What can we do about Childhood Obesity?
Firstly, we have to acknowledge it. Parents often do not recognize when their children are becoming overweight. Because young children at a healthy weight look skinny and because children who are overweight are becoming the norm, parents often do not realize when their children are not on a healthy track. I think we only start to worry when obesity affects their day-to-day lives. Like when the child begins to pant when walking a distance or when puberty kicks in, or worse, when the child is diagnosed with an illness that is a complication of obesity.
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Parents need to be enlightened on the complications of obesity and why buying a carton of chocolates for a child is not ‘giving the child a treat’. Ideally, parents should be talking to their child’s pediatrician about how to attain a healthy weight and make healthier choices with their child – even if the paediatrician doesn’t bring it up. I am hammering on parents, because they are the best advocates for their children. Parents can play a role by speaking up at PTA meetings by advocating for healthier meals in day cares centres and schools and demanding that the places children visit, such as schools and parks, are promoting healthy eating and physical activity.
The home environment is undoubtedly an important setting in preventing overweight and obesity. Television-viewing has been identified as an independent risk factor for obesity. Potential strategies to reduce television time include messages to parents about not having a TV in children’s bedrooms, encouraging family rules restricting television-viewing, and not having the TV on during meal times.
Two years ago, a 10-year-old boy was rushed to the emergency department on account of altered consciousness. The usual culprits- cerebral malaria, meningitis and sepsis were entertained. However, when his glucose levels were checked, we immediately changed our diagnosis. It was a whopping 25mmol/l! The endocrinologist was called to review what we thought was type 1 Diabetes, but upon further tests, the diagnosis was confirmed to be type 2 Diabetes. A 10-year-old fa! He was obese with a BMI of greater than 35kg/m2 and confessed to drinking up to six bottles of coke per day. What were his parents thinking?
Secondly, since it seems that encouraging children to eat a healthy diet and exercise more is the route to success against childhood obesity, then it is only right that schools are involved. Schools play a very critical role in encouraging healthy behaviours in children. Many children spend a significant amount of time at school where both good and bad habits can develop. Physical activity and health education should be mandatory for those in kindergarten through high school. I remember when P.E was part of the school’s curriculum and was incorporated into the lessons at school. It was not unusual for us to go out for sports on the field in between classes. Nowadays, in most schools, sports is optional and lumped together with other after school activities as more priority is given to educational subjects. I understand that schools are under a lot of pressure to teach core subjects but healthy living is something they should be also be educated about. Schools have a responsibility to create a safe, supportive place where the healthy choice is the easy choice.
Thirdly, after acknowledging the problem, the next step is to treat it. All patients with overweight or obesity should be evaluated for underlying causes or complications of weight gain. The evaluation should include a complete history, physical examination, and laboratory testing. Consideration should be made to substitute medications associated with weight gain (e.g., select antipsychotics, antiepileptics, and antidepressants) whenever possible.
Children who are overweight should be monitored regularly and classified based on their risk factors. For example, if a child is obese and has a family history of Diabetes, then his (the child’s) risk of diabetes immediately increases. Another example is when a child’s father was said to have been obese and died in his fifties of a stroke or heart attack and the now the child is gradually becoming overweight; chances are the child will also become hypertensive and suffer the same weight as the father. Therefore, assessing risk factors is very important.
In addition to eating healthy and exercise, treatment may also include pharmacotherapy (medication) and surgery where applicable. The medication given helps to reduce appetite, stimulate early satiety (the feeling of being ‘full’ after eating) and reduce fat absorption.
However, in the management of childhood obesity, prevention is key. Children should be taught how to reduce their caloric intake and increase physical activity. Strategies to achieve these goals include increasing the number foods with low-caloric density; drinking water instead of juice or sugary drinks; using smaller plates; eating 10 servings of fresh fruit or vegetables each day; having physical activity 2-minutes every hour for a total of 30 daily minutes; using tools to measure physical activity such as a pedometer; and being physically active when feeling hungry.
A public health approach to develop population-based strategies for the prevention of excess weight gain is therefore, of great importance and has been advocated in recent years. There are a wide range of policy areas that could influence the food environments. These areas include fiscal food policies such as mandatory nutrition panels on the formulation, implementation of food and nutrition labelling and restricting marketing and advertising bans of unhealthy foods. In addition, lowering the prices of food items significantly increases the consumption of healthy food. A small study done in a cafeteria-setting was designed to look at the effects of availability and price on the consumption of fruit and salad. It was shown that increasing the variety and reducing prices by half roughly tripled consumption of both food items, whereas returning price and availability to the original environmental conditions brought consumption back to its original levels. How many people can afford to buy a single mango for N500 to N1,000 per piece?
Another strategy is to have policy areas influencing physical activity environments. This includes urban planning policies, transport policies and organizational policies on the provision of facilities for physical activity. Living in walk-able communities and having parks and other recreational facilities nearby are consistently associated with higher levels of physical activity in children and adolescents. Once upon a time, there were parks in every district area were the children in the neighbourhood gathered to play football in the evenings. Nowadays, all those parks have been sold and high-rise buildings erected in their place.
The impact of childhood obesity is vast. For many, if childhood obesity is left unaddressed, the psychosocial and physical co-morbidities will last into adulthood when associated morbidity is high and life expectancy is reduced. Overweight and obesity prevention or reduction essentially involves lifestyle modification through behavioural change at the individual level. Policy alone is unlikely to achieve this, it merely facilitates the process. Therefore, we as parents have to do the best we can do to curb this menace before it consumes us all.
Eat less and Exercise!