in 2015-16 to 4.1 per cent in 2019-20.
Dr Khan Amir Maroof is of the opinion that the rising trend in overweight and obesity is being seen across age groups, gender and geographical regions. Explaining the reason behind the same, Dr Maroof said,
One thing is sure that obesity is an issue of the affluent and those who can afford calorie dense and processed food. It’s a market. But if we look at the trends, urbanisation is happening at a rapid rate which means it is reaching rural areas as well. As a result of this, we are seeing a rise in obese people in rural parts of the country too. We have to look at the economic situation also. When parents are involved in other activities and focused on improving their financial status, it is convenient for them to give some money to the child and ask him/her to eat chips or cold drinks or some other ready-to-eat food while they focus on work. If you have more money, you are pushing your child towards unhealthy food which is high in sugar, salt and food. Similar is the case if you have less money and if there is the availability of processed food around you.
POSHAN Abhiyaan launched by Prime Minister Narendra Modi in 2018 focuses on reducing other forms of malnutrition like undernutrition and stunting but there are no targets for tackling obesity. Similarly, other campaigns like Eat Right Movement launched in 2018 and the FIT INDIA Movement started in 2019 aim at improving public health, combating negative nutritional trends and making fitness an integral part of our lives. But no direct attention is being given to obesity.
Dr Maroof believes that now is the time to introduce some targeted programmes to tackle obesity, especially among children. He added,
When health related initiatives were first undertaken in India, the primary focus was to contain mortality. Also, back then, there was high undernutrition and famine in certain regions. In the recent past, we have started to witness a trend in obesity and now based on the available data, we should have a policy for different age groups and sectors.
The month of September is celebrated as POSHAN Maah (Nutrition Month). This year, thematic POSHAN Maah is being celebrated with Poshan Vatika (nutrition gardens) being one of the themes. Nutrition gardens are kitchen gardens created outside homes to enable families with malnourished children to improve their nutritional status and include a variety of nutritious foods in their diet. Dr Maroof said that while we are promoting nutrition gardens in urban spaces or kitchen gardening, we also need to ensure unprocessed food is widely available and profitability for the food industry.
On one hand, we are saying create ‘Poshan Vatikas’ whereas on the other side you constantly find advertisements for processed food. The food regulator has to play a role; people need to be supported and motivated to continue with kitchen gardens. Parallely, we have to promote nutri-gardens throughout the year rather than making it a photo opportunity, he said.
NDTV – Dettol Banega Swasth India campaign is an extension of the five-year-old Banega Swachh India initiative helmed by Campaign Ambassador Amitabh Bachchan. It aims to spread awareness about critical health issues facing the country. In wake of the current COVID-19 pandemic, the need for WASH (Water, Sanitation and Hygiene) is reaffirmed as handwashing is one of the ways to prevent Coronavirus infection and other diseases. The campaign highlights the importance of nutrition and healthcare for women and children to prevent maternal and child mortality, fight malnutrition, stunting, wasting, anaemia and disease prevention through vaccines. Importance of programmes like Public Distribution System (PDS), Mid-day Meal Scheme, POSHAN Abhiyan and the role of Aganwadis and ASHA workers are also covered. Only a Swachh or clean India where toilets are used and open defecation free (ODF) status achieved as part of the Swachh Bharat Abhiyan launched by Prime Minister Narendra Modi in 2014, can eradicate diseases like diahorrea and become a Swasth or healthy India. The campaign will continue to cover issues like air pollution, waste management, plastic ban, manual scavenging and sanitation workers and menstrual hygiene.