Child Obesity's Heavy Burden

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By Sushma Veera

CHILDREN need lots of 'nutritional fuel' because they are growing. A varied and nutritious diet is essential for their development. However, like adults, if they take in more energy - in the form of food - than they use up, the extra energy is stored in their bodies as fat.

Being a few extra pounds overweight does not mean a child is obese, although this may indicate the child's tendency to gain weight easily, and a need for changes in diet and exercise.

Obesity means having too much body fat. Unlike adults, the acceptable amount of fat in a child changes as he/she matures from infancy to toddlerhood, through childhood, adolescence and young adulthood. Therefore, there isn't a fixed Body Mass Index (BMI) cut-off that defines obesity in children (paediatricians use a BMI centile chart to measure obesity). The World Health Organisation (WHO) defines overweight as a body mass index (BMI) of at least 25 and obesity of at least 30. However, studies have shown that the health risks of increased body fat rise progressively above BMI levels of 20-22.

Consultant paediatrician Dr Chow Su Lin said a child is defined as obese if their weight is more than 20 per cent higher than the ideal weight for a boy or girl of their age. It is among the easiest medical conditions to recognise, but among the most difficult to treat.

Obesity most commonly begins in childhood between the ages of five and six, and during adolescence. Studies have shown that a child who is obese between the ages of 10 and 13 has an 80 per cent chance of becoming an obese adult.

In a large-scale study conducted by Universiti Kebangsaan Malaysia in Peninsular Malaysia in 2000, it was discovered that 11 per cent of children between the ages of six to 12 were overweight and six per cent were obese.

In a study of primary school children (seven to 10 years old) in almost all schools in Kuala Lumpur conducted around the same time, about 8.4 per cent of them were found to be overweight.

How do you know if your child's weight gain is normal and when it's leading to childhood obesity?

"Children who take in more calories than they need gain weight beyond what's needed to support their growing frames. In these cases, the added weight increases their risk of obesity and weight-related health problems," said Dr Chow.

She said childhood obesity is particularly troubling because the extra pounds put them at a dangerous headstart for adult-type health problems like high blood pressure, high cholesterol and diabetes, which can lead to serious adult medical conditions, such as heart disease, heart failure and stroke.

"Preventing or treating obesity in children may reduce the risk of their developing these conditions as they get older. One of the best strategies to combat excess weight in your children is to improve the diet and exercise levels of your entire family. This helps protect the health of your children now and in the future.

"The key to ensure children of all ages are at a healthy weight is by formulating a whole-family approach. It's the `practice what you preach' mentality," she added.

She said parents should commit themselves to new, healthy habits and behaviours as a family, with all members sticking to the plan. If not, your child may feel singled-out, deprived or resentful.

There are several ways to achieve this, and it involves eating a healthy diet and increasing the child's activity level.

Said Dr Chow: "Parents are the ones who buy the food, cook the food and decide where the food is eaten. When buying groceries, choose fruits and vegetables over convenience foods high in sugar and fat. Always have healthy snacks available. And never use food as a reward or punishment."

Limit sweetened beverages, including those containing fruit juice. These drinks provide little nutritional value in exchange for their high calories. They also can make your child feel too full to eat healthier foods.

Dr Chow said physical activity is also important as it not only burns calories, but can improve your bones and muscles; reduce the risk of contracting diabetes, abnormal cholesterol and heart disease; and increase your overall energy levels.

Tips to avoid falling into some common eating behaviour traps:

* Don't reward children for good behaviour or try to stop bad behaviour with sweets or treats. Come up with other solutions to modify their behaviour.

* Don't maintain a clean-plate policy. Be aware of kids' hunger cues. Even babies who turn away from the bottle or breast send signals that they're full. If kids are satisfi ed, don't force them to continue eating. Reinforce the idea that they should only eat when they're hungry.

* Don't talk about `bad foods' or completely eliminate all sweets and favourite snacks from overweight children's diets. Children may rebel and over-eat these forbidden foods outside the home or sneak them in on their own.

Many factors, usually working in combination, increase your child's risk of becoming overweight:

* Diet - Regular consumption of high-calorie foods, fast foods, baked goods and vending-machine snacks, contribute to weight gain. High-fat foods are dense in calories. Loading up on soft drinks, candy and desserts can also cause weight gain.

* Inactivity - Sedentary kids are more likely to gain weight because they don't burn calories through physical activity. Popular, inactive leisure activities, such as watching television or playing video games, contribute to the problem.

* Genetics - If your child comes from a family of overweight people, he or she may be genetically predisposed 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 boredom. Their parents may have similar tendencies.