Obesity in Children
Children are fast adopting physically inactive lifestyles and consuming more ‘energy-dense, nutrient poor’ diets. Despite increasing the cases of cerebrovascular disease (strokes), cancers, Type II diabetes, osteoarthritis, hypertension and high cholesterol, Indian children are not eating the recommended amount of fruits or vegetables as part of their daily diet. All these factors are having a serious impact on their well being and quality of life. Obesity in Children
Agrawal family decided to visit doctor as Anuj is feeling very tired and psychologically depressed now-a-days. His family was also feeling that most of his friends started ignoring him and stopped to invite him in most of the common parties due to his sedentary lifestyle. However, they never expected that their fourteen-year-old son was suffering from Type II diabetes, which they came to know after visiting doctor. The doctor explained that Anuj’s overweight is primary reason for development of Type II diabetes. The family had never realised that Anuj’s weight had increased from 45 to 94 just in last five years. The probable reason of his weight gain might be his love for pizza, burger, spicy chicken, fried food and aerated drinks. However, the doctor informed the family that Type 2 Diabetes in children can be evaded by avoiding weight gain, inactive lifestyle and dietary modifications. Anuj’s overweight could be controlled by adopting active lifestyle and improving food habits. A recent study by the World Health Organisation (WHO) has revealed that India is home of approximate 14.4 million overweight children. The ‘Global Burden of Disease’ study 2013 reported that by 2025, India will have over 17 million obese children and stand second among 184 countries after China. Obese children are at a significantly high risk for adverse health outcomes including both medical and psychological problems. It is well-established that overweight and obese individuals have increased risk of developing various
chronic diseases, such as Type-II diabetes mellitus, hypertension, and cardiovascular disease (Figure 1). Body mass index (BMI) is a measure of body fat based on the body weight in relation to the height. It is used as a screening tool to determine whether a person is underweight, overweight or obese. Furthermore, increased BMI is associated with higher risk of mortality. Commonly accepted BMI ranges are: Underweight: under 18.5 kg/m2; Normal weight: 18.5 to 25 kg/m2; Overweight: 25 to 30 kg/m2; and Obese: over 30 kg/m2. Obesity arises when energy intake exceeds energy expenditure. Body weight is determined by the interactions between genetic and environmental factors. It is estimated that 40-70% of BMI variation is hereditary, while the other 30% is determined by lifestyle factors. Figure 1 also indicates that sugar or fat is not the sole reason for the recent rise in obesity as emphasised in many literatures. Instead there are many other factors which are responsible for increase in cases of obesity. However, genes, environment, and emotional factors also influence food intake, and mood states that trigger eating of palatable foods for comfort in negative emotional states are important factors. This repetitive eating of comfort foods, rich in carbohydrate, highfats and sugar, leads to obesity. Obesity in turn regulates mood, which disturbs our brain activity, leading to abidirectional vicious cycle of mood, food, and obesity. Obesity in Children
Relationship of macronutrients with obesity Research has been unable to identify the real culprit that leads to obesity. Nowadays, both in the western world and in developing countries, diet predominantly consists of processed, unhealthy foods. Promotional campaigns advertise low-fat diets; however, this instead encourages companies to use high sugar content. The first incidences of hypertension, diabetes, and obesity were noticed in Europe (England, France and Germany), which happens to be the place where sugar first became available to the public. This demonstrates the correlation between the consumption of sugar and obesity. Moreover, the introduction of sugar in developing countries later also coincides with the rise in obesity and heart disease in those countries. Obesity in Children
High-fructose corn syrup (HFCS) is a sweetener made from corn starch having the same chemical composition (glucose and fructose) as table sugar, which is sucrose (naturally occurring carbohydrate found in many plants and plant parts). HFCS has become the primary choice of food industries due to its better shelf life, more palatability and competitive price compared to table sugar. The combination of table sugar and HFCS has resulted in an additional 30% increase in overall sweetener intake and has been found to be a critical component associated with the risks of obesity and cardiovascular diseases. Obesity in Children
This is related to the inability of fructose as compared to glucose to stimulate the release of the hormones insulin and leptin and to inhibit production of ghrelin, all factors that are known to affect the satiety centre in our brain. Insulin is responsible for regulating blood glucose levels. Leptin made by fat cells, decreases appetite, and ghrelin plays a role in body weight by increasing appetite. The consumption of fructose also leads in reduced kidney function and increase in arteriolar thickening whereas equivalent amounts of glucose or starch do not induce these affects. Fructose is the only sugar that raises uric acid concentrations, a potential risk factor for inducing gout, a disease in which defective metabolism of uric acid causes arthritis. Obesity in Children
High-carbohydrate diets may also be one of the reasons of obesity. One of the common justifications for eating a low-carb diet is that the human body has a limited ability to store carbohydrate and any carbohydrate that our body can’t store gets turned directly to fat. Depending on the source, starch generally contains 20 – 25% amylose and 75 – 80% amylopectin, which are broken down by enzymes into monosaccharides during digestion. This is temporarily stored as glycogen in the liver and skeletal muscles, and subsequently converted into lipids to be stored in adipose tissue when consumed in excess. Obesity in Children
Lipids are vital for energy storage and biochemical functioning and act as structural components of cell membranes. Triglycerides are a major form of energy storage, located in the). Fat supplies more than twice the number of calories per gram in comparison to carbohydrates. Saturated fat is the type of fat primarily responsible for clogging our arteries and increasing cholesterol levels. Nowadays, food industries are using hydrogenated or trans-fat which is more appropriate for their food processing needs. Trans-fats are easy to use, inexpensive to produce and can be used many times in commercial fryers. They also give food a desirable and texture and are used in most of the fast foods and fried foods like French fries, doughnuts, cakes, pie crusts, biscuits, frozen pizza, cookies, crackers, and stick margarines. Artificial trans-fats (or transfatty acids) are created in an industrial process that adds hydrogen to liquid vegetable oils to make them more solid. However, these trans-fats are more dangerous and harmful for the heart and raise bad cholesterol (LDL) levels and lower the good cholesterol (HDL) levels. High-fat diets lead to changes in adipose tissue deposition and play a very important role as cause of obesity. Exercise and the consumption of higher amounts of unsaturated fats (mostly found in plants oils) are of importance in managing obesity. Obesity in Children
Food psychology: Food reward, habits and obesity
The interaction between mood, emotional state, and feeding behaviours is complex and it is hypothesised that individuals regulate their emotions and mood by changing both food choices and quantities. Reward and gratification associated with consumption of highly palatable food leads to certain chemicals called hormones activating reward and pleasure centres in the brain, suggesting a neuronal mechanism of food addiction leading to overeating and obesity.
Table 1: Smart Ways to Reduce Sugar and fat Consumption
| What to replace | By what | Chemical relevance |
| Sugary soft drinks and juice drinks |
Diluted fruit juice or sparkling water, whole fruit |
It will decrease the percentage of fructose, which serves as a fuel for the body and is processed almost entirely in the liver where it is converted to fat Fructose in whole fruit comes with fibre, which slows down and reduces the absorption of the sugar in the body Sparkling water will hydrate the body without any significant sugar content |
| Jam or honey on your toast |
Low-fat spread, sliced banana or low-fat cream cheese |
Both jam and honey is loaded with fructose and glucose |
| Processes foods | Natural foods or go for low-sugar version |
It will provide less sugar and transfat |
| Cereals loaded with sugar, salt and saturated fat |
Whole-grain breakfast cereals, but not coated with sugar or honey |
Whole grain breakfast cereals are less processed and contain more vitamins, minerals and phytochemicals. |
| Sugar in hot drinks, or in your breakfast cereal |
Gradually reduce the amount until you can cut it out altogether |
Skipping sugar in breakfast may cut down 6 spoons of sugar a day |
| Sugar-laden energy chews, gels and jelly beans |
Natural dates or dried fruit of choice |
Quick source of simple carbs and sugar |
| Sweet, candy bar with sugar |
Protein, a handful of pistachios with 1-ounce of dark chocolate |
Protein helps to increase ‘satiety’ or a feeling of fullness, so it can help reduce calories from mindless snacking |
| Whole milk | Semi-skimmed/ skimmed milk |
Low percentage of fat |
| Mayonnaise, cheese, sour cream and salad dressings |
Herbs, spices, vinegar and fresh lemon juice |
Low percentage of fat |
There are several neurotransmitter systems involved in feeding such as serotonin, dopamine, opioids, and gamma aminobutyric acid (GABA), of which serotonin and dopamine are the most closely linked to feeding behaviour. Dopamine mediates reward specifically the ‘wanting’ or approach behaviours toward a biologically relevant goal more so than ‘liking’ or enjoyment aspect. Obesity in Children
Lifestyle Obesity in Children
Children are fast adopting physically inactive lifestyles and consuming more ‘energy-dense, nutrient-poor’ diets due to modernisation, mechanical lifestyle, availability of processed and fast foods, and increasing dependence on television, computer and mobile phones for leisure. Despite increasing the cases of cerebrovascular disease (strokes), cancers, Type II diabetes, osteoarthritis, hypertension and high cholesterol, Indian children are not eating the recommended amount of fruits or vegetables as part of their daily diet. All these factors are having a serious impact on their wellbeing and quality of life. Obesity in Children
Conclusion Obesity in Children
Current literature suggests a high burden of generalised obesity among Indian children and adolescents, with a definite socio-economic difference. According to WHO, people from Asian populations may have vastly different levels of fatness and different fat distribution compared to Caucasian populations (‘white’ or ‘of European ancestry’) at a given BMI. Asian-Indian children are increasingly susceptible to unfavourable body composition, as well as regional adiposity. Obese Indian children have a high burden of subclinical inflammation (a characteristic of obesity), insulin resistance and metabolic syndrome at a younger age than their non-obese counterparts. Research studies indicate an increase in the proportion of Type-II diabetes with declining age in India. These factors indicate the direct link between childhood obesity and the diabetes epidemic in India. According to WHO, the proportion of Asian people with a high risk of Type-II diabetes and cardiovascular disease is substantial at BMIs lower than the existing WHO cut-off point for overweight (BMI great than 25). Obesity in Children
Hippocrates, father of modern medicine, said: ‘Let your food be your medicine, and your medicine be your food’. In the modern society, apart from heredity and demographic factors, the major causes of obesity are sedentary life style leading to reduced physical activity and surplus of hyper-palatable foods which activate dopamine rewarding centres leading to over-consumption. Besides mood changes, high-fat diets promote increased weight gain, visceral adipose tissue, larger waist circumference, and more cardiovascular disease mortality. These changes again lead to neurobiological impairment affecting mood disorders such as depression and anxiety and stress, which further induces overeating and obesity. However, a diet too high in refined carbohydrates and sugars and low in fat can be as unhealthy as a highfat diet because it also increases the risk of diabetes and cardiovascular diseases. Combined lifestyle interventions target physical activity as well as diet and include psychological techniques such as willpower, motivational interviewing and cognitive behavioural therapy. The influence of food choice includes biological determinants of hunger, appetite, taste, cost, income, and availability of food. A combination of balanced diet, regular exercise and stress management certainly help to lead a healthy life. Obesity in Children
Policies are equally important in management of obesity. Apart from malnutrition, Government should equally focus on obesity too. This may lead to stop future generation suffering from multiple complications in their adulthood. Schools may play critical role to control an epidemic of obesity by stopping sell of processed food and aerated drinks in school canteens and regular counselling. WHO has also developed the ‘Global Action Plan for the Prevention and Control of Non-communicable Diseases 2013-2020’, which includes halt in the rise of global obesity to match the rates of 2010. Obesity in Children
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