“There is a garden in every childhood, an enchanted place where colours are brighter, the air softer and the morning more fragrant than ever again”- Elizabeth Lawrence
Childhood is a beautiful part of life and every child should be allowed to live it to the fullest. A child should be able to explore, indulge in various outdoor games and activities and even eat as they please. But increasing reliance on technology, advent of social media and narrowing of outdoor spaces is pushing children to spend more time indoors. Coupled with widespread availability of unhealthy food choices, this has led to a steep increase in childhood obesity rates in the last decade. It is estimated that in the United States, about 13.7 million children and adolescents aged between 2-19 years are affected by Obesity.
The increased weight in childhood is worrisome as it leads to an early onset of complications like Type 2 Diabetes, hypertension, Increased Cholesterol levels and predisposes to higher risk for future cardiovascular disease. Treating children with intensive Lifestyle modifications including physical activity and behavioural changes is particularly difficult and hence requires a more specialised approach.
How to recognise Obesity in Children?
Obesity is usually recognised by parents who may notice that their child is overweight compared to his/her peers. Obesity is diagnosed by calculating Body Mass Index (BMI) which is measured as Weight (in Kgs)/ Height (in Metre2). BMI values to diagnose obesity in childhood requires the use of BMI charts rather than specific values. A child is diagnosed as Obese if BMI is >95th percentile on standard CDC BMI charts.
Risk factors for Obesity
Weight gain is most often a result of an imabalance between daily calorie intake and calorie expenditure. A persistent Positive calorie balance (calorie intake>calorie expenditure) will eventually lead to weight gain.
Nutrition – High calorie diet is one of the main risk factors leading to obesity. Calorie dense foods such as sweetened foods, baked foods, sugary drinks, desserts are a major cause for recent increase in prevalence of obesity.
Lack of exercise – Time spent in sedentary activities such as watching television, playing video games, time spent on social media(Screen time) has increased dramatically in past few years. And it is no surprise that this has coincided with highest rates of increase in childhood obesity.
Genetic factors – Children with either parent with Obesity are at a higher risk of being obese. This is further exacerbated by environmental factors like high calorie diet and poor physical activity.
Psycho-social Factors – Excessive stress, anxiety and depression leads to abnormal eating patterns which predisposes to obesity.
Hormonal Factors – Certain genetic syndromes and Endocrine causes like Hypothyroidism, Growth Hormone Deficiency, Cushing’s syndrome may lead to obesity. Early identification of these conditions is essential for appropriate management.
When to consult a Doctor?
If you are concerned that your child is overweight compared to peers, it is advisable to consult a doctor. Alarming symptoms such as rapid gain in weight, changes in appetite, lack of growth in the child should prompt you to seek an urgent consultation with the doctor.
Complications of Obesity
Childhood obesity increases the risk for Type 2 diabetes, Increased Cholesterol levels, high blood pressure and fatty liver disease. In adolescent girls, weight gain is strongly associated with risk for developing Polycystic ovarian disease (PCOD). In addition, obesity leads to poor body image and lack of self esteem, behavioural and learning problems and depression.
Maintaining a healthy balanced diet and encouraging regular physical activity from early childhood can go a long way in preventing obesity. Some useful measures are:
– Limit intake of added sugar and sugary drinks
– Decreased consumption of processed and high fat foods
– Encourage increased intake of fresh fruits and vegetables
-Maintain age appropriate portion control of foods
– Ensure dietary measures are followed by all members of family
– Limit Screen time to less than 2 hours a day
– Encourage regular physical activity for atleast 1 hour per day
How to Treat Obesity?
Initial treatment for Obesity involves modification of Dietary patterns (such as Calorie restricted diets) and advice regarding increased Physical activity. These changes require good adherence and persistence to have beneficial effects. Role of specific diets like Keto diet/ intermittent fasting etc is still not proven and long term effects are uncertain. Appropriate calorie restricted diets give the best chance of weight reduction and maintanence of weight loss.
Medications for weight loss may be adviced in adolescents depending on degree of Obesity and presence of associated complications like Type 2 diabetes/ increased cholesterol etc. Weight loss surgeries may be required rarely in cases of severe obesity not responding to dietary changes and medications.
It is important to remember that childhood obesity is modifiable and early changes in diet and physical activity will have long lasting benefits for the child.
Dr. Patanjali C P
Aster Speciality Clinic, Discovery Garden