India will have more than 27 million obese children by 2030. Can we combat this?

In fact, she weighed normal in her childhood. But then came the school years, the peer pressure, the rebellious distaste for comfort food, the junk food binges at meetings and ordering. In a nuclear family, where working parents are torn between home and office responsibilities, the food app waved a magic wand. So much so that Rohini, who mostly had food apps on her cell phone for emergencies, ordered different kinds of food every day, a habit that soon turned into an addiction. However, nothing seemed to satisfy her. Never too outdoorsy, she didn’t like it much physical activity either.

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Dr. Ganesh Jevalikar, a children’s endocrinologist at Max Healthcare, who has been monitoring her unusual obesity, says: “Bariatric surgery, which involves shrinking the stomach to kill hunger and increase satiety, is not an acceptable solution and we had to wait until he had gained puberty. You can’t drastically cut calories in preteens when growth hormones kick in. He had a dangerously high BMI (body mass index) of 47, normal was 25. His diabetes and his levels cholesterol levels worried us. She admitted that gorging on food was a stress reliever. In urban India, the onset of type 2 diabetes in adults is becoming common. We are seeing an increase in bone problems and PCOD in girls.” There has been a gradual increase in hyperactivity and neurological conditions, all the result of overeating, she adds.

Childhood obesity, particularly in a sedentary world legitimized by the pandemic and a life of desire that thrives on food delivery, is an emerging epidemic in India. According to UNICEF’s World Obesity Atlas by 2022, India is projected to have more than 27 million obese children, representing one in 10 children worldwide, by 2030. Dr. Anuja Agarwala, Former Senior Dietitian, Department of Paediatrics, All India Institute of Medical Sciences (AIIMS), says: “The National Family Health Survey (2019-21) found that 3.4 per cent of children under the age of five are now overweight compared to 2 .1 percent in 2015-16. And if you compare another 2012 study of private schoolchildren aged 14 to 16 from private schools (in urban upper-middle-class settings) with the present one, the obesity rate has risen sharply from 25 percent and is hovering almost around of 30 percent. An obese child becomes a obese adult and obese adults constitute a sick generation.”

The burden of disease is evident in the number of adolescent patients that Dr. Priyanka Rohatgi, chief nutritionist at Apollo Hospitals, receives every day despite their educated backgrounds. “Ritika* is 18 years old and her mother is a doctor. Due to her erratic schedule, her mother loaded her payment wallet and Ritika ordered online. she developed Irritable bowel syndrome, which affected their intestinal health. At 5 feet 6 inches, she weighed close to 200 pounds. She hardly slept more than five hours and this distorted her metabolism. If, in our time, you could see one or two big kids in a class, now a skinny one is an exception.”

As a nutritionist, Rohatgi has dissected how food aggregators are a temptation, particularly for teens and tweens. “First, they lead to portion distortion. The pop-ups always show an extra Coca-Cola, sundaes or chocolate cakes, for something between Rs 30 and Rs 50, along with the pizza ordered. Seemingly pocket friendly, these offerings also fill the snack plate with what they may want but don’t need. The biggest misnomer is the category called ‘health food’ which seems to be disease friendly and has solutions for all kinds of food allergies. But have the hygiene levels in cloud kitchens ever been tested or the fact that the same oil is used multiple times for cooking, which increases free radicals, the main cause of most diseases, including obesity, heart disease and diabetes? And they all have the same three triggers: refined carbohydrates, high fat, and excess salt.” In the past, kids didn’t have as many processed foods or options to buy a meal, so they didn’t carry the calorie load they do today, even when their metabolism has stayed the same.

My healthy dish of the day.

While compiling her study at AIIMS, Agarwala tracked our popcorn-eating habits, with that being the easy snack for all age groups. Whereas 20 years ago (one family) had five cups adding up to 270 calories (in one sitting), our mindless addiction has meant that today we have 11 cups or 630 calories.

Of course, it’s easy enough to blame a generation’s consumer choices for food dependencies, but convenience as a virtue cannot be totally denied. Nor can it be denied that habits, good or bad, are generated when the child is in his formative years. As Agarwala says, “The biggest mistake a mother makes is to distort the baby’s appetite by supplementing breast milk with complementary foods. Her breast milk is all the child needs. I’ve had mothers who want their babies to gain weight simply because they don’t look chubby enough. Most Indians think that not looking chubby means the baby is weak.” Another myth is that baby fat disappears once the child grows older. But the evidence shows that many preschool or elementary school children who are obese or over weightThey still are, as they enter adolescence. Most of them fail to outgrow this problem as they grow older.

He also says that if children were exposed to the flavors of all fruits and vegetables, without salt, of course, in the first and second years of their lives, they would never be picky eaters. “A mother once asked me if she could feed her eight-month-old son cola simply because she refused to eat but she seemed to like the taste of cola. Children pick up their flavor profiles very quickly and even if you’re Cooking at home, you must be aware of the food you give them. Complex flavors mean evolved preferences.”

Jevalikar highlights the need to program the taste buds of the child during the first three years of his life. “Make that meal that everyone in the family must have, no excuses allowed. Make eating a participatory family ritual rather than an individual indulgence. And maybe it’s a good idea to relive the tiffin concept,” he says. Rohatgi was surprised that despite “make your own food” sessions in schools, 18-year-old Ritika did not know how to make buttermilk at home. In her place, she would opt for tetrapack juices and healthy drinks, full of preservatives.

Indian babies are born with more fat than muscle even if we look thin and skinny compared to their western counterparts. That’s because Asian genetics are different. Also, your BMI does not take into account the amount of fat in your body. So for Indians, it’s the waist-to-hip ratio that’s important, which is why we have one of the highest burdens of non-communicable diseases in the world. So what can be done to reverse childhood obesity that is practical and implementable, bearing in mind that an acquired habit may not be easily eliminated until the alternative seems equally attractive? Agarwala suggests a family counseling approach. “Most children with obesity also have parents with extremely sedentary lives and dietary preferences. Therefore, they need to change and support their children’s weight loss process.”

For starters, Agarwala has revisited the food pyramid with the healthy eating plate. “Imagine your plate is a pie chart. We need half to be full of fruits and vegetables, basically plant foods. A quarter should be protein and the remaining quarter should be carbohydrates. Usually, we tend to reserve the largest portion for rice and wheat, thinking that the meal would have no satiety value. It is the same reason why, despite having a two-egg omelet (good protein with a high satiety value), people always accompany it with bread. Millet, whole grains, legumes, and legumes include as many complex carbohydrates as possible, as they are slow to break down. Hydration is also very important. Ditch the flavored or sparkling water and opt for boiled water instead. Even reverse osmosis removes most of the healthy minerals from the water.” As a dietitian, she also feels the need to reorient us toward quick and easy home-cooked meals that don’t take too much of a working mom’s time.

Agarwala suggests that parents ensure behavior modification through simple tricks and treats. “Limit portion sizes so kids have some room in their bellies and don’t feel heavy. Monitor mindless eating while they’re connected to their devices and invite them to take a break. Treats are not meant to be rewards, change the reward to maybe a short walk together or some fun outdoor activity.”

Rohatgi advocates smart substitutes that don’t compromise a child’s nutritional requirements. They both have ideas on how consumers and food apps can make this work. Agarwala thinks apps should display a total calorie count of the ordered meal as a pop-up so you know what kind of exercise is needed to burn it off. Rohatgi calls for a new food aggregation business based on dabba nutritional services. “In Bangalore, a food aggregator is connecting mothers to help their children eat better,” she adds. Or, just put in a chart that Agarwala compiled in AIIMS called “Easy to eat but hard to burn.” A piece of cake (250 calories) requires lawn tennis (singles) for two hours. Similarly, 40 g of chocolates (220 calories) would require jogging for an hour at 6 km per hour. Vegetable pakoras (200 calories) can be neutralized by aerobic dancing for an hour! Do we need more incentives to kick the habit?

*Names have been changed to protect identity