Bigger the waist line, shorter the life line: Childhood Obesity- an Epidemic

Childhood obesity is one of the biggest public health challenges of the 21st century especially in developed and in developing countries undergoing economic and nutrition transition.

 The problem previously thought to be affecting mainly developed countries and high income group is now steadily affecting many low and middle class families in developing countries, particularly in urban settings. The prevalence has increased at an alarming rate.  According to WHO (World Health Organisation) report the number of overweight children under the age of five globally, is estimated to be over 42 million in 2010. More than half of these are living in developing countries.

Overweight and obesity are defined as ''abnormal or excessive fat accumulation that presents a risk to health".

The common cause for childhood overweight and obesity is an energy imbalance between calories consumed and calories expended. In other words, it's caused by kids eating too much and exercising too little.  Most kids prefer junk food as they think it is quick, tasty, convenient and also fashionable. But they are unaware of the calories it contains. Occasionally there are some genetic and hormonal causes of childhood obesity.

The society and environment influences the child to eat unhealthy choices thereby putting them at risk of overweight and obesity. Television commercials promoting unhealthy foods and eating habits is a large contributor. Children are surrounded by environmental influences that do not encourage physical activities.

 

Risk factors leading to childhood obesity are

Diet: Regularly eating high-calorie foods, drinking soft drinks containing sugar. Foods and beverages like these are high in sugar, fat and calories. Frequently eating food outside home, at restaurants and cafeterias where child tend to eat a larger quantity of food than when they eat at home.

Lack of exercise: Inactive leisure activities, such as watching television or playing video games, computer games contribute to the problem. Children who don't exercise much are more likely to gain weight because they don't burn calories through physical activity. Burdening the students with the studies and academic activities has left no room for physical activities.

Family history: If child comes from a family of overweight people, he or she may be more likely to put on excess weight, especially in an environment where high-calorie food is always available and physical activity isn't encouraged.

Psychological factors: Some children overeat to cope with problems or to deal with emotions, such as stress, or to fight boredom.

 Cultural factor: misconception in India that the fat child is a healthy child

Why should someone worry about children’s weight?

Overweight and obese children are likely to stay obese into adulthood and more likely to develop diseases like diabetes, heart diseases, high blood pressure and high cholesterol at a younger age. They can also suffer from breathing difficulties, sleep problems and early puberty. In addition to the above physical complications, an obese child is at risk of social and emotional problems like low self esteem, depression, behaviour and learning problems and can experience bullying. These diseases put a huge economic burden to the family and country.

Prevention is better than Cure:

Overweight and obesity and their related diseases are largely preventable.

Treating obesity in children and adolescents differs from treatment in adults. Treatment should revolve around the entire family and not aimed at that particular child. Management of childhood obesity cannot be accomplished by just dieting. It needs to address multiple aspects of the child and the family’s lifestyle, nutrition and physical activity patterns. Management should begin with assessing the readiness of the child and the family to make changes and set realistic goals.

Diet Therapy

 A dietitian is involved in treating an obese child or adolescent, who can address the child’s needs. Dietitians do not always recommend restricting caloric intake for children. They educate on how to identify healthy food, cut back on portions, understand the food pyramid and eat smaller bites at a smaller pace.

Physical Activity

Increasing physical activity can decrease, or at least slow the increase, in fatty tissues in obese children. It is recommended that children get at least 60 minutes of physical activity each day.

Behavior Modification

Lifestyles and behaviors are established at a young age. It is important for parents and children to remain educated and focused on making long-term healthy lifestyle choices.

Vitamin D Deficiency in Children

What is Vitamin D?

Vitamin D is a fat-soluble vitamin that is needed for good health. Vitamin D is important for strong and healthy bones. Vitamin D promotes calcium and phosphorus absorption in the gut.

Where can we find Vitamin D?
 

A main source of vitamin D is made by our own bodies. It is made in the skin by exposure to sunlight. Ultraviolet B (UVB) rays in sunlight convert cholesterol in the skin into vitamin D. Season, time of day, length of day, clouds, fog, skin colour, and sunscreen are some of the factors that affect UV radiation exposure and vitamin D synthesis. It is naturally present in very few foods. The best dietary source of vitamin D is oily fish (salmon, tuna, and mackerel) and cod liver oil. Egg yolk, liver, and mushrooms contain small quantities of vitamin D.

 

                        

Who gets vitamin D deficiency?

Vitamin D deficiency means that there is not enough vitamin D in your body.  It can happen in 3 groups of people

• Someone with an increased need for vitamin D.
• Example: Growing Children, pregnant women need extra vitamin D.
• Someone who is unable to make enough vitamin D
• Example: Poor exposure to sunlight (children who are often kept indoors, children who are fully clothed with no areas of skin exposed to sun), dark skinned children
• Not enough vitamin D is being taken in the diet or poor absorption
• Example: Children with a strict vegetarian or vegan diet, Children with fat malabsorption conditions like Crohns disease, liver disease etc

What are the symptoms of Vitamin D deficiency?

·         Babies with severe vitamin D deficiency can get muscle cramps, seizures and breathing difficulties. These problems are related to low levels of calcium.

·         Children with severe deficiency may have soft skull or leg bones. Their legs may look curved (bow-legged). They may complain of bone pains, often in the legs, and muscle pains or muscle weakness. This condition is known as Rickets.

 

·         Poor growth. (Height is usually affected more than weight)

·         Tooth delay. (Children with vitamin D deficiency may be teething late)

·         Irritability

·         More prone to infections.
 

How is vitamin D deficiency diagnosed?

Your doctor may request a simple blood test for vitamin D level to make the diagnosis. He or She will request blood tests for calcium, phosphate levels and liver function which are often linked to vitamin D levels. They would do wrist X-ray of the child to look at the bones.
 

What is the treatment for vitamin D deficiency?

The treatment is to take vitamin D supplements. Vitamin D can be given as an injection or as syrup.

                                     

"Is my child growing normally?"

 Often parents and even children worry when they are not as tall as their peers. Though many diseases impair child's growth, most short children are normal. Delayed puberty and disproportionate short stature can be a sign of a chromosomal disorder. short and overweight can indicate an endocrine or hormonal problem

 

 

Most children are short because they have short parents. In other words, parents genes play a major role in child's growth.Children's growth is often divided into 3 phases - infancy stage, childhood stage and puberty stage.

Growth in infancy stage is the most rapid growth and child grows about 25 cm  during the first year of life. This growth is predominantly influenced by the nutrition . Children in early childhood usually grow at a rate of about 4- 8 cm per year, up until they begin puberty. Growth in 2nd phase is influenced by Growth hormone, Thyroid hormone and nutrition. Then there is an acceleration in growth as they hit their peak growth velocity in puberty, to about 8-10 cm/year for girls and 10-12cm/year for boys. Growth then slows again in girls to about 3-4 cm/year after menarche (the first period) until they reach their adult height. Boys and girls usually continue to grow until they are 14-16 years old, but this depends on when they started puberty. Growth in the puberty phase is predominantly influenced by sex hormones.

 

Common reasons for short stature:

 

Familial short stature:  Child's parents are short. These children usually grow at a normal rate

Constitutional delay of growth: These children grow at or below the 3rd percentile for their height, but their growth velocity or rate of growth is normal. They will have a delayed bone age, showing that there is still growth left. These children are described as 'late bloomers'. They should reach a final adult height that is near their target height.

Growth hormone deficiency: Children with growth hormone deficiency are short, often look younger than their chronological age. They are short, often look younger than their chronological age, they will usually have a delay in their bone age, will have a slow rate of growth and they will have a growth curve that falls away from the normal growth curves.

 

 

 

 

 

Nutrition Basics for Children

Nutrition Basics to help your Child Stay Healthy 

Nutrition is important to your children's health. Proper nutrition can prevent many medical problems. Balanced food provides required nutrition, which is essential for children's growth.

Most food contains Macronutrients and Micronutrients in varying amounts.

Macronutrients provides energy for daily function and activities. It is essential in large quantities for healthy growth and development. Carbohydrates, Proteins and Fats form the essential macronutrients.

Micronutrients play an essential role in regulating metabolism. Vitamins and Minerals form the essential micronutrients which are found in tiny amounts in food.

Carbohydrates

 

 

Carbohydrates are available in nearly all foods of plant origin. Some carbohydrates are good source of energy while others add only calories but less of nutritive value. Carbohydrates  (chains of sugar molecules) can be classified as simple (fruits- fructose, milk- lactose, sugar- sucrose) or complex (potato- starch, oats, vegetables- fibre) based on structure. Foods that contain complex carbohydrates, which take longer time to break down to glucose, are considered as better carbohydrates in comparison to foods containing added sugar like cakes and cookies.

Better Carbohydrate	Carbohydrate
Brown Rice	White Rice
Brown Bread	White Bread
Whole Apple	Apple Juice
Fruits	Cakes

Proteins

Protein is essential for growing children as it is important for cell growth, repair and maintenance. Physical activities and exercises increase your children's need for protein. Dietary protein can be obtained from both animal and plant origin.

Plant Protein	Animal Protein
Pulses	Red Meat (Lamb, Pork, Beef)
Nuts	Fish, Poultry (Chicken)
Seeds	Eggs
Grains	Milk Products

Fats

Not all fats are bad. Some fat plays an important role in the absorption of fat soluble vitamins A, D, E and K. Cholesterol is essential for the production of sex hormones. However only a small amounts is required from diet as our body manufactures the rest. Trans fats, Saturated fats and Cholesterol are less healthy than polyunsaturated and monounsaturated fats.

Good Fat	Bad Fat
Olive Oil	Coconut Oil, Palm oil
Fish Oil	Ice Cream
Corn Oil	Cheese
Sunflower Oil	Butter

Vitamins & Minerals

Vitamins are essential for normal growth and development. Eating a variety of foods is the best way to get enough vitamins as no one food contains all the essential vitamins. Vitamins are organic substances (made by plants or animals).  Minerals help in regulating body metabolism. Minerals are inorganic elements that come from earth soil and water which are absorbed by plants. Minerals are needed only in tiny quantities.

Vitamins & Minerals	Source
Vitamin A	Carrot, Cabbage, Liver, Eggs
Vitamin B	Spinach, Eggs, Nuts, Meat
Vitamin C	Oranges, Mango, Cabbage, Tomato
Vitamin D	Fish, Egg
Vitamin E	Almonds, Peanuts, Prawns
Vitamin K	Grapes, Pears, Cabbage, Carrot
Calcium	Milk, Cheese, Yoghurt
Iron	Chicken, Meat, lentils, Spinach

Best way to keep your children healthy is to encourage them:

• Not to miss Breakfast
• To have  5 Fruits a Day
• To eat Variety of Foods
• To balance the food they eat with Physical Activity
• To choose a diet with

           v Plenty of Grain Products, Vegetables and Fruits
            v      Moderate in sugars and salt
            v      Low in fat, saturated fat, and cholesterol

·         To choose a diet that provides enough calcium and iron to meet their growing body's requirements