Dr Samriti Gupta
Health comes through long way right from its conception in the mother’s womb till the individual lives on earth. Adequate nutrition is the key to good health across all stages of life. However, the most important stage is the first 1000 days of life. Adequate and appropriate nutrition and good health at this stage embark on a healthy future. Considering the large burden of under nutrition as a major public health problem and the importance of the first 1000 days, the Government of India initiated the National Nutrition Mission in 2016 which was later named Poshan Abhiyaan in 2018. The Poshan Maah is celebrated every year in the month of September to strengthen the community to combat malnutrition among children, adolescents, and pregnant women. Despite large-scale efforts of the health sector and government, the recent Comprehensive National Nutrition Survey has reported alarming results with 33% underweight, 17% wasted and 35% stunted children between 0-5 yearsand4-8% obese or overweight adolescents. This has led to the need for introspection within us regarding the nutrition we are giving to the current generation.
Obesity- a rising epidemic in children
India along with the entire world is currently facing the triple burden of malnutrition- under nutrition, micronutrient deficiencies and obesity. While the leading world health agencies like WHO, UNICEF as well as health ministry in India have been working for years to combat under nutrition, the prevalence is higher. On the other hand, obesity is rising like an epidemic in countries of all strata. The prevalence of obesity among children and adolescents has almost tripled from 4% to 18% between 1975 to 2016 in India. The projected estimate of obese children and adolescents by 2025 is 1.73 crores as per WHO reports if no measures are taken India will be just second to China in terms of childhood obesity. Though a lot of efforts have been taken to identify children with under nutrition and their corrective measures at all levels, no such initiatives have been taken to deal with obesity in children.
What causes childhood obesity?
Most of the parents equate overweight children with good health. Lack of awareness and knowledge regarding the consequences of higher weight for height as well as nutritive values of foods among parents and caregivers contribute to more weight gain among small children. Exposure to food items rich in fats, sugars and salts like candies, chocolates, juices, processed foods, chips, cola drinks, burgers and pizzas at early ages contributes to childhood obesity. Indoor activities combined with increased screen time for infants and toddlers lead to a lack of outdoor physical activity and promote sedentary behaviour. All this sets the vicious cycle of more consumption with less utilization of calories and hence leading to childhood obesity.
What harm childhood obesity can do?
Childhood obesity sets the foundation stone for non-communicable diseases (NCDs) in adulthood. These conditions like hypertension, diabetes mellitus, hyperlipidemia, stroke, and myocardial infarction which were previously thought to be diseases of late adulthood or the elderly population, have now been seen in older children, teenagers, and young adults. Various hormonal disorders like menstrual disorders, hypothyroidism, polycystic ovarian syndrome, and osteoporosis have also been on a rising trend in adolescents and young adults due to the epidemic of obesity. Besides obese children also have more psychological problems.
Tackling childhood obesity with healthy nutrition
So, what can we do at our own level to keep our children healthy? There are certain tips and tacticsthat can help to control our child’s weight and prevent the chances of being overweight and obese.
* Starting at inception: Good maternal nutrition during the prenatal and entire antenatal period and correction of micronutrient deficiencies like anemia contribute to the baby’s good health.
* Breastfeeding: Exclusive Breastfeeding till six months is a boon to a child whois laden with all the nutrients and immunity-boosting factors, resulting in adequate physical growth, brain development and less chance of infection. Also, exclusively breastfed babies have less risk of obesity and other NCDs.
* Complement with feeding: Beyond six months, the child must be initiated on complementary feeding. The right composition, consistency, amount, and timing of complementary feeding is very important to prevent both types of malnutrition in a child. Besides, breastfeeding should be continued till two years of life.
* Concept of balanced diet: In toddlers and school children, the concept of a balanced diet should be included in daily routine. A traffic light plan should be applied for all meals with more consumption of green foods (fresh fruits, vegetables, nuts), and moderate consumption of yellow foods (cereals, pulses, fats) while avoiding red foods (sweetened drinks, processed foods, fried foods). Their each meal plate should include, 25% cereals, 20% protein-rich food, 50% fresh vegetables and fruits and less than 5% fats. This also applies to older children, adolescents and even adults.
* Avoiding JUNCS: JUNCS include junk foods, ultra-processed foods, nutritionally inappropriate foods, caffeinated or carbonated beverages and sugar-sweetened beverages. These types of foods should be restricted among all ages of children for the prevention of obesity.
* Physical activity: Incorporating 60 minutes of daily moderate to vigorous physical activity is essential to be healthy in all age groups. Age-appropriate exercises and outdoor games should be part of the routine since early childhood.
* Screen time: Exposure to any type of screen time including TV, mobiles, computers, tablets, and video games results in a sedentary lifestyle. Besides watching the screen while eating is associated with uncontrolled snacking and grazing of foods. Watching advertisements of the promotion of junk foods and cola drinks may also result in an inclination towards eating such items. Screen time should be avoided in children <2 years and in children >2 years, it should be restricted to 1-2 hours and too under parental supervision.
* Sleep: Adequate sleep hours appropriate at each age are necessary to promote healthy well-being. Sleep routine and hygiene should be maintained. There should be no screen time at least 1 hour before sleep.
* Health education as a part of the school curriculum
* Regular physical activity during morning assemblies, as well as dedicated time for physical education
* Regular weight, height and BMI monitoring of school children for early recognition of obese as well as at-risk children
* Provision of healthy foods like fruits, and salads in the school canteen or cafeteria
* Banning of junk foods and foods high in sugar and salt content in school premises
* Training of teachers in health education for repeated short workshops
Government and administrative level
* Training of ASHA and AWW for anthropometric measurements with ability to recognize overweight and obese children.
* Regular health education and awareness activities for mothers regarding healthy nutrition and physical activity.
* Restriction of marketing and promotion of JUNCS food items.
* Initiatives by Government and healthcare sector to promote healthy eating.
Preventing obesity by opting for healthy food choices and regular physical activity is the best option to control childhood obesity. The responsibility lies jointly among the individuals, families, schools, the healthcare sector, and the government. The data currently points towards the expanding balloon of obese and overweight children in India which needs to be controlled before it bursts. Hence, to save our future, the time to act is NOW!
Do’s and Don’ts for prevention of childhood obesity
(The writer is Assistant Professor, Department of Pediatrics, AIIMS Vijaypur, Jammu).