A threat rising with COVID pandemic

There used to be a time that malnutrition was the bigger threat when talking about the nutritional status of Sri Lankan children. But the emerging unhealthy food habits coupled with the sedentary lifestyle has caused a significant rise in childhood obesity in Sri Lanka in the recent past. Obesity has many long and short term consequences to health; both physical as well as psychological. Furthermore, shedding light to this topic is even more important as the majority of childhood obesity is easily reversible with the right lifestyle changes. Today, Dr.Maheshaka Wijayawardena, Consultant Paediatrician, Base Hospital Wathupitiwala, will answer some pressing questions about childhood obesity.

Obesity is caused by an imbalance between energy intake and expenditure. The global incidence of childhood obesity is estimated to be around 7.8% in male children and 5.6% in female children. While we don’t have exact figures, a recent study done in obesity in Sri Lankan urban school children revealed a 10.3% prevalence of obesity.

Obesity 
Obesity is defined as a Body Mass Index (BMI) at or above the 95th percentile for children and teens of the same age and sex. Children within 85th to 95th centile are considered overweight while children abouve 99th centile are called severly obese. BMI is calculated by dividing a person’s weight in kilograms by the square of height in meters. This value can be charted in the relevant BMI chart.

Causes 
Obesity is a result of the contribution of many factors. Unhealthy food habits including frequent fast and processed food, sedentary lifestyle with a lack of exercise and rarely, certain medical conditions like thyroid disorders, eating disorders and certain syndromes can cause obesity.

“We have observed a marked rise in children coming with obesity to our clinics as well as the ward, in the past year or so,” states Dr. Wijayawardena, noting that the trend might be caused by the sedentary lifestyle associated with the movement restrictions imposed by the COVID pandemic. Staying indoors and less physical activities can cause rapid weight gain in children. In addition, binge eating behaviours associated with stressful situations can also cause obesity.

Risks 
Obesity can cause short and long term health risks. 

Conditions that can affect the heart like hypertension, increase in ‘bad’ cholesterol levels in blood and thinning of blood vessels and reduced heart muscle function can occur with time in children who are obese.

When it comes to the endocrine system, Metabolic syndrome is frequently seen in children who are suffering from obesity. Early Type 2 Diabetes, associated with impaired insulin function in the body, more commonly seen in adults is now frequently found in obese children and teenagers. Obesity also causes a risk of precautious puberty, meaning the physical changes associated with puberty can present much earlier in life in obese children. In addition, increased risk of polycystic ovarian syndrome in girls, associated with many gynaecological problems later in life, is more common in obese children.

Gastrointestinal problems such as gallstones and fatty liver can occur earlier in life in an obese child. They have found to be at risk of impaired kidney function as well.

They also can suffer from joint pains and musculo-skeletal discomfort associated with increased body weight, as well as hip problems.

Skin discoloration, in a condition caused acanthosis nigricans and frequent fungal infections can occur.
Obesity is associated with psychological impacts to the child as well. Low self esteem, depression and anxiety are found more commonly in children suffering from obesity.

   Childhood obesity is a major risk factor for adult obesity, which is again associated with a multitude of problems including heart disease and cancer

Investigating 
When investigating an obese child, investigations like fasting blood sugar, Lipid profile, Liver Function tests and full blood counts are done to identify other co-morbidities associated with obesity. An ultra sound scan of the liver is usually recommended to exclude non-alcoholic fatty liver disease. As hypothyroidism is a cause of obesity, thyroid function tests are also done.

Management 
Managing childhood obesity is easier when compared to adult obesity, because, only a relatively low weight drop is adequate. As their bodies are still growing, just 500g-1kg body weight drop per month will usually help children catch up with the height increase, bringing them back to average BMI range.

    This drop in weight is done through healthy diet and regular exercises. Reduction of starchy, fatty and sweet food, while increasing the intake of natural fruits, vegetables and proteins is recommended. Staple food like rice, rotti, pittu etc. can also contribute to obesity when consumed in excessive amounts. 

   Television and internet are major contributory factors to a sedentary life in the modern world. Limiting the daily screen time to around  30 minutes in children, instead encouraging them to play outdoors would help promote physical health of the children. Aerobic exercises like walking cycling and swimming aids in improving physical health.

In morbidly obese children, weight loss could be achieved through surgical methods, following the recommendation of specialists.