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Childhood obesity: Upcoming pandemic

Post by on Monday, November 22, 2021

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 Malnutrition is a major public health problem and a complex issue to solve. Both under-nutrition and obesity are high risks for premature death and disability. On one hand the levels of under-nutrition have fallen by 10 percent as per National Family Health Survey (NFHS) 2016, there is marked rise in frequency of obesity on other side of spectrum, which is an independent risk factor for various non-communicable diseases including hypertension, diabetes mellitus and subsequent heart attacks and brain strokes.

Obesity has reached epidemic proportions globally and its prevalence has doubled in the last two decades. Over the last 5 years, most developing countries have reported prevalence rates of obesity (inclusive of overweight) > 15% in children and adolescents aged 5–19 years. Childhood obesity is increasing at an alarming pace in India, giving rise to adult diseases in youth, like high blood pressure, type 2 diabetes mellitus (T2DM), heart disease and joint disorders.
The increasing frequency of obesity in childhood is due to following factors:
Unhealthy nutrition
Comparatively low cost of energy-dense foods, improved purchasing power, television advertisements targeting children and junk foods being sold in the school cafeterias are shifting the children’s dietary habits from healthy foods to fried fatty and processed foods.
Working status of parents
Parents these days are both working and have a hectic lifestyle. They are often overworked and it is easy to let children order “fast foods” and hardly have any time to oversee balanced nutrition for children.
Lack of physical activity
Shift from outdoor play to indoor entertainment; television viewing, Internet and computer games has contributed to increased childhood obesity. Children no longer want to ride a cycle and parents feel it is safer to ride a car than a cycle in a chaotic city.
Increasing burden of academic competitiveness among students have led to decreased participation in sports and any other form of physical activity. This is particularly true for girls who are sedentary from school years. Many of the studies from India show that females have more obesity and metabolic syndrome as compared to males.
Increased socio-economic status
Increased purchasing power in the form of daily allowance (pocket money) to purchase foods/snacks available in school cafeterias or nearby fast-food joints could be a major reason for this.
Wrong parental approach
Parents in India and other developing countries usually have a general misconception that an obese child is a healthy child. And that if the child is fat, “baby fat” will go away with time. In an effort to keep the child “healthy”, he/she is fed in excess. Many of these children remain obese for the lifetime.
Most importantly with the advancement in technology, especially in the field of entertainment, more time is spent in front of television, computers and video games at the expense of sports and physical activity, making it a sedentary lifestyle for the children.
The worrisome situation is that Covid lockdowns have resulted in an increase in various disorders in children like increased screen time, sedentary lifestyle and its adverse consequences on weight and behavior. The increased screen time in children as a consequence of online classes has resulted in eye strain, behavioral changes, sleep disorders and increased weight.
Due to lockdowns, children remain confined to their homes and their only recreation comes from watching videos on mobile phones and or other gadgets.  On the other hand, people, in general, don't have knowledge about the balanced diet and daily requirements for energy, carbohydrates, fat protein, macro and micronutrients. They eat whatever they can afford and is pleasurable to their taste buds. People eat as much as they can afford without giving a single thought to calories excess or deficiencies.
Research finds obese kids under lockdown in Italy ate more junk food, watched more TV at expense of physical activities. “First things first, online classes have increased stress and a sedentary lifestyle in children. On average, lockdown has increased screen time in children by as much as three times as compared to pre-covid times.”
This study, published in April on obesity, examined 41 overweight children under confinement throughout March and April in Verona, Italy. Compared to behavior recorded a year prior, the children ate an additional meal per day; slept an extra half hour per day; added nearly five hours per day in front of the phone, computer and television screens; and dramatically increased their consumption of red meat, sugary drinks and junk foods. Physical activity, on the other hand, decreased by more than two hours per week, and the amount of vegetables consumed remained unchanged.
There is no doubt that lockdowns which were implemented across the world to contain COVID-19 pandemic have negatively impacted diet, sleep and physical activity among children, according to new research.
Body mass index (BMI) is a measure that uses height and weight to work out if the person is healthy or obese. An ideal BMI is in the 18.5 to 24.9 range and more than 30 is defined as obesity.
In most children with obesity, environmental and hereditary factors play a major role. Only less than 1% of kids with obesity do have underlying pathology for childhood obesity.
Childhood obesity is associated with significant complications. Obesity is responsible for development of insulin resistance due to fat deposition in skeletal muscles and liver. Insulin resistance predisposes a person to develop type 2 diabetes mellitus, polycystic ovarian syndrome, metabolic syndrome, and non-alcoholic fatty liver.
The cardiovascular effects of obesity in children are due to higher prevalence of dyslipidemia, hypertension and consequent atherosclerosis particularly in coronary arteries supplying blood supply to heart muscle and tissues. Childhood obesity is one of major risk factors for premature coronary artery atherosclerosis and heart attacks at a young age.
Further obesity is a risk factor for many orthopedic ailments like flat foot, genu valgum and osteoarthritis.  The most debilitating complication of obesity is slipped capital femoral epiphysis which results in pain in the groin and abnormal gait.
Obesity is associated with frequent gastrointestinal complications including gastroesophageal reflux disease and non-alcoholic fatty liver. Fatty liver is present in 40 percent of children with obesity. Around 2 percent of children with obesity develop gallstones and can result in life threatening complications like pancreatitis in them.
This higher incidence of obesity and associated complications calls for mass level awareness programs.
Malnutrition is the main cause of death and disease in the world. Developmental, economic, social and medical impacts of malnutrition are serious and lasting.
Balanced diet is defined as a nutritionally adequate and appropriate intake of food items that provide all macro and micro nutrients in desirable quantities. Cheap food tends not to be healthy food; we need government policies that make healthy food more available and affordable. We need to see changes in the public sector so that government organizations will ban all unhealthy food particularly outside or inside schools.
Health education and investment in food research will be crucial over the next five years. “One of the biggest barriers is availability of the right food, which is still dictated by the large producers. We need to find a way of engaging with the food industry to change the content of food products. In some countries, a desire to eat the right food cannot be met because of the choice of food available at the supermarket and its price.”
It is high time to have a major review into food and technology and people must know how food is produced, how many calories it contains, and what percentage of carbohydrates, fats and proteins are in particular food. It is time to educate people about the advantages of polyunsaturated fatty acids and the disadvantages of saturated fats.
The three major reasons for young heart attacks are obesity, smoking and drug addiction and it is time to address all of them holistically in the shortest possible time frame so that many young lives can be saved.
Depending on the duration of the lockdown, the excess weight gained may not be easily reversible and might contribute to obesity during adulthood if healthier behaviors are not re-established. "This is because childhood and adolescent obesity tend to track over time and predict weight status as adults."
Generally speaking, people in Kashmir have good affordability and accessibility to food. The erratic food habit in Kashmir is a major reason for increased obesity in general masses and children. People in Kashmir are voracious meat eaters and high consumption of butter, ghee, poultry and its products has increased the soaring levels of obesity and its subsequent metabolic complications.
For prevention of obesity especially during childhood emphasis should be laid on a healthy and active lifestyle and creating a nurturing environment that helps the youth recognize their own worth and respect cultural food ways. It is recognized that obesity, eating disorders, hazardous weight loss, nutrient deficiencies and size discrimination are all interrelated and need to be addressed in a comprehensive manner, thus requiring a multilevel approach.
Childhood obesity is associated with a number of health problems such as hypertension, T2DM and hypercholesterolemia, strokes, heart attacks, which were once confined to adults.
It is also associated with significant other morbidities including gallstone, dyslipidemia, obstructive sleep apnea syndrome, early puberty or menarche, eating disorders, skin infections, orthopedic disorders, asthma and other respiratory disorders.
Apart from medically impacting the individual, childhood obesity also adversely impacts the psychosocial development of the child as well as the financial economy of the individual household as well as the country.
Community-based interventions should aim at providing a conducive environment for children to follow a healthy lifestyle, promote healthy food alternatives, and generate awareness about an increase in physical activity.
Further sports activities should be encouraged across the Jammu and Kashmir and the government shall develop all the facilities for said activities at villages and towns.
(The author is the lecturer pediatrics, GB Pant Children Hospital Srinagar)

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