Kerala   

A weighty problem in the making

C. Maya

Although a majority of children in Kerala are underweight, the State is fast catching up with the West in child obesity, and unless addressed on the family and social fronts with seriousness, Kerala could soon be faced with yet another health-care challenge.

THIRUVANANTHAPURAM: It took a television reality show to issue a wake-up call to parents across the U.K. and the U.S. about what the future held for their children, given their food and lifestyle habits.

The BBC television series `Honey, We're killing the kids!' had a nutritionist walk into homes and shock parents by showing them computer-generated images of the long-term impact their lifestyle could have on their children. Paediatricians and parents in Kerala too are slowly waking up to the fact that our nine to 14-year-olds are growing up overweight and obese, putting them at a high risk of developing metabolic abnormalities like insulin resistance in the prime of their youth.

The increasing number of obese or overweight children has now prompted doctors and health experts to sound a warning about the urgent need to improve the eating habits and life styles of children. Child obesity should not be dismissed as just `puppy fat.' Instead, it should be managed at the earliest, with the emphasis on helping children develop healthy eating habits for life. Paediatricians have advocated that schools be made to play a key role in shaping healthy lifestyles for children by making nutrition education, healthy eating patterns and physical fitness programmes a core programme in school curriculum.

Obesity among children is a global issue. An estimated 10.4 per cent children in the age group of 2-5 years and 15.3 per cent in the age group of 6-11 years in the U.S. are either overweight or obese. In the U.K., the Government has now announced its policy to target obesity in under-11-year olds as statistics show that obesity in children in the 2-10 age group has climbed from 9.9 per cent in 1995 to 14.3 per cent in 2004.

Defining obesity among children is a difficult task. The BMI (Body Mass Index) chart for adults cannot be used for children as they are in the growing stage and children generally put on weight when they approach puberty. Researchers usually measure obesity in children by the standards fixed by the National Centre for Health Statistics in the U.S.

Studies on obesity

There have been few documented studies on obesity among the 9-14 age group in Kerala. A study on obesity among adolescents (13 to 19-year olds) in six schools and six colleges in Thiruvananthapuram in 2002 put the prevalence of obesity at 5.5 per cent. The study done by Yamini Thankachi at the Achutha Menon Centre for Health Science Studies showed a marked difference in obesity prevalence in government and private schools, indicating that obesity was linked to family income, the higher income group the higher the chances of children becoming obese. Obesity among children in private unaided schools was 7.2 per cent, while in government schools this was 4.9 per cent.

The obesity in children was also found to be clearly linked to parental and sibling obesity. The fathers of 10.9 per cent children and the mothers of 13 per cent students were obese. More strikingly, only 12 per cent of the adolescents engaged in regular physical activity or outdoor games, with 74 per cent girls having no exercise or games at all. "I observed that obesity here is clearly a problem of the higher socio-economic group where both parents are working. There is little time for parents to cook at home and children are used to consuming food and fried snacks from outside on a regular basis," says Dr. Thankachi.

High consumption of energy-dense but low-nutritive food with little or no physical activity is the direct cause for obesity in children. Although at least 60 per cent of the daily energy requirement of a 10-year-old should come from carbohydrates, children take in more than 50 per cent of this energy from saturated fats and sugar in fizzy drinks, potato wafers and other fried snacks, says Mini Mary Prakash, dietician.

Energy expenditure in children is also less these days. Playing outdoors is a rarity and much of their leisure time is spent on sedentary activities such as computer games or TV viewing. While it is natural for growing children to eat more, the stress should be on eating foods that are fibre-rich ad high in nutrition but not calorie-dense. Childhood obesity can carry over to adulthood because the fat cells once formed will remain in the body. Dine-outs, fried snacks, pizzas and ice-creams should be an occasional treat, Ms. Prakash points out.

Obesity should be addressed as a family problem and unless the entire family shifts to a healthier diet and regular physical activity, it will be difficult to tackle obesity in children. Good eating habits begin at home and parents too should become better informed about eating right. However, the nutrition and child health profile of the State offers strange contradictions.

Cases in State

"In the case of Kerala, obesity and malnutrition among children are two ends of the spectrum. Obesity is indeed an emerging issue, but a large number of children in rural areas do not have enough food. A study of the children in top private schools alone might give the message that child obesity is high but when the entire district is profiled, under-nutrition is the single most important issue affecting children's health," points out M.K.C. Nair, Director, Child Development Centre, here.

A study conducted by S. Geetha, paediatrician, Sree Avittom Thirunal (SAT) Hospital here, in 2003 among 3,000-odd high schoolgirls in the district, in both government and private schools, substantiates this point. It was found that in the district, 7.6 per cent girls were underweight, while an equal number - 7.5 per cent — were either obese or overweight. The overall prevalence of obesity was 2.2 per cent. In the city schools, obesity was 4.2 per cent while in government schools it was only 1.1 per cent. "It would mean that obesity and under-nutrition among children co-exist in Kerala. Any adolescent nutrition programme would have to focus on both the issues," Dr. Geetha says. The key findings for the State in the latest National Family Health Survey III (2006) also points out the State's dismal record in child nutrition. The percentage of children under three years who are underweight has gone up from 27 to 29 per cent while those wasted (too thin for height) has gone up from 11 to 16 per cent in the last five years, NFHS III has reported.

Schools need to strengthen their policies of nutrition and physical education. It has been suggested that schools monitor closely the food served in their canteens and ensure that students are offered healthy, nutritive meals that are low in fat, sugar and salt. Coordinated school health programmes should be introduced wherein children are taught about food, nutrition and the importance of physical activity in an interactive manner. Teaching them about the food pyramid, how different foods produce different effects on the body can all encourage children to look at food in a new light.

Doctors and nutritionists warn that focussing on obesity alone and scaring children about their food habits could be counterproductive. Instead, the message should be about becoming more fit, healthy and strong. And, at the macro level, on pulling the graph of nutrition up for the majority and saving the majority from the junk food trap into which the poor in the developed world has fallen.

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