Written by Dr Sanjay Borude
India has the second highest number of obese children in the world, with 14.4 million reported cases, according to a new study published in The New England Journal of Medicine. The country is the second most populous nation in the world with 27.05 per cent of its population in the 0-14 age range. The obesity rank corresponds to India’s global position in terms of population, but the numbers are alarming nonetheless.
It is commonly believed that obesity arises due to eating junk, unhealthy food, fried in saturated fat and so on – the list is endless. But social and cultural factors are equally responsible and often unaccounted for. The paucity of playgrounds in urban areas leads to children remaining glued to screens with little physical activity. Their day is packed with extracurricular activities and tuitions, leaving no time or energy for play. Physical activity becomes minimal or is missing from daily schedules unless obesity or its symptoms arise. Exercise is often perceived or undertaken as a measure to combat obesity. Many forget that physical activity is important for sound physiological, mental and overall well-being, irrespective of whether the person is overweight or otherwise. It cannot be reiterated enough that obese children are at a high risk of suffering from chronic diseases later in life.
When a family seeks help for their obese child, doctors commonly begin with a conservative plan that focuses on diet. Alongside counselling, the family is advised on diet plans and daily calorific intake. For some children, the doctor may advise an exercise programme coupled with behavioural change, a nutritionist and a mental health professional’s expertise along with the doctor’s guidance.
Studies suggest that lifestyle modification, along with parental support, works best for most children. Obesity among children is not simple. It is not only a result of over-eating and not engaging in physical activity. Many factors are at play here: the child’s genes, hormonal cycles that dictate metabolism, sleep cycles, the family’s socio-economic status and lifestyle choices.
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Years ago, I conducted a survey on the weight and BMI (body mass index) of children attending a school that was located in a lower middle-class locality in Mumbai. They lived in simple settlements; did not pursue many extra classes or own gizmos that would keep them glued to sofas. It implied that most children would be of appropriate weight. My happiness was short-lived because during a subsequent interview, the students confessed that they had a high affinity for junk food, such as pastries and pizzas. The seemingly healthy bunch was clearly unhealthy and at a high risk of gaining weight in future.
Shed the myths
Myth 1: Childhood obesity is genetic
Fact: While genes do influence weight, they are only one small part of the equation. Most kids can maintain a healthy weight if they eat right and exercise.
Myth 2: Children who are obese or overweight should be put on a diet.
Fact: Unless directed by your child’s doctor, the treatment for childhood obesity is not weight loss. The goal should be to slow down or stop weight gain, allowing your child to grow into their ideal weight.
Myth 3: It’s just baby fat. Children will outgrow the weight.
Fact: Childhood obesity does not always lead to obesity in adulthood, but it does raise the risks dramatically.
Healthier food choices
Start by taking small, gradual steps towards healthy eating. If the family is accustomed to desserts after meals, one can swap a fruit-based cake or pudding in place of ice cream or deep-fried sweets. Parents can then move towards reducing dessert quantities or meal portions to balance the calories consumed. Similarly, if children tend to snack in front of the television, parents can offer fruit or snacks like “kurmura” (puffed rice), seeds, etc. Add a salad to dinner every night or swap French fries for baked potatoes and later, baked potatoes with baked vegetables.
A visual treat
There is always a way to create interesting patterns for children. The diet can be designed to include red (beets, tomatoes), orange (carrots, squash), yellow (potatoes, bananas), green (lettuce, broccoli) and so on – just like eating a rainbow. Fruits can be frozen and served as popsicles; vegetables can be cut into strips and served to resemble pasta, and so on. You can also explore recipes with your child and understand tastes that appeal to them and devise food accordingly. Fussy eaters can be lured into eating a variety of foods if presented invitingly, like a bowl of ice cream garnished with fruit or pasta made fun with colourful veggies like broccoli, purple cabbage, tomatoes, etc. You can also make a game out of identifying colours with younger kids.
For older children, the parent must connect with aspirations that drive them. For someone, it could be excelling at sport, another may wish for enhanced concentration, better skin and hair or even “aesthetic” food that they can photograph and share on social media. You can plug in food that fits with their desires, communicate the role of food and nutrition and embark on a joint effort to eat the rainbow.
Breakfast can be the meal that the family eats together.
The sugar trap
Look for hidden sugar in foods like bread, canned soups, pasta sauce, pickles, frozen foods, low-fat meals, fast food and ketchup. The major culprits are health drinks and milk supplements, which are endorsed by leading athletes and celebrities. They mislead people into believing that milk alone does not contain enough nutrients and should be reinforced with powders for added nutrition. A major ingredient in these supplements is sugar. A popular cornflakes brand implies that its packaged grub has more nutrition than almonds. Similarly, several health drinks that claim to have Vitamin C are also laden with sugar.
The body gets the required amount of sugar from natural foods like fruits, milk and even some vegetables like potatoes and grains like rice. Instead of buying milk drinks or supplements to be added to milk, try creating healthier alternatives at home. Use cocoa powder and dates to recreate the lure of chocolate milk. Even the traditional masala milk with cardamom, saffron and dried fruits is packed with nutrition.
Limit juice, soda and coffee drinks. Soft drinks are loaded with sugar. Most juices offer little nutrition as the fibre is often discarded with the peel and pulp. Offer your child sparkling water with a twist of lime, fresh mint or a splash of fruit juice with pulp instead.
Don’t ban sweets. A “no sweets” rule invites cravings and overindulgence when the chance arises. Instead, limit cookies, candies and baked goods that your child eats and introduce fruit-based snacks and desserts.
Schedule regular meal times. If your kids know they will only get food at certain times, they will be more likely to eat what they get when they get it. Limit dining out. if you must eat out, try to avoid fast food.
Do not go for low-calorie sweeteners. According to a report by the Harvard TH Chan School of Public Health, “low-calorie sweeteners (LCS)” have a higher intensity of sweetness per gram than sweeteners with calories. These include artificial sweeteners, such as aspartame and sucralose, as well as extracts from plants like steviol glycosides and monk fruit.”
The good fat
Don’t go no fat; go good fat. Not all fats contribute to weight gain. instead of trying to cut out fat from your child’s diet, focus on replacing unhealthy fats with healthy fats. Avoid trans fats that are dangerous to your child’s health. Try to eliminate or cut back on commercially baked goods, packaged snacks, fried foods and anything with “partially hydrogenated” oil in the ingredients, even if it claims to be trans fat-free.
It is impossible to avoid the lure of packaged cakes and chips that dot markets. A better idea would be to create these goodies at home. Unsaturated or “good” fats include nuts and seeds like peanuts, almonds and cashews. Eggs, avocados, olive oil, fatty fish, soy, tofu, flaxseed, etc also consist of healthy fats. But they are also high in calories, so their consumption must be limited. Cooking fat like butter, ghee, coconut oil, mustard oil and unrefined oils are imperative to maintain health.
Choose saturated fat wisely. The USDA recommends limiting saturated fat to 10 per cent of your child’s daily calories. Focus on the source of saturated fats consumed: a glass of whole milk or natural cheese rather than a hot dog, doughnut or pastry; grilled chicken or fish instead of fried chicken, etc. Some ads portray butter, ghee and traditional oils as “harmful” and promote factory made margarine and substitutes in their place.
Some brands also package ready-to-eat foods as “trans fat-free.” While the claim is true, do check for their calorific value versus nutritional value. Be smart about snacks and sweet food. Your home is where your child most likely eats the majority of meals and snacks, so it is vital that your kitchen is stocked with healthy but interesting choices; khakhras, millet-based munchies, etc. Keep snacks small.
Watch portion sizes. To keep calories in check, use the hand as a measuring unit. For women, the size of their palm indicates the quantity of lean protein that they should consume; the fist the size of vegetables or salad, a cupped hand the portion of carbs like rice or starchy vegetables like potatoes. Finally, fat should only be a thumb-sized quantity. Serve food on individual plates instead of putting the serving dishes on the table. Divide food from large packages into smaller containers. The larger the package, the more people tend to eat without realising it.
(Excerpted from Generation XL, published by Penguin)