Health Topics

Healthy Living

November 2009
Puppy Fat is No Longer Cute
Dr Subrata Dey
Traditionally, a fat child is considered as an 'attractive' child, and is even often referred to as a 'healthy' child. But with the adverse and serious consequences of childhood obesity such as high blood pressure, high blood fats, diabetes and heart disease being now proven beyond doubt, puppy fat is no longer 'cute'.Childhood obesity seems to have a central role in the development of these disorders by causing insulin resistance. Parents, teachers and doctors therefore, have an important role in the recognition, prevention and control of the obesity 'epidemic'. More so since India is in the midst of a rapidly escalating 'epidemic' of Type II Diabetes and Coronary Heart Disease

A Global Epidemic
According to WHO (World Health Organisation), at least 50 percent of adults and 20 percent of children in U.K., U.S.A. and Australia are currently overweight. Childhood obesity has tripled in Canada in the last 20 years. Recent Indian studies have also documented this trend of escalating obesity in both adults and children, although there appears to be a direct correlation with better socio-economic status and urban habitation. 50 to 80 percent of obese children become obese adults, and all complications of adult obesity are made worse if the obesity begins in childhood.

Causes of Obesity
The important causes of the epidemic in India appear to be
  • Unhealthy eating patterns
  • Reduced physical activity
  • Increased sedentary pursuits
  • Family history

Prevention of Obesity
Healthy eating patterns
Emphasis should be on nutrition rather than 'dieting'. It is important to maintain healthy components of traditional diets (i.e., micronutrient rich food such as fruits, vegetables and whole grain cereals) and guard against heavily marketed energy dense fatty and salty foods (e.g., pre-packaged snacks, ice-creams and chocolates) and the sugary aerated drinks. The strategy should be to recognise and eliminate risk features of high calorie intake such as frequent snacking (samosas, potato chips), eating out frequently (burgers, pizzas), celebrating with food (cake, chocolates) and drinks (aerated drinks). Habits attained early have more chances of remaining throughout life.

A simple message should be: A day's food composition as a thali wherein 50 percent (half) is full of vegetables, salads and fruits. A quarter (25 percent) should be made up of cereals such as rice and/or chapattis and the remaining quarter should be protein based (dal/milk/egg/animal protein). Fried snacks and sweets to be avoided.

Increased physical activity
Children should be encouraged to be active not only for weight control but for general wellbeing. Many adolescents/pre adolescents find defined physical exercises (aerobics, tread-mills) boring and punitive and are more likely to continue activity if it is incorporated into their daily routines, e.g., walking or cycling to school and playing with friends in the grounds.

In general, moderate to vigorous activities for a period of at least one hour a day should be a practical recommendation for all school going children.

Decreased sedentary behaviour
Perhaps even more important is decreasing sedentary behaviour. In our country, chief sedentary behaviours are television (should be restricted to no more than two hours a day), computers and telephone conversations.

Special Strategies for Special Groups
Infants and young children
  • Mothers should prevent excess weight gain in pregnancy, and control diabetes or impaired glucose tolerance in pregnancy.
  • Promote exclusive breastfeeding for six months.
  • Avoid adding sugars, starches or oils to feeding formulas.
  • Assure appropriate micronutrient intake especially of iron, calcium and vitamins.
  • Monitor growth with weight for height and BMI.
  • Mothers to accept the child's appetite and not force feed.
  • Families must be made aware that 'fat infants make fat adults'.
School based programs
Schools are probably the ideal medium of intervention as they are central to children's lives, and information can be relatively quickly dissipated through this channel. Aspects to be considered are:
  • Training of teachers in lifestyle, nutrition and activity.
  • Introduction of ideal school meals or provision of canteens offering only healthy options.
  • Introduction of 'nutrition and physical education' in school curriculum. These activities should become compulsory and /or a 'scoring subject' with marks to be added to total grades. Only then will parents/students give the required attention and time to this, in the otherwise competitive world of academics.
  • After school games (supervised/ unsupervised) to be encouraged. Opening up of school playgrounds on weekends and holidays.
  • Obese children should not be teased, targeted, bullied or isolated.
  • Involve parent associations.
  • School health check-ups should monitor BMI along with height and weight annually.
Clinic based individual assessment of the obese child and principles of therapy - diet and exercise with judicious use of medications in selected cases. Aggressive weight control and lifestyle modification in children and adolescents is of paramount importance.

Prevention of childhood obesity should be an important priority for parent, schools and medical professionals. Lifestyle changes enumerated above are very important for prevention of obesity. 50 to 80% of obese children become obese adults and all complications of adult obesity are made worse if the obesity begins in childhood. Insulin resistance in childhood obesity confers a significantly increased risk for cardiovascular disease in adulthood. Aggressive weight control and lifestyle modification in children and adolescents who are already diagnosed with obesity should be conducted in a clinic setting by experienced medical professionals. Fat is no longer cute.

Dr. Subrata Dey is Sr. Consultant Pediatric Endocrinologist Apollo Gleneagles Hospital, Kolkata