Alarming rise in Childhood Obesity in Delhi- What should we know?
Childhood obesity is on alarming rise in Delhi and other metro cities. As per one of study by Dr. Marwaha & Dr. Nikhil Tandon in children studying in private schools in Delhi, almost 20 % of children are overweight and 5-6% of children are obese in Delhi. Obesity in children and adolescents leads to a variety of diseases like Type 2 diabetes, (usually associated with older adults), sleep apnea, high blood pressure, high cholesterol, bone and joint problems, and depression. Also overweight girls are at risk of PCOD and hormonal imbalances leading to irregular periods, hirsutism etc. Childhood obesity remains a challenging problem, and more effective interventions are desperately needed.
In another study from AIIMS by Dr. R. Khadgawat & Dr. Thushanth Thomas, among the demographical factors associated with weight gain, the main factors that could identify were increased time spent in front of T.V and computer, lack of physical activity, dietary factors and family history of obesity/Diabetes. Television viewing leads to increased sedentary habits. Also many of the subjects had the habit of having food while watching television (87.7% having at least one meal in front of TV). This can involuntarily increase the amount of food taken. The other adverse effect of TV viewing is regarding the content of programmes aired. Among all the types of commercials, food advertising is the most frequent, especially junk food, beverages, fast food and ready-to-eat frozen food. These lead to negative consequences on food choice and nutritional status.
The first recommendation to prevent obesity would be to reduce the time spent watching television by children and also by their families. They should not spend more than 1 to 2 hours daily watching television, playing video games, talking or texting on cell phones, or using the computer/laptop for fun.
A child with overweight/obesity should be assessed by an Endocrinologist. Sometimes there may be hormonal problems causing obesity in children like thyroid problem or Cushing syndrome. As a general rule, any hormonal problem causing obesity in children also compromise height of child. Rarely, genetic problems/syndromes like Prader-Willi syndrome are cause of obesity in children.
Lifestyle changes to combat childhood obesity
The children should be encouraged to opt for healthy eating habits which include:
Controlling caloric intake through portion control
Avoiding the consumption of calorie-dense, nutrient-poor foods (e.g., sweetened drinks (such as soda, juice and sports drinks ), most “fast food,” and high-calorie snacks such as chips and candy)
Increasing dietary fiber, fruits, and vegetables
Eating regular meals, particularly breakfast, and avoiding “grazing” after school
Children should also be encouraged to engage in at least 60 minutes/day of vigorous physical activity.
What can parents do to help prevent pediatric obesity?
It is recommended that children should have a minimum of 4- 6 months of exclusive breast-feeding. Infants exclusively breast-fed for 3 to 5 months are 35% less likely to be obese when they enter school. Babies should be fed when hungry but should not be forced to finish. Between the ages of 2 and 6 years, children often develop irregular eating patterns. They may want to eat the same foods repeatedly and refuse to try new foods. What is important is that the quality and the overall quantity of the food be appropriate and consist of healthy choices. If young children are allowed to decide when to eat and when to stop without outside interference, they will eat as much as they need.
Parents should promote healthy habits related to diet and activity. For example, it is important for parent to be an example of these healthy lifestyles, avoid overly strict dieting, avoid use of food as a reward or punishment, and try to build children’s self-esteem. A positive approach works best. Parents should encourage healthy eating and regular exercise without developing a fear of food. This is the first step in establishing the behaviors essential to long-term success.
Anti-Obesity Medications-There is very limited studies on safety and efficacy of anti-obesity medications in children. None of the medications are approved by regulatory bodies for children and younger adolescents. There is a risk of adverse effects of medications in children. So, medications are generally not used in children for weight loss.
Bariatric Surgery/Obesity surgery
Obesity surgery either reduces the size of the stomach, bypasses the small intestine, or both. There is limited data and experience as of today about obesity surgery in children. The Endocrine Society of USA suggested that obesity surgery was appropriate only in a few circumstances where all the following situations apply:
For adolescents who have a BMI over 50 (or over 40 with significant, severe obesity-related diseases).
The child has not been able to lose weight while on a diet and exercise program for at least 6 months, while under the care of a physician.
The child has achieved his/her final height.
Parents and the teen must understand and be willing to follow the many lifestyle changes that are necessary after surgery.
After psychological evaluation confirms the stability and competence of the family unit.
There is access to an experienced surgeon in a medical center employing a multidisciplinary team, capable of long-term follow-up of the physical and mental health needs of the patient and family.
The Endocrine Society of USA recommended against surgery for pre-adolescents, adolescents who have not attained their final height. It recommended that surgery never be performed in adolescents with an unresolved eating disorder, untreated psychiatric disorder, or Prader-Willi syndrome.
The studies that have been done on bariatric surgery in teens show these operations are as safe for this age group as for adults. However, research and data is limited to show if there are any long-term effects on growth for teens that undergo weight loss surgery. Teenager’s bodies are still changing and developing. They will need to be careful to get enough nutrients during the period of weight loss following surgery and will need to take certain vitamins and minerals for the rest of their life.