Obesity In Children
This happened 2 years back. Ashiq came to us with his parents as a chubby child, 12 years old. His mother had diabetes and was my patient. He received a blood test and physical examination. His parents were quite surprised when I told them that Ashiq has high blood pressure and high cholesterol.
We educated his parents on need to change his dietary habits and need for regular exercise. Last week Ashiq was back again. He had increased thirst and was passing excessive urine. His blood tests showed blood sugars more than 300 mg/dl. He had developed diabetes. Ashiq is one among the many adolescents in the clinic who has diabetes. And it is not unusual for us to see an adolescent with diabetes once every 2 weeks.
Kerala is fast developing as one of the states with the highest prevalence of obesity among children and adolescents. Studies show that one among four kids in the affluent schools in Kerala is overweight. Obese children are at risk of diabetes, high blood pressure, high cholesterol, sleep apnoea and musculoskeletal problems.
Although most parents feel that food consumption among these children is not anything different, a careful dietary recall by a trained dietician will highlight the excess calories consumed by these children. Portion sizes have now increased and higher portions are offered with minimal increments in price. Add-ons like toppings, extra cheese and creams will lead to increased calorie intake.
Traditional whole grain food has been replaced with refined food and this adds to calories without fibres and vitamins.
Physical exercise among children has reduced significantly. Tuitions have replaced the free time spend by kids. Physical activity classes in schools are replaced by extra classes. Most children end up spending time in front of computers, video games and television (media time) after they are back from school.
lthough most parents bring children to endocrinologists with a belief that there is something inherently wrong in their hormones, more than 95 % of the obesity is due to lifestyle factors. Rare problems of hormones like thyroid and adrenal disorders and genetic syndromes like LMB syndrome and Prader-Willi syndrome can also present as obesity.
The role of the endocrinologist is to confirm that the child is obese, does not have any hormonal/genetic diseases, exclude obesity related problems like diabetes, cholesterol and high blood pressure and to advise treatment. Treatment is mainly aimed at good dietary habits, regular exercise and behavioural modification.
Patients are called back to discuss problems and suggest solutions for following behavioural modifications. The aim in children less than 7 years is to maintain weight. Older children are advised weight loss especially if they have any obesity related complications. Behavioural modification includes changes in eating habits, healthy choice of food, restricting media time daily to less than 2 hour, choosing active games over sedentary games. Medical treatment like Orlistat can be used in children above 12 years.Adolescents who worsen despite conservative measures may be advised bariatric procedures.
And for Ashiq, he has lost weight, has improved his diet habits, does regular exercise with his parents and maintains normal blood sugars.
Dr. Mathew John