January 29, 2013 00:00 By Pavintra Harinsoot Somnuke, MD
The West doesn't have a monopoly on obese children, as some parents in Thailand are learning first-hand
When media coverage focuses on the epidemic of childhood obesity, it tends to highlight how serious the problem has become in the western world, especially in the US. And, as statistics have clearly shown, there are good reasons for this genuine alarm.
In the US, the prevalence of obesity in children between the ages of 6 and 11 has nearly tripled in just the past 30 years, going from 7 per cent in 1980 to 20 per cent in 2008. During that same period, the obesity rate for youngsters aged 12 to 19 years rose from 5 per cent up to 18 per cent.
Obesity isn’t easy for kids to “outgrow”. Studies show that, among adults who had been obese during pre-school age, one in three will still be obese into adulthood. Nearly half of obese school-age children will be obese adults.
Children born to overweight or obese parents stand a much higher chance of having weight problems during childhood compared to kids born to normal-weight parents.
At any age, being overweight can lead to a risk factor for health problems and diseases - cardiovascular disease, high cholesterol, high blood pressure, joint and bone problems, sleep apnea, low self-esteem, depression and insulin resistance, a pre-cursor to diabetes, fertility problems, strokes, osteoarthritis and various types of cancer.
While the problem in western countries has been building for decades, Thailand’s childhood obesity problem is a more recent phenomenon. Statistics from Thailand’s Ministry of Public Health reveal significant increases in the rate of obesity among children.
In the past five years, the percentage of obese pre-schoolers rose from 5.8 per cent to 7.9 per cent; in school-age children, the obesity rate went from 5.8 per cent up to 6.7 per cent over the same period. These statistics represent five-year obesity growth rates of 36 per cent (pre-school age) and 15 per cent (school age).
Among Thailand’s young adults (those in the 20 to 29 age range), the obesity rate over the same five-year period increased 36 per cent among men, and for women the obesity rate grew 47 per cent.
Parents can be somewhat oblivious to the situation, as many don’t realise their child is obese. While the Body Mass Index (BMI) is well-recognised as a measuring tool for adults, it wasn’t specifically designed for children.
The causes of increasing childhood obesity are fairly simple and visible. Today’s younger generation takes in too many calories, favours “junk food” that has little nutritional value, consumes soft drinks and beverages packed with sugar and calories, and spends too much time on sedentary activities like watching TV and playing computer games rather than part taking in outdoor physical activities, sports or exercise.
The hectic pace of modern-day life, combined with the growing trends of both parents working outside the home and the affordability of fast food, are at the root of the obesity problem. Kids are increasingly making their own food choices, and it’s no surprise they tend to choose junk food, highly-processed foods, sugary sodas and salty snacks that contain lots of calories but little nutritional value. They’re taking in energy-dense foods high in fat, salt and sugar, but low in vitamins, minerals and other nutrients.
Nearly every Thai town has a shopping mall and several fast food outlets within a child’s easy reach. Every house
hold has a television, and kids can play computer games at home or at a nearly internet cafe.
In the most simple terms, obesity is being fuelled by an energy imbalance, wherein the number of calories consumed is greater than calories burned off.
Obesity is not just a dietary problem; it’s a lifestyle problem. While schools usually make an effort to guide students toward healthier choices, the solution must originate from home. Ideally, parents and teachers should work together to coordinate effective, enduring solutions.
One of the most effective tools against obesity is family meals. One or two generations ago, most families ate breakfast and dinner together at home. That was a different era, and it will take some effort to make the necessary adjustments to work schedules and life patterns. But parents need to take responsibility for their child’s weight, and that requires
that they supervise what their children are eating.
More specifically, parents need to monitor and limit their child’s intake of saturated fat, sugar and salt while increasing the amount of fruit, vegetables and whole grains.
You don’t need to be a dietician to make intelligent nutrition choices. Opt for fresh, instead of processed, foods; serve water or fresh fruit juice rather than sodas and sugary drinks. And eating at home beats eating out.
And prepare healthy snacks such as fruit and vegetables that kids can take with them, so they won’t be forced to choose their own snacks.
Food is only half the problem; parents and teachers should encourage kids to be more physically active in order to burn off the energy (calories) they’re consuming. Games and sports are excellent, but even simply having time to play outdoors, instead of being home in front of a screen, will make a significant difference.
Increase physical activity gradually by slowly extending activity duration and intensity, with the goal of a child getting a full hour of activity every single day, preferably spread out over the course of each day.
I recommend parents establish a limit of seven hours each week for TV watching or computer usage. This is important not only for the sake of the child’s healthy physical development but for his or her intellectual development as well.
It’s never easy establishing limits where children are concerned.
Gentle encouragement is usually the best approach, and parents should avoid criticising their child for being overweight, as their self-esteem is likely to already be somewhat fragile. Consider the changes to be part of a medium- to long-term project, and ease the child gradually into the new routine.
Above all, make sure your children know that you love them and have their best interests at heart. It’s important that they know that you are doing this not as a means of punishment, but because you want them to grow up to be happy, healthy adults.
Dr Pavintra Harinsoot Somnuke is a specialist in paediatric endocrinology at Bumrungrad Hospital, Bangkok.