Your “healthy” child needs attention!!

A 13-year-old boy came to our endocrine clinic with his mom.

“Yeah, tell me. What’s your problem?”, I asked.

The mother grabbed the collar of her son’s shirt and pulling it behind, she said, “Doctor, do you see this black discoloration developing over his neck? It has been there and increasing over the last year.”

“Okay, we shall talk about it. Do you have any other problem?”, I asked.

The boy shook his head and looked at his mother. She said, “No doctor, nothing else. Only this black color on his neck and in his armpits is awkward.”

Well, I din’t have to ask this boy or his mother the reason they were there to see me. The issue with him was quite evident to me as he walked into my cabin.

Moreover, what I could see, unfortunately the parents couldn’t.

The boy then handed over a piece of paper to me, that displayed his weight.

“Seventy-five kgs!!” I spoke aloud. “Does the weight and built of your child not worry you?” “Doctor, my child is healthy, since his late childhood”, the mother smiled and said with pride.

 “I call him fat; not healthy!” I dint mind being rude to the mother.

In the clinic, I see at least 1 child each day with excessive weight gain.

Ignorance is bliss.

Parents often fail to recognise overweight as a problem and are unaware of the various adverse effects it has on the health of a child .

If you assume you already know a lot about obesity and quit reading this article here, it is again your ignorance towards this massive problem and your kid’s health.

In June 2012, the American Medical Association declared obesity a disease and it has now become the modern pandemic. Childhood obesity is on a rapid rise, but unfortunately has not come into the spotlight to the general population.

Over half of the overweight and obese kids who come to the clinic, visit us for concerns other than their weight.

In the modern era, obesity has not remained merely a disease of the developed society. A developing nation like India which fights malnutrition, on one hand, is seeing a growing trend of childhood obesity, in the bigger cities as well as the smaller towns.

Whom do we call as overweight and obese?

Obesity in simple words is excess body fat mass.

For adults,

Body Mass Index (BMI), calculated as weight(kilogram)/ height2(meter) is used as a simple measure of body fat calculation.

For Asian Indian adults, BMI of 23 kg/m2 or more is labeled as overweight and BMI of 25 kg/m2 or more is labeled as obesity.

In children, percentile charts for the weight for length and BMI are used.

In simple words, these are the charts developed from various research studies, and they indicate what the ideal weight of a child should be for his age, gender and height.  The charts also bear various cut off lines which indicate whether your child is overweight or obese.

For children younger than 2 years of age, weight for length charts are used while BMI charts are used for older children.

Your doctor will plot your child’s weight and BMI in these charts and explain what it signifies.

Broadly obesity can be of two types:

  1. Endogenous obesity:

A small proportion of childhood obesity is due to underlying major disorders in certain genes (which comprise the monogenic and syndromic causes of obesity) and a small percentage is due to endocrine disorders like hypothyroidism and Cushing syndrome (excess steroid hormones).

Many parents attribute weight gain in themselves and their children to hypothyroidism which is generally not the case. In fact, hypothyroidism is associated with only a mild increase in the BMI.

The above causes of obesity are generally associated with distinct features like decreased height gain, unusually high appetite, weight gain starting at an early age, delayed developmental milestones. Your doctor will order further investigations to identify these disorders if there is clinical suspicion.

2. Exogenous obesity:

In the majority of children and adults, overweight and obesity result from an excessive calorie intake or an inadequate physical activity or both. This forms a large chunk of obese individuals.

Why should you bother if your child is heavy?

Obesity is the root of many other illnesses. Without interventions, a heavy child unexceptionally grows into a heavy adult and is predisposed to the following complications.

  1. Hypertension: high blood pressure
  2. Type 2 Diabetes mellitus: high blood sugar
  3. Acanthosis nigricans: the black discoloration on the neck and armpits is due to hyperinsulinemia and signifies insulin resistance. It is a forerunner to type 2 diabetes.
  4. Dyslipidemia: high triglyceride, high low-density cholesterol (bad cholesterol) and low high-density cholesterol (good cholesterol)
  5. Atherosclerosis and premature cardiovascular diseases
  6. Early or late onset of puberty
  7. Diseases of bone and joints: Blount’s disease (bowed legs), slipped capital femoral epiphysis, osteoarthritis.
  8. Breathing and sleep disorders: snoring, disrupted sleep, daytime sleepiness, learning difficulties
  9. Non-alcoholic fatty liver disease
  10. Psychological issues: isolation from friends, bullying, anxiety, depression, low self-esteem, poor school/academic performance
  11. Menstrual irregularities in females: polycystic ovarian syndrome

What can you do to protect your child?

Obesity is a disorder with limited treatment strategies. But the good news is that overweight and obesity are largely preventable.

When it comes to obesity, prevention is not only better than cure, but much easier than cure.

Moreover, the participation of the child and the family is the essence of the interventions for curbing the progression and causing the reversal of obesity and its ill effects.

Being aware of what leads to overweight and obesity helps you take the right steps to halt the disease….

Various genetic, environmental, behavioural factors play a role in causing the chronic imbalance between the energy intake and expenditure that results in obesity.

  1. Parental obesity: Due to genetic influences, a child has a 30% chance of obesity if one parent has obesity and a 90% chance if both parents are obese. Increased maternal weight and maternal diabetes during pregnancy increase the birth weight and risk of obesity in the child.

2. Behavioral factors:

DIETARY HABITS:

Increased intake of energy dense oily/fried foods that are high in calories, high in fat, salt, and low in nutrients is the major contributor to obesity.

Excess feeding leads to excess weight that in turn leads to increased hunger that then turns into a vicious cycle.

Easy delivery of such foods and beverages at your doorstep is ensured at the tap of a button.

Aggressive marketing of junk foods to the population who lack information further exacerbates the problem.

Here are some tips for optimising dietary habits to prevent excessive weight gain:

  • Early initiation and exclusive breast feeding until 6 months of age is of utmost importance towards a good start of feeding healthy.
  • Food preferences are established in early life. Therefore, choosing nutritionally adequate and safe complementary food and introducing it timely at 6 months of age is recommended for prevention of obesity in young children.
  • Avoid use of energy dense, high fat, high sugar, and high salt diet to feed the infants.
  • Older children must consume 3 major meals with 1 to 2 snacks per day, taking care of the portion size.
  • Minimise topping the bread with ghee and butter.
  • Withhold frequent snacking to overcome boredom rather than hunger.
  • Increased intake of fruits and vegetables, legumes, whole grains must be encouraged. These may be given in place of fried snacks.
  • Don’t always express love through feeding delicacies.
  • Oily foods and special foods to be reserved for limited occasions.
  • Do not offer food (chocolates, eating out) as rewards for your child’s achievements.
  • Prefer non-sugary drinks like buttermilk, tender coconut water or just plain water over energy dense beverages.
  • Prefer fresh fruits over sweetened fruit juices.
  • Use skimmed milk or toned milk over full cream/whole milk.

SEDENTARY LIFESTYLE AND REDUCED PHYSICAL ACTIVITY:

With urbanization and booming technology, children and adults are getting trapped in their houses. To add to this is the enhanced academic competition.

Moreover, the duration of time a child spends at school playing outdoors is drastically decreasing. I was astounded to hear from one of the kids that they have no sports period at school.

But all work and no play make Jack a dull boy.

As parents, it is important to understand the importance of physical activity and intervene. It not only ensures that the child stays fit and active but also boosts mental and emotional well-being, through social interaction.  

When I interact with the kids coming to our clinic, they have plenty of reasons to justify being lazy. Here, I enlist a few.

“I have no company to play in.”

“I don’t have time to play.”

“I have too much home work.”

“I get tired while I play.”

“I don’t enjoy playing cricket.”

“We live in an apartment on the streets. I have no place to play.”

“I started exercising 6 months ago. But it didn’t make any difference.”

Make efforts to get to the roots of why your child is not being able to play and ensure that the needful is done.

Some tips for you to start with:

  • Use stairs instead of elevators and escalators.
  • Infants and young children must be as active as possible. They may be allowed to play as much as they like. For an older child, daily moderate to vigorous physical activity of 60 minutes or more must be encouraged.
  • Exercise must be fun-filled and something the child enjoys. It can be running, swimming, playing football, dancing, cycling, etc.
  • Consider enrolment in sports academies or dance classes if you feel the need. Your child may grow to be a star.
  • For overweight and obese child, support for a high level of activity consistently.
  • Older children and adolescents can use devices like activity trackers.

Be prepared for the following

  • Don’t expect your child to run a mile on the 1st day. Make realistic goals and congratulate the child for every small effort.
  • Motivate the child each day for a little better performance than the day before.
  • Don’t accept irrational excuses. Consistency is the key.
  • No pain, no gain. To start with, the child may experience body aches. A gradual increase in activity should be advised.
  • Coach is important. It may be a friend, a parent, a teacher, or a sibling.
  • Reinforcement is necessary. It is easy to gain weight and takes conscious efforts to lose.
  • Exercise should not be an excuse for eating more.

INCREASED SCREEN TIME AND REDUCED SLEEP TIME:

This refers to the time the child spends in viewing television, computer and mobile phone screens.

Harm caused by this mode of entertainment:

Screen time steals time for active outdoor play.

Children get trapped by the yummy noodles and chocolate commercials.

Watching television while eating leads to unconscious munching and large portion size of the meals.

Tips to help you:

  • No screen of any kind for the first two years of life. No media to be used while the child eats. No Chota Bheem or Doraemon to feed the child.
  • An older child must not be allowed a non-academic screen time of more than 1 to 2 hours.
  • Minimal time to social media.
  • Inadequate sleep leads to hunger. Make sure your child sleeps timely and adequately to continue to have a normal sleep wake cycle and a normal eating pattern.

TELL YOUR CHILD, IT IS MUCH FUN TO PLAY CRICKET (OR ANY SPORT) OUTDOORS THAN WATCHING SOMEONE ELSE PLAY ON THE TELEVISION.

3. Environmental factors:

In the current society, children live in an obesogenic environment.

The neighbourhood is flooded with highly palatable street foods, unethical marketing strategies to attract the innocent kids to buy “junk” foods and moreover their easy availability in the vicinity of your household and nearby to schools. The amplitude of the problem is magnified by peer influences, over-pampering by parents and grandparents, and poor emphasis at schools on nutrition and sports activities.

Tips to deal with it

  • Interact with school teachers and ensure activities at school and participation of your child.
  • Ensure access to safe areas of exercise. Take your child to the nearby park or playground if your neighborhood is not child friendly.
  • Everything said above should apply to the entire family and not just the child. Change the lifestyle and food habits of the entire family
  • Make exercise a part of your family routine.
  • Remember, your child watches you and learns from what you do. Therefore, parents have to behave in a way they expect their children to be.

Hope this post has brought you some awareness and motivated you to make a move.

Your endocrinologist and dietitian will precisely guide you on how much calories your child must consume.

Read this article over and over again and see what applies to you and your child and what actions you can put into effect for a better future of your family. Do not forget to share the knowledge.

Thank you for reading through this post. Do not hesitate to ask your queries.

Get up and start exercising today, to build a healthy family. Come back and share with me, what changes have you implemented into your lifestyle.

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