Weight warning

Childhood obesity cause for concern in the UAE

Obesity is a world-wide epidemic. The effects of excess weight on mortality has been known for more than 2,000 years. Hippocrates recognised that sudden death is more common in those who are naturally fat than in the lean. According to Dr Humaira Nasser MD, specialist, Endocrinology, Metabolism & Nutrition, Welcare Hospital, "There has been a steady increase in the percentage of people who are overweight worldwide."

According to a recent survey, approximately 40-45 per cent of the UAE population is overweight. This epidemic is mostly related to environmental and societal factors, a mismatch between the food people eat and what they need to eat. In some ethnic groups almost everyone is obese, so the role of genes cannot be ignored.

One of the more significant concerns today is the growing health problems existing in children owing to obesity. A large number of seriously overweight children are in danger of picking up life-threatening health problems like high blood pressure, premature heart attacks and diabetes. This apart, overweight children face peer stress and ridicule, physical risks and labelling. All these lead to diverse emotional complications and children develop a lower self-esteem or confidence level.

The cause of childhood obesity is primarily due to a decrease in physical activity further intensified by modern means of transportation, television, computers and video games. With the increasing availability of high calorie food, children have adopted an unhealthy pattern of lifestyle.

Highlighting the problem of childhood obesity, Dr Humaira Nasser says: "It is commonly assumed that heavy children are lazy or lethargic, but this is because their size limits their capabilities. Excess weight in children can result in reduced endurance, leg pain from stressed joints and often make even simple activities more taxing. Reduction in movement capabilities and exercise activities, combined with the potential for reduced self-esteem, increases the probability of continued weight gain.

Individuals can become overweight at any age, but this is more common at certain times. Sometimes, calorie intake by mothers may influence the body size, shape and later the body composition of a child. Dr Nasser says: "Birth weight does not predict future obesity. In the first years of life the corelation between body weight among identical twins begins to converge.

Infants born to diabetic mothers have a high risk of being overweight as children and adults. Infants who are small, short or have a small head circumferance are at higher risk of developing abdominal fatness and other co-morbidities associated with obesity later in life.

Childhood obesity can also begin with infant feeding practices, where infants fed artificial formula tend to gain more weight than do breast-fed infants.

Facts about childhood obesity:

* An increase in body fat in the first year of life is an important predictor of obesity in infants and young children with parents who are overweight.
* Childhood obesity between three and 10 years of age can develop into obesity in adulthood.
* Parental overweight plays a strong role in this age group where according to Dr Nasser "nearly 75 per cent of overweight children, aged 3-10 years, remained overweight in early adulthood if they had one or more overweight parents, compared with 25-50 per cent if neither parents were overweight.

Problems: Overweight children are at a risk of developing medical, social and psychological disabilities. The spectrum includes the range of medical and behavioural problems. A comprehensive approach to arrest this growing problem is to balance exercise, nutrition and behaviour modification.

Careful individual dietary monitoring by a health specialist and an exercise programme that is safe and effective for overweight individuals can be incorporated in the child's lifestyle to overcome the problem of obesity gradually. Further, behaviour counselling and parental participation focussing on preventive measures can ensure long-term success.

Therapies: Behavioural modification and behaviour therapy has become standard in most treatment programmes. Explains Dr Nasser: "The goal of this therapeutic strategy is to help patients modify their eating habits, to increase their physical activity and to remain more conscious of both these activities in their lifestyle. Behavioural strategies to treat obesity include self-monitoring of the food intake, reducing environmental cues for eating, slowing the pace of eating and increasing activity in the place of eating.

Using behavioural therapy on children and on one or both parents, compared with a child alone or a limited treatment control group, showed dramatic results.

Children treated with their parents maintained less excessive weight for the next 10 years. This technique is especially desirable for children aged three to 10 years with one overweight parent. Weight changes of more than five to 10 per cent are considered successful.

Weight control: To maintain weight or prevent further weight gain, a low fat diet should be habituated. Again, a very low energy diet with less than 800 kilo calories a day is an undesirable treatment for obesity. The long-term success of such a diet is not only unhealthy for the body but can also be low because people often stop following the diet and may become non-compliant.

Physical activity: Exercise or physical activity as treatment for obesity is extremely vital. A gradual increase in physical activity is beneficial for all ages and all groups. Drug treatment or surgical treatment is not a desirable option for treatment of childhood obesity.

Role of Parents: Says Dr Nasser: "It is important for parents to understand what their role should be in preventing obesity and later on when the child develops obesity to see what measures need to be taken."

What parents need to know:

* Children should visit the paediatrician regularly to dispense any problem. Conduct specific laboratory evaluation to rule out any medical disorder.
* Children should be involved in regular physical activities, and if required parents must accompany them.
* Parents also need to follow the dietary guidelines set by the doctor for children.
* Do not blame the child for his/her obesity, especially in the presence of others.
* Buy healthy snacks.
* Obese children need continued support from their parents and family to help them succeed.