Childhood Obesity: Emerging epidemic in Kashmir

Dr. S. Muhammad Salim Khan

The economic transition and enhanced buying capacity of middle class Kashmiri society is leading to a major nutritional crisis of malnutrition, not under-nutrition as it used to be a century back but over-nutrition. The reasons are multifold but the major factors are excessive intake of food with almost no physical activity and binging on junk-foods.

With the rapid globalization and industrialization, we are experiencing a significant economic, environmental, lifestyle, socio-cultural and demographic transition. Coupled by urbanization and the penetration of market giants into every household through influencing electronic media, it has been said that current changes in eating pattern and physical activity are the most rapid and dramatic in course of human history. Overall economic growth and development are known to influence health status of the individuals, families and the community at large. This phenomenon has started affecting life style of the individuals and the population at large and our children in particular by increasing the burden of non communicable diseases like- Cardio-Vascular Diseases, Type-2 Diabetes Mellitus, hypertension and obesity.

Among the major contributor of childhood obesity is our changing dietary behaviour. There are three important components of food behavior related to obesity, (a) what is eaten and why; (b) how much is eaten and (c) where is eaten.

Food Habits: Nowadays, it appears that majority of the food are home cooked although there is increase in the processed food contribution and modulated by parenting, which is related to factors like exposure and accessibility, modeling of eating behavior, providing food that leads to positive and negative psychological consequences and feeding practices utilized. Food behavior of children, even in under-five years most closely resembles that of their parents than anyone else, including sibs. The most familiar and preferred foods in childhood tend to combine two principal ingredients; sugar and fat. Restricting children’s access to certain foods encourage intake of the restricted foods when they became available, even in the absence of hunger.

Data suggest that consumption of fried food items, more than six times a week was associated with significantly higher odds of being overweight compared to those who consumed less than 2.5 times/week. Lack of time with working parents in current society encourages use of convenient and ready to eat foods. Snacking may contribute significantly to positive energy balance, and self-reported information may be misleading. Foods eaten away from home, an increasing trend observed in most developed societies, are usually calorie dense and larger in portion size. Availability of precooked and ready to eat items itself drives passive over consumption.

According to the NSSO, the trend of Indian dietary intake in the past three decades suggest that there is no increase in individual per capita daily caloric intake. In fact per capita daily caloric intake has decreased by 200 calories in rural areas and by 75 calories in urban areas over this period. However, over the past two decades (between 1983 and 2004-2005) per capita daily fat consumption has increased by 10 grams (25 grams to 35 grams) in rural areas and by 15 grams (35 grams to 50 grams) in urban areas. More specifically, per capita consumption of edible oil has increased by 30% in rural India and about 18% in urban India over 10 years (1993-94 to 2004-05). Market research project that, by 2015 the share of cereal consumption will reduce from 29% to 18% and that of processed foods and drinks will increase from 11% to 23%.

In our Kashmiri society, food is an integral part of family and social life, and is deeply embedded in the culture. Most global as well as local fast food chains have started customizing and changing our menu, composition and preparation.

Physical Activity Behavior: In a recent study among adolescents (12-17 years) from Hyderabad found that prevalence of overweight and obesity was significantly higher (10.4%) among those who watched TV for more than 3 hours/day, and lower among those engaged in outdoor play more than 6hrs/week (3.1%) and household activities more than 3 hrs/day (4.7%). In another study among apparently healthy children of age group 6-16 years, 6.4% of the children were overweight. The children who slept less than 8.5 hours a day were more overweight compared to the children sleeping more than 9.5 hours a day. The duration of sleep and TV viewing were significantly associated with the BMI of children.

Physical activity in children is a complex behavior determined by family, personal, school, socio-cultural and physical environmental influences. Similar to food behavior, parents appear to be primary influence on the physical activity behavior of their children.

What to do: Involving parents along with obese children in physical activity intervention program resulted in greater weight reduction and maintenance over longer duration compared to the child-only strategy. These observations indicate that effectiveness as well as long term sustainability of weight loss is likely to be more when the interventions are family-based.

With increasing academic competition, lack of adequate neighborhood facility, lack of family and social support for recreational physical activities and concern for safety and pollution, children are progressively confined to home. Sedentary behavior compounds the problem by encouraging in between snacking and passive consumption of energy-dense foods.

Its suggested that we take a holistic care of our children with regard to their food habits, physical activities and recreation at an earliest else they are liable to fell to the global influence of energy-dense fast-food, ready to eat foods that predispose them to various life-style diseases like obesity, diabetes, hypertension at a younger age.

(The author is a preventive medicine consultant.)


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