If had I mentioned that Indian children are becoming obese a decade ago, people would have laughed at me, commenting that India is one of the highest ranking countries in the world for the number of children suffering from malnutrition.
But today, obesity in children and adults
is a reality that is fuelling the diabetes epidemic. This poses a double jeopardy to the government and health experts - on the one hand, they have to tackle the malice of malnutrition and on the other, they have to fight obesity among children.
Tackling these two important problems requires serious and single-minded intent but radically different approaches, resources and efforts.
The prevalence of overweight in 14 to 17 years old schoolchildren has increased significantly from 10% in 2006-2007 to 12% in 2009, while those underweight decreased in Delhi. Affluence clearly impacts body weight.
The prevalence of obesity among school children attending private schools is almost double those studying in government schools. Similar figures have been reported from other cities in India.
The comparatively low cost of energy-dense foods, television advertisements targeting children and junk food and aerated drinks being sold in school cafeterias are the primary causes of childhood obesity.
Interestingly, fast food and cola companies are increasingly targeting children with lucrative offers; including gifts, waiters dressed as jokers, and play areas in restaurants. Moreover, these fast foods are just a click or a phone call away.
In a study carried among Delhi adolescents, approximately 1.8 cans of cola per week (540 ml/wk) per person consumption was recorded (1 can [300 ml] 132 kcal and 33-40g sugar), which would result in nearly 3 lb weight gain per child per year.
Paradoxically, many of these fast food and cola companies have launched health campaigns in schools under the garb of corporate social responsibility. This is clearly a matter of conflict of interests. Finally, television advertisements of fast foods target children in a most aggressive manner, bombarding them with lucrative audiovisuals.
Furthermore, children playing in parks has become a rare sight. TV, Internet, computer games and studies keep children confined indoors. This leads to too little physical activity and increased snacking. Parents too feel that it is safer for children to travel in a car than ride a cycle in an ill-planned city that has few parks and open spaces.
There are many parties to blame for this situation. The parents - overworked, busy and stressed out - often prefer that their children attend tuitions over playing. Many misconceptions about obesity are often passed on from one generation to another.
Our children are not obese but just healthy - is a common phrase that parents resort to when it is pointed that their children are overweight. What they do not realise is that if a child is obese, chances are that he/she is going to remain obese for a lifetime and will develop diabetes and heart disease in the early 30s.
The shared environment in many homes is of sedentariness, laziness, unhealthy foods and low priority for fitness.
The environment in many schools is no better, mostly conducive to the development of obesity - little activity in the playground, no weightage for physical activity period and little discussion on health and nutrition.
The school canteens are given to contractors who use cheap, partially hydrogenated, vegetable oils (containing high amounts of harmful trans fatty acids) for the preparation of greasy snacks that have a long shelf life.
The results are there for all to see - unfit and obese children soon become unfit and diabetic young adults who later on develop multiple problems of heart and lungs.
A strong political will is the need of hour is provide the necessary impetus to reduce obesity among children and such an endeavour must be a part of the National Diabetes and Cardiovascular Control Programme.
Periodic situational analysis and trends by the Indian Council of Medical Research and the ministry of health should be taken into account for policy changes. Administrative and legal actions should ensure that importance is given to the physical performance of children in their annual assessments.
There should also be a course on healthy nutrition and exercise in the school curriculum. It should be mandatory for the school canteens to keep healthy foods and ban colas within and outside school premises.
Television advertisements of colas and fast foods should be banned during prime time. Just like anti-tobacco warnings, television commercials of junk food and colas should also be accompanied with running warnings.
Celebrities should pay heed to their conscience and not endorse unhealthy products. They can rather disseminate tips on healthy nutrition and physical activity on the mass media without charging any fee.
Admittedly, for such a Herculean task multiple stakeholders are needed - medical and nutrition experts, non-governmental organisations, media and even the food industry. For eg, commercial fried snacks could be prepared in health-friendly oils, an initiative recently taken by some commercial nutrition companies.
Community leaders and resident welfare associations should make fighting child obesity a movement. MARG, a large-scale community intervention project, was launched with the help of the International Diabetes Federation and the World Diabetes Foundation. Similar programmes should be launched.
Ultimately, it is parents who must take the responsibility for child obesity. Parents, who are active, fit, non-obese, exercise regularly and follow healthy diets, can steer their children onto the highway of optimal health.
The responsibility of training parents and children with appropriate knowledge and providing facilities, including sports fields, cycle tracks, parks and open spaces should be undertaken by both public and private institutions. These cost-effective measures can go a long way in curtailing the epidemic of diabetes and heart disease in India.
Anoop Misra is chairman, Fortis-C-DOC Centre of Excellence for Diabetes, Metabolic Diseases and Endocrinology
The views expressed by the author are personal
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