Childhood Obesity- Somewhere the Parents are to Blame!

The term overweight refers to excess body weight for a particular height whereas the term obesity is used to define excess body fat. Overweight and obesity primarily happen either due to excess calorie intake or insufficient physical activity or both. Furthermore, various genetic, behavioural and environmental factors play a role in its pathogenesis.

Childhood obesity is a forerunner of metabolic syndrome, poor physical health, mental disorders, respiratory problems and glucose intolerance, all of which can track into adulthood.

Developing countries like India have a unique problem of ‘double burden’ wherein at one end of the spectrum we have obesity in children and adolescents while at the other end we have malnutrition and underweight.

Common Causes of Obesity-

• Diet
• Lifestyle
• Genetic
• Endocrinal

Our Lifestyle is to Blame:

No exercise generation – With the dramatic change in technology the lifestyle of people has significantly changed. There was a time when mothers had to call and coax children to come back home from a field game. Today mothers have to coax their children to get up from in front of television sets, xbox, play station or ipad and mobiles to go out and play. I must say a lot of inspiration is derived from us adults.

We love to eat junk – Rapid urbanisation of society has also change eating habits. Consumption of junk food , carbonated drinks, and tendency to eat larger sized portions both at home as well as in restaurants are a major contributory factor. I still see grandmothers pointing out at their overweight grandchild and commenting-‘doesn’t he look weak? Or he has lost weight’. I have to bluntly answer many times that he needs to lose weight. The old Indian thought that babies should be chubby and fat has to go. Fat is not healthy. Just as an underweight child is malnourished, an overweight or obese child is also malnourished.

Issues Associated with Obesity:

Obesity can affect virtually every system of human body. The following is a list of common problems which can be contributed to by obesity.

Cardiovascular

• High blood pressure
• Early onset of atherosclerosis
• Left ventricular hypertrophy

Endocrine

• Insulin resistance
• Diabetes mellitus (NIDDM)
• Menstrual abnormalities
• Polycystic ovarian syndrome (PCOS)

Gastrointestinal

• Gallstones
• Non alcoholic steatohepatitis (NASH)
• Hepatic fibrosis
• Cirrhosis

Neurological

• Pseudotumor cerebri

Orthopedic

• Slipped capital femoral epiphysis
• Tibia Vara
• Osteoarthritis

Psychosocial

• Obsessive concern about body image
• Expectation of rejection
• Progressive withdrawal
• Low self esteem
• Depression

Pulmonary

• Increased bronchial hyperactivity
• Asthma exacerbation
• Obstructive sleep apnoea
• Pickwickian syndrome
• Pulmonary embolism

Renal

• Increased sensitivity to sodium
• Decreased natriuresis
• Proteinuria
• Focal Segmental Glomerulosclerosis (FSGS)

Management of Obesity-

Very often when I tell the parents that your obese child needs to lose weight, they take the issue very lightly , sometimes smile and say , ‘ yes we ask him to play daily’ or ‘ doctor you tell him not to take soft drinks’. However the approach needs to be much more aggressive. There is a major role of dietician who is supposed to plan the diet for the child, planned physical activity, some basic investigations to rule out endocrinal problems and even lipid profile to see the effects to obesity. The plan should be target oriented and the child needs to have a multidisciplinary follow up on a monthly basis to yield desired results.

Conclusion:

Obesity is a major health concern today especially in the metros where about 30 % children are obese. Childhood obesity can be a forerunner of many illnesses in adulthood. If there is a family history of diabetes or heart disease then it is a good idea to keep your children on the lower side of graph as far as weight is concerned. Finally overweight children are NOT healthy, they are unhealthy.