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Obesity in children, time to stop turning blind eye
In the era of social media, many videos of chubby and often obese children are posted and seen as cute, healthy and perfectly normal
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span>In the era of social media, many videos of chubby and often obese children are posted and seen as cute, healthy and perfectly normal. This mindset will lead to catastrophic health outcomes in the next 10 to 20 years.
Obesity and noncommunicable diseases (NCDs) in youth are growing concerns worldwide. According to the World Health Organization, half of overweight children under 5 years of age live in Asia. A large portion of these NCDs stems from poor eating habits and a sedentary lifestyle from early life. The Basic Health Survey (Riskesdas) in 2018 reported that 8 percent of children under 5 are overweight or obese. Although many view obesity and NCDs as diseases of “rich people”, data prove otherwise: Riskesdas 2018 shows the highest rate of overweight and obese children under 5 occur in Papua, one of the poorest provinces. Hence, obesity affects all layers of society.
The issue of pediatric obesity is not well highlighted as the country still suffers from high rates of undernutrition; as often cited, Indonesia faces the double burden of malnutrition. Our health policies do not yet focus on pediatric NCDs, reflected by a lack of obesity prevention and treatment in national health and school programs, as we are still preoccupied with decreasing stunting numbers. So how big of a problem is pediatric obesity?
Obesity is defined as excessive fat accumulation in the body. The simplest and most common way to determine if one is obese is through the body mass index (BMI). This parameter only requires height and weight measurements. For children, the BMI is plotted in reference charts, the Center for Disease Control and Prevention (CDC) 2000 or WHO 2006 curves.
Many factors contribute to early life obesity, including maternal smoking, birth weight, obesity in parents, screen time, early BMI and weight gain, and short sleep duration. Many researchers report the adverse effects of childhood obesity, such as hypertension, insulin resistance, increased blood cholesterol levels, cardiovascular diseases, sleep apnea and orthopedic problems. Pediatrician Aman Bhakti Pulungan of the University of Indonesia and Cipto Mangunkusumo General Hospital found that 38 percent of obese adolescents in Central Jakarta showed signs of insulin resistance, which can lead to type 2 diabetes melitius (DM) and other metabolic syndromes.
Cases of type 2 DM and metabolic syndromes in children are emerging throughout Indonesia, although the real number is unknown because many patients are not registered and undiagnosed.
Another major concern relating to obesity is mental health, as obese children and adolescents tend to have more psychosocial problems compared to lean peers. Negative stereotypes, low self-esteem and a negative body image may affect daily life, including academic performance. Graver psychiatric complications may include depression, anxiety and eating disorders.
The approach to obesity in children differs from adults. First, parents should be aware that obesity is a disease and treatment should not be delayed. A cohort study in the United States found most children with severe obesity in kindergarten or early elementary school continued being obese throughout adolescence. In contrast with adults, calorie count should not be decreased in obese children. As children are still growing and developing, balanced and healthy nutrition should be given according to height or age calorie requirements.
The Indonesian Pediatric Society recommends applying food rules to manage nutrition intake in obese children. Mealtimes should be scheduled: three main meals and two snacks in between — each meal not more than 30 minutes. Only water is allowed if they feel hungry outside mealtime. Parents should ensure that eating is enjoyable, without pressuring the child.
Children over 2 years old should engage in at least 60 minutes of physical activity daily, with bone and muscle strengthening activities at least three times a week. Physical activity is preferably adjusted to the child’s age and interest; for example, children aged more than 10 years are usually interested in group activities. Simple day-to-day habits such as walking or cycling to school can also bring benefits. Screen time must be limited to less than two hours per day because children already spend most of their times sitting at school.
Fighting obesity is a joint effort involving parents, the community, medical workers, stakeholders and policy-makers. Encouraging exclusive breastfeeding is an excellent way to prevent obesity from infancy. Steps must be taken as early as preschool by screening obesity, as well as increasing physical activity and healthy eating in the school curriculum. The government should start limiting access to unhealthy food and sedentary lifestyle; simple examples are by labeling menus in restaurants and tightening laws for fast food advertisements.
Infrastructure should be improved to promote an active lifestyle, such as pedestrian-friendly streets, parks, accessible mass transportation and bicycle routes — a sight hard to find in most of today’s Indonesian urban cities.
If not taken into account, health consequences caused by obesity will further aggravate already soaring health costs. In dealing with NCDs, prevention is key. The government and society must stop turning a blind eye, acknowledge that obesity is an emerging problem and commit to tackling this disease together.
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The writer is a general practitioner, a graduate of the School of Medicine at the University of Indonesia, currently practicing in East Jakarta with experience in South Kalimantan. She is a research assistant of Dr. dr. Aman Bhakti Pulungan, Sp.A(K), FAAP, FRCPI(Hon.) at the Child Health Department, Cipto Mangunkusumo General Hospital, Central Jakarta.
