The sharp rise in obesity has prompted health officials to take urgent measures to halt this disturbing trend which affects our whole body starting with children who are the most vulnerable to its adverse outcomes.
The Sunday Observer asked Consultant paediatric Endocrinologist, LRH, Dr. Navod Atapattu to explain to our readers why obesity especially in children is so important, how to detect early symptoms, and most importantly how to prevent it with healthy foods and easy exercises on a regular basis.
Excerpts
Q. World Obesity Day was observed yesterday (March 4) under the theme ‘Changing Perspectives: Let’s Talk About Obesity’ with the focus on using conversation and stories to help people change their lifestyles. How relevant is this theme to Sri Lankans in general?
A. Sri Lanka is going through a socio-economic transition where people are leading sedentary lives with easy access to energy dense/ fast food items. This has led to a sharp rise in obesity – akin to an obesity epidemic . Obesity thus needs to be discussed at priority level .
Q. During the past two decades some local studies have shown the prevalence of overweight and obesity to be 15-25 percent depending on the age. These are alarming figures. As the Consultant Paediatric Endocrinologist for the country’s premier Children’s Hospital Lady Ridgeway could you comment on this and its adverse impacts on children?
A. These figures are of course alarming and the studies done in various districts of the country testify this observation. In fact the number of referrals coming to LRH is on the increase. I got 164 referrals in 2022 and 142 referrals in 2021 for obesity. There are other units which look after children with obesity and the numbers would be more or less the same. This is causing concern as obesity itself is a disease (though not many realise it) and it increases the risk of other medical complications including diabetes mellitus. High blood pressure, strokes. In fact it causes problems to the entire body - from head to toe starting from headache to joint pain.
Q. How is obesity in a child measured? Is it the Body Mass Index( BMI)?. What is it?
A. BMI is used to measure the weight status of the child. It is calculated by dividing the weight in kilograms by the square of height in metres. It has to be interpreted based on centile charts for the age and sex of the child. Unlike in adults we cannot give a figure and say
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| Dr. Navod Atapattu |
BMI above a certain figure is considered obese. Once the BMI is calculated it has to be plotted on the specific chart. When the BMI is more than 95 percentile for the age and sex it is considered obese and over 85 the percentile is considered overweight. However, does not measure body fat but correlate with direct fat measurement methods which are cumbersome to perform in the field (Skin fold thickness, densitometry are some of those direct measures of fat content)
Q. Do you have an international chart to guide you?
A. We use WHO centile charts to define obesity and it is found in the child health development record given at birth. Waist height ratio is also an easy method of checking whether one is obese or healthy.
Q. Are there other methods also being used to diagnose obesity in children such as looking at visible signs on their bodies ? If so, what are they?
A. Children with obesity tend to have velvety thickening of the skin which you noticed as dark pigmentation at the back of the neck At times this is seen in the armpits, knuckles and sometimes the whole face becomes pigmented or dark compared to when they were not obese. This pigmentation is called acanthosis nigricans. It tells us that the child has a high risk of diabetes. It is a marker of insulin resistance- meaning the body is resistant to the hormone called insulin which keeps the blood sugar under control. In addition to this pigmentation, some children tend to have a fat pad at the lower part of the back of the neck like a hump.
Some also tend to have stretch marks on the body particularly on the stomach, thighs or buttocks signalling the recent rapid weight gain stretching the skin
Q. What are the main underlying causes that drive childhood obesity? Is it their unhealthy diets?
A. The most important cause of obesity is unhealthy food which contains a lot of fat and sugar. They could be fast foods or foods that are home prepared. Fried food contains significant amounts of fat. Sweets and sweet based foods also contribute to Obesity. There are some children who tend to eat large portions of healthy food. However, I should warn their parents that even a plate of healthy rice could become unhealthy if consumed in large quantities. This is an important fact I wish to reiterate as most adults (and children) do not think that portion size matters when it comes to obesity. The starch, sugar, and oil get converted to energy and excess energy is deposited in the body as fat giving rise to obesity. This fat can accumulate under the skin as well as around the body organs increasing the risk of insulin resistance and diabetes.
Q. What about the sedentary lives that many people, including children lead nowadays due to their pressure of work that allows limited time for physical activities thus leading to obesity?
A. Correct. In addition to excess energy intake, their energy expenditure has become very limited due to sedentary lifestyle which does not involve energy expenditure such as watching TV or playing a computer game, This imbalance of energy intake and energy expenditure is the recipe for childhood obesity.
Q. What role does the genetic factor play in contributing to childhood obesity?
A. Genetic factors play a role in childhood obesity. However this contributes to a minority of the population. The obesogenic environment plays a bigger role in running obesity in families. The background child lives in where the food choices, food habits physical activity level has an impact on weight gain increasingly clustering obesity in certain families
Q. Are there special clinics to treat obese children at the LRH?. What is the treatment procedure?
A. We do have special clinics at LRH for children with obesity. We mainly focus on inculcating healthy food habits and appropriate exercise routine for children depending on the socio economic background. Each child would go through a thorough assessment of the food habits and exercise routine and individualised plan is put in place. Some children will have to undergo blood tests to see whether they have got complications of obesity (diabetes, high cholesterol) to provide appropriate therapy. They are regularly followed up in the clinic and some children receive behaviour therapy. It is advised that the whole family to follow the same healthy routines.
Q. The craze for junk food and instant meals has spread to almost every town and village in Sri Lanka. Is eating these unhealthy foods containing preservatives as well that harm them a leading cause for child obesity?
A. This has contributed to some extent. Easily available packed food items, especially biscuits, fried snacks, not only promote obesity, but also have other consequences as they do have a lot of preservatives. Fast food, processed snacks and drinks are loaded with fat, carbohydrate and sugar. These food items are often addictive due to their taste and it increases the portion size as well as the frequency of such food intake which worsen obesity and play a significant part in childhood obesity.
Q. Since our country is replete with vegetables, fruits, and eggs ,corn, maize and rice are also available though stocks have dwindled today due to various reasons, could you suggest some healthy seasonal meals for children in place of the junk meals they now consume?
A. Rice in appropriate quantities, rice based food such as string hopper, hopper, pittu, gives the variety for the meals. Vegetables , particularly green leafy vegetables, salads and easily available protein rich food such as winged beans, beans, soya, dhal, fresh/sea water fish and eggs can be included in a balanced healthy diet.
Fruits, corn, nuts would be the best alternatives to biscuits as snacks. Encourage children to drink water for thirst rather than fizzy drinks. We advise to take whole fruit rather than fruit juice.
The number of servings from each food group can vary with age and activity level of the child and this is explained at our clinic setting.
Q. You mentioned doing exercises at home. What kind of exercises do you recommend and for how long?
A. We recommend they engage in moderate physical activity for at least 1 hour daily.
Walking, skipping, swimming, running, cycling are a few examples of activities they can do. However, adolescents who get involved in more strenuous exercise need advice from a registered trainer. This type of activity is not a must. Making time for a walk or run is good enough and it could be used as an activity done by the whole family together. Playing badminton, football, elle, volleyball are some of the activities and done in a group. Skipping, squatting, stretching are some alternative methods to keep the child fit.
Q. What is the role of the parents in helping obese children to lose excessive weight?
A. Just as it is the parents’ responsibility to make healthy food options available at home, they are also responsible for introducing unhealthy food. Parents should try to provide home prepared food as much as possible. When eating out, they should also help their children to select healthy choices,
Fast food, processed snacks and drinks are loaded with fat carbohydrate and sugar. These food items are often addictive due to their taste and it increase the portion size as well as frequency of such food intake which worsen the obesity.
Q. What is your message for parents of young children with overweight problems.?
A. lSelect healthy food and make them available at home
*Watch on what you offer them; portion size
*Read food labels and assess how much energy is there in the store- bought food.
*Using the Traffic light system is one option to help select healthy foods
*Encourage children to eat plenty of vegetables, fruits, legumes and nuts.
*Limit eating out and sugary drinks
*Don’t let them skip meals
*Eat meals together with all the family members as much as possible
*Do not bully them, do not punish them if they refuse to eat food you serve.Instead appreciate and encourage their attempts when they make the right choices.
*Appreciate their attempts to be healthy
*Give opportunities for them to be physically active
*Change the whole family environment towards making healthy food choices, and appropriate physical activity
*Limit screen time
Q. Is there a contact number where parents of children with weight problems can reach ?
A. Contact Lady Ridgeway hospital to get referred to a unit which helps children to fight obesity.