Childhood obesity has tripled in the recent past resulting in negative, long term and short term outcomes. This obesity epidemic has led to early development of non communicable diseases, once described as old age diseases. Health officials are now seeing more young people afflicted with heart diseases, hypertension, diabetes, skeletal joint pains, due to excess body fat which puts an increased weight load 
on the joints. Besides these physical outcomes, overweight children have to face ridicule from their peers leading to depression “The alarming fact is that for the first time in human history the current generation will have a shorter life expectancy than their parents!”, warns a leading Diabetes expert and Endocrinologist, Dr Noel Somasundaram of the National Hospital, Sri Lanka.
In his interview with the Sunday Observer, he tells us how childhood obesity starts, how it develops, the importance of exclusive breast feeding for the first six months, and careful choice of weaning foods thereafter. He also tells us how this dangerous trend can be reversed and prevented- by eating well balanced diets and taking plenty of exercise in place of the preferred junk foods and sedentary lifestyles which most young children indulge in.
Excerpts...
Q. Childhood obesity has become an increasing concern for health officials, both, in Sri Lanka and abroad, due to their long term and short term negative health consequences. What are these negative factors?
A. Childhood obesity occurs when a child is well above the normal weight for his or her age and height. It is a condition where excess body fat negatively affects a child’s health or well being.
Overweight and obese children tend to be teased because of their weight and are less likely to exercise as a result of teasing.
They tend to perform poorly at school and are less likely to achieve their future potential than the normal weight children. As a result, obese children are more likely to be depressed and have a higher risk of being unemployed.
In addition, there are multiple physical problems of being obese. Skeletal problems include joint pains and even dislocated head of the hip bone as result of the increased weight load on the joints. We are becoming increasingly concerned about the long-term metabolic consequences of childhood obesity.
These include, liver (fatty liver and later cirrhosis) and cardiovascular including high blood pressure, high cholesterol, diabetes and higher risk of heart attack in young age.
Q. What happens if this dangerous trend continues?
A. If the current epidemic of childhood overweight or obesity continues unabated we have a future generation at great risk of diseases at younger age and even the risk of dying is higher.
The alarming fact is, for the first time in human history the current generation would have a shorter life expectancy than their parents!
Q. It is said, at least 2.6 million people die as a result of being overweight and obese. What is Sri Lanka’s position in childhood obesity? Compared to the past has it increased significantly?
A. Over the past two decades childhood obesity has become a major problem and has tripled. In Sri Lanka, studies show prevalence of overweight and obesity to be 15-25% depending on the age. These are alarming figures.
Q. At what age does childhood obesity begin?
A. As long as the child is breast fed the child is protected most of the time. The problem begins when the child is weaned from the mother’s milk and started on ‘unhealthy food regime’. In Sri Lanka, children are monitored on the childhood development chart and weight gain can be picked up early.
Q. Is it true that children who are overweight are more likely to stay obese and develop non-communicable diseases like diabetes and cardiovascular diseases at a younger age?
A. Non-communicable diseases have been a disease of the old people in the past. However, we see an increasing number of children with multiple cardiovascular problems at a younger age, today.
Obesity is often progressive and the metabolic and cardiovascular complications often tend to get worse over time.
Q. Does this prove the claim that for most NCDs resulting from obesity, the risks partly depend on the age of onset and duration of obesity?
A. Yes.
Q. What do you consider as most significant consequences of childhood obesity?
A. On a personal level these children will spend more time being unwell and being treated for physical and mental illnesses. The personal cost of obesity can be very high: obese children spend three times more money on getting healthy. In addition, there are multiple social and psychological consequences, such as, not being employed, not getting the right job because of obesity, being depressed, etc.
So the consequences are multi-pronged. At a social level, obesity can be a major burden to society, as its health consequences such as, high blood pressure, high cholesterol, diabetes, and fertility problems due to obesity can disturb the social fabric of society. At an economic level, obesity would cost enormously to the nation.
Q. Among the reasons for childhood obesity, two main reasons have been, fast food consumption and lack of exercise. Do you agree?
A. I agree. There are four key factors to be considered:
Firstly, there are genetic factors. A child with an obese parent is more likely to become obese. A child tends to pick up his/her parents’ unhealthy habits. The most important factor though is poor eating habits.
Children’s dietary habits have shifted away from healthy foods (such as fruits, vegetables, and whole grains) to a much greater reliance on fast food, processed snack foods, and sugary drinks. These foods tend to be high in fat and/or calories and low in many other nutrients. Patterns associated with obesity are eating when not hungry and eating while watching TV or doing homework. Over the past few decades the consumption of unhealthy foods, not just fast foods, have increased.
Only 30% of Sri Lankan households use adequate vegetables and fruits in their meals. These have been replaced by starch, sugar and fat- the dangerous triad that causes many illnesses, including, obesity, heart diseases and even cancers.
Q. Any other contributory factors?
A. Physical inactivity. The popularity of television, computers, and video games translates into an increasingly sedentary (inactive) lifestyle for many children. Children spend many hours a day watching television.
Not only does this use little energy (calories), it also encourages snacking. Sitting for prolonged periods is an independent risk factor for obesity. Sleeping late and not getting adequate sleep time are also factors.
Depression can also cause a child to overeat. But then again, an obese child can develop this psychological disorder. Depression can be both, the cause and effect of childhood obesity.
Q. Some low income and middle-income countries face the double burden of infectious disease and under nutrition in the same community and even in the same family. How did this happen? Can inadequate pre-natal infant and child nutrition followed by exposure to high fat, energy dense micro-nutrient poor foods be a cause?
A. We see the combination of under nutrition along with over nutrition in the same society.
The key reasons include, maternal environment where the child is undernourished in the womb and is programmed as fetus to survive in an environment of scarcity.
However, when these children are overfed later they develop diseases such as, obesity and metabolic consequences of obesity as they were not meant to be in an environment of plenty.
Feeding has to be thought of as eating to live rather than living to eat.
Q. How do you diagnose childhood obesity? What are the symptoms? Are they always visible? Explain in detail
A. BMI (Body Mass Index) is used as a screening tool to identify possible weight problems for children. Another way to diagnose is to check the waist of the child for central obesity.
Some of the consequences of obesity may be externally visible such as, thickened skin on neck, elbows and knuckles known as acanthosis nigricans- this develops as a result of insulin resistance. Some children tend to have problems of puberty such as, delayed puberty in boys and related signs such as smaller genitals and enlarged breasts.
Q. How is it treated? I understand there is a special clinic for obese children at the NHSL. Is the treatment given the same as for adults? Do they get medication? Or put on a strict diet and exercise regimen?
A. We tend to concentrate more on the lifestyle changes as they have long term implications. Learning to eat healthy is an important skill that children need to develop. We also train on improving physical activity in these children.
There are few medications such as, orlistat for treatment of obesity. In those who cannot lose weight and have complications of obesity surgical options for weight loss are considered.
Q. Can these exercises be done at home?
A. As children, it is important to incorporate physical activity into daily life and we encourage children to enjoy life and make full use of their time in a balanced manner.
Those who haven’t done any exercise are encouraged to start slow and gradually increase the time spent as well as the intensity of the exercise.
Physical activity in all forms can be increased by cutting down the mechanization of modern life. Examples in which physical activity can be incorporated into daily life are gardening, home chores, walking to places, and climbing stairs instead of taking the lift.
Q. What is the role of the parents in helping an obese child to reduce weight?
A. The home environment is very important. Parents can help create a healthy environment at home. This has to start from birth, and parents can provide continuous guidance for children to lead a balanced and healthy life; this can prevent obesity in children as well as help children to lose weight.
Parents should start on the correct weaning food in childhood that includes vegetables and a balanced diet, than getting children addicted to unhealthy foods that are commercially marketed nowadays. Pressure on children to perform academically has brought down the time they spend playing and this results in poor physical fitness and leads to obesity.
Lots of children gain weight during exam times as they stop all games and instead stay in one place. These are important things in the prevention of weight gain.