Obesity: Are parents responsible?

Rahul recently celebrated his 11th birthday. But he looks much older. He has a prominent paunch and weighs over 48 kilos. He hates outdoor games and loves watching television. He is the only child of his doting patents. Sitting by the window of a train zipping from New Delhi to Trivandrum, he refuses a healthy homemade breakfast of idlis and tomato chutney. All he wants is chips. He finishes one packet, then another. His Dad tells him to stop, but he is not listening. He finishes the last packet in his backpack before washing it down with half a litre of a popular sweet carbonated drink. His breakfast is over.

A couple of hours later as the train chugs to a stop at a station, he gets his Dad to buy him deep-fried banana fritters, a bar of chocolate and another soft drink. His mother, a Delhi-based school teacher, proudly announces that he lives on junk food and laughs.

She better not laugh.

Obesity among children is a serious disease stalking urban India. Doctors say the disturbing trend will lead to numerous health complications not only in childhood, but also later on in life. It can lead to hypertension, cholesterol, cardio-vascular disease, diabetes and sleep apnea and bone problems caused by the stress of carrying excess weight. “Obesity in childhood is going to be the root of diabetes and heart related problems in adults. That is why above-30 has already become a dangerous age for the obese,” warns Dr.Sushil Sanghi, a child specialist in Jaipur who says even smaller cities are now seeing the phenomena. Many erroneously think it is only a metro phenomenon.

Parents have little time to ensure their children go outdoors. Pic Ramesh Menon.

A recent study by the National Diabetes, Obesity and Cholesterol Foundation covering Delhi, Agra, Pune and Bangalore threw up some shocking results: 68.4 per cent of mothers of school-going children were found to be obese. Interestingly, only 19.2 per cent of their sons and 18.1 per cent of their daughters were obese.

The study showed a strong connection between childhood obesity and higher family income and higher level of education of parents. Seema Gulati, lead author of the study infers that awareness of the problem was low as an unhealthy diet had no immediate effect on health. "More than half the mothers we interviewed did not know about the link between diet and heart disease, high cholesterol and cancer. Most of the mothers believed that refined vegetable oils, ghee and butter contributed to good health."

Delhi-based Dr Anoop Misra who was the co-author of the study said, “Controlling childhood obesity can cut down half of all non-communicable diseases including diabetes, heart disease, kidney dysfunction and hypertension. Obesity in children is linked with insulin resistance, subclinical inflammation and Type II diabetes."

Another study conducted among children aged between 14 and 18 by All India Institute of Medical Sciences found 17 per cent to be obese or overweight.

Obese children get teased and ridiculed all the time by their peers and elders and this seriously affects their sense of self-esteem. It can also lead to depression. Over 80 per cent of obese children end up as obese adults.

Obesity increasing

Doctors say that obesity among children is increasing every year. Parents are worried and so are teachers. This had to happen. The quality of diet has changed. Children eat more fried junk food and items made from maida that is a product of finely ground wheat that does not have any fibre. Ironically, all maida products like biscuits, cakes, pastries, sweets and noodles are tasty and parents are pressured to buy it. In the long run, it is harmful for the intestines, warn doctors. But nobody is listening.

Dr. Sanghi says that the trend of children becoming obese started over a decade ago when television and video games made an entry. The direct consequence was that children who played outside and burnt calories, were now indoors spending long hours before the idiot box unconsciously munching mostly fried food and sipping aerated drinks.

Numerous hospitals today have started obesity awareness programmes to deal with the increasing hazard that children are facing.

Actually, it is much easier for children today to become fat as lifestyles have become sedentary. Playing outdoors, which was associated with fun earlier, is now identified with sweat, heat, dust and pollution. It is much better sitting at the computer playing games or chatting. They also have easy access to high calorie junk foods and sweets that are heavily advertised and promoted. Fast food chains are even organising school trips for children to their outlets under the ploy of educative lessons. For instance, fast food chains churning out burgers in Noida approach schools saying that they would be happy to show their kitchens to the children to explain the importance of hygiene. They also offer a free snack. Schools are too happy to board their children into a school bus and make an outing of it.

Today, children hardly ever have to walk or cycle to school. The bus almost comes to the doorstep. What little exercise they had has also been eliminated with modern lifestyles.

All open spaces in urban areas are vanishing.  Huge residential areas are coming up in urban pockets with hardly any areas earmarked for playgrounds.

A study of school children from north India found that 23 per cent were obese and most of them belonged to the higher socio-economic strata. These children were found to be spending most of their time in sedentary activity and majority of them ate fatty food from the school canteen.

Over-feeding is the culprit

It is right that growing children need lots of energy. Parents translate that to mean that they should eat a lot. The best thing is to let them eat when they are hungry, say doctors. Points out Dr.Vinod Jacob Cherian, Consultant Paediatrician, Westfort Hospital, Thrissur: “Over- feeding by anxious mothers is a principal cause of obesity among children. Mothers associate love with food and more food signifies more love to them. It is a dangerous concept to nurture. We do not even let our children experience hunger. Parents and grandparents love feeding children and so children end up eating even when they do not need to. The excess fat enriched food does not get burnt up and the result is there for all of us to see and regret later in life. Children today are being brought up like broiled chicken. What we have in the end is just a confused mass of protoplasm.”

Aparna from Thrissur says she ended up over-feeding the child as both her mother and mother-in-law chided her when the baby would cry. Points out Dr. Cherian: “For the first five to six months, babies should be exclusively breast fed. The child should be fed every three hours or so which works out to about eight feeds a day. Instead, mothers today unaware of the needs of the child, overfeed. Crying need not denote hunger. It may be because of a mosquito bite or a wet nappy. In the past five years, I do not know how many hundred times I must have pleaded with mothers not to overfeed. A baby will suckle even if it is not hungry.”

As far as obesity is concerned, the first two years of a baby’s life is actually the determining factor. It is at this time that fat cells are created. If too many are produced, there is a greater chance of the child being obese not only through childhood, but also through adulthood, as the fat cells do not decrease. That is why dieting helps to only momentarily reduce weight. The moment you start eating, the weight will rise.

Ideally, a baby should be breastfed for the first six months. Then, semi-solid foods can be introduced. But parents now start weaning at two months giving it cereals, bananas and even ghee. Health is associated with being fat and chubby in India, especially in north India.

Parents should be role models

Earlier, there were many children in a joint family enjoying everyone’s attention. But nuclear families today normally have just a child as parents are working. Pampering is a natural consequence as guilty parents fight for their attention. They find it difficult to say no when children demand junk food. Just like Rahul’s parents.

But parents need to become role models. If they are obese, it is most likely that their children also will follow. If they love fat-rich food and have a lifestyle with little physical activity, children also will copy it as they share eating and activity habits. Points out Dr. Arvind Taneja, Director, Paediatrics, Max Healthcare, New Delhi, “Parental obesity has a big role to play because of genetic factors and habits.”

Parents of obese children need to tread carefully. They should not arbitrarily put their child on a diet, as it is a short-term route to lose weight. Instead, they need to replace unhealthy food with healthy ones. They need to teach children to slowly enjoy what they eat and not gulp down food. Meals should be served at regular times and it is best if the family eats together. They should cook food that is high in nutrients and roughage and low on calories.

Children hate exercise as they see it almost as a punishment. So, the trick is to make it look like fun. Join the children for a walk, swim, biking or dancing. The focus needs to be fun, not losing weight. Try to run up or down the stairs and make it look like a competition. Only then, will they forget the elevator. Doctors recommend at least 30 minutes of physical activity each day.

Doctors also advise lifestyle modification apart from responsible parenting as another way out. Parents must live an active life and involve their children in it. It all depends on how a parent deals with it. A parent in Jaipur was told by the doctor to force his obese son out everyday for at least two hours to play. The father, a well-heeled businessman asked the doctor if he could instead invest in a treadmill and put it in his son’s air-conditioned bedroom so that his son who loved television could watch TV and also exercise in comfort.

Internal imbalances

Obesity in children need not always be because of food or an unhealthy lifestyle. It can also be caused due to hormonal imbalances like thyroid deficiency, growth hormone deficiency and “Cushing Syndrome,” where there is more natural production of steroids in the body.  It could be due to drugs like steroids for kidney ailments or sodium valproate given for epilepsy. Other reasons could be mental retardation and hypothalamic distortions created in the brain.

According to new research, children who have an inherent insulin resistance that is genetically determined will have a tendency to be obese.

“There are insulin receptors especially on the fat body cells that allow the entry of glucose into the cell for its metabolism. If these insulin receptors do not bind the insulin because of genetic factors, then the body’s pancreas, which has to produce the insulin, has to work overtime. These children will have high insulin levels and high glucose levels in the bloodstream. The high blood glucose gets converted into fat making them obese. These children are likely to develop heart disease and cerebral stroke. They may also get type 2 Diabetes,” warns Dr. Taneja.

Harmful suppressants

New medicines are available that curb appetite but it has harmful side effects. Appetite suppressants like sibutramine induce the feeling of your stomach being full and so decreases food intake. Then, there are others like Orlistat, which is a reversible inhibitor of gastrointestinal enzymes used to digest fat. Doctors are not in favour of both, as it would also stop the absorption of vitamins A and D.

Dr. Anju Virmani, Paediatric Endocrinologist, Apollo Hospital, New Delhi, points out that as a genetic variation, Indians tend to have more fat. “Even a thin Indian is fatter than a thin American. But many of us moan the fact that obesity runs in the family and we are helpless. Instead, we need to tell ourselves that we have to do something about it in terms of more exercise,” she says.

Dr. Virmani points out that when children are fat families are more concerned about the cosmetic consequences it involves. Instead, they should concentrate on the fact that these children run the risk of diabetes, hypertension and polycystic ovarian disease. In addition, boys may develop large breasts making it worse as it affects their self-esteem.  Fat children may also find the skin under the armpit, nape of the neck and several parts of the body darkening with increased insulin levels in the blood.

Paediatricians say that one way out is to ensure education of parents on what causes obesity among children. Parents often complain to doctors saying that the child does not eat. And doctors like Cherian bluntly tell them to stop storing junk food or buying it. “Children will eat and will eat good food if they are hungry, he says.

A one-year old needs approximately 1100 calories per day while a five-year old needs approximately 1500 calories. Instead of punishing children with a diet regimen, parents can make nutritious food choices and at the same time build proper eating habits that they will carry with them right through life.