Obesity: When is a child in the danger zone?

At 14, Sam Muganzi weighs 55 kilogrammes and struggles to carry himself around. Because his weight contrasts his age, the Senior Two student says he gets bullied a lot by his classmates. “My classmates tease me a lot, calling me names such as big masavu,” says Muganzi amid sobs.

His mother Alice Mirembe, says Muganzi started showing signs of being overweight when he was nine. “From that point, he has had trouble with his schoolmates. He is stigmatised because children make fun of his weight. We have to counsel him every morning before he goes to school,” she says.

Muganzi’s mother says she sought medical help for her son’s condition, and the doctor aised him to eat less beef and instead consume more leafy vegetables. He was also aised to engage in regular exercise, both at home and school.

Although following this routine programme has not helped Muganzi to loose the extra weight, his mother says she is optimistic that one day, her son will regain the normal weight he previously had.

She says so far, Muganzi has not been diagnosed with any of the health conditions such as diabetes and high blood pressure, which are commonly associated with obesity.

What is childhood obesity?
Dr Gerald Mutungi, the commissioner in charge of non-communicable diseases (NCDs) at the Ministry of Health, says childhood obesity is a condition in which there is abnormal or excessive fat accumulation in the body that may impair health.

A body mass index (BMI) is considered the ideal measurement used to establish if a person is underweight, normal, overweight or obese. MBI is calculated by dividing a person’s weight in kilogrammes against their height in metres.

For children, depending on different ages, a BMI of 18 to 24 is an indication that a child’s weight is normal, while 25 to 30 means a child is overweight, a situation that may increase the risk of other health conditions.

Dr Mutungi says although the number of overweight or obese children and adults in Uganda is not known, it is increasingly becoming a health threat, especially in urban settings, because of lifestyle changes.
“While the Health ministry is still battling malnutrition, especially in rural areas, we now have to start looking at emerging conditions such as obesity,” says Dr Mutungi.

“Many children in urban areas are being fed on junk foods such as soda, chips and chicken, which contain a lot of sugars, salts and fats. On top of that, these children do not engage in adequate physical activities. This is a huge contributing factor to obesity,” he says.

The problem, Dr Mutungi says is exacerbated by schools that do not have play grounds or physical education programmes.

“As a ministry, we know that obesity is becoming a problem in children and therefore the first step is to sensitise the public, but also come up with a programme that would ensure physical exercises are made compulsory in schools,” Dr Mutungi explains.

He says such a programme would restrict the Ministry of Education from licensing schools that do not have playgrounds and other platforms that keep children physically active and fit.

Gloria Nabaasa, a nutritionist at Mulago National Referral Hospital, says predisposing factors such as genetics can also lead to obesity. “When a family has a history of obesity or being overweight, it is likely that the children may suffer from the same condition,” notes Nabaasa.

Inactive leisure activities, such as watching television or playing video games also contribute to the problem

“Children who are obese can return to normal weight once they adjust their lifestyle and daily diet. This means reducing consumption of carbohydrate-rich foods and those that have a lot of fat and sugars.” says Nabaasa.

Jamiru Mpiima, a nutritionist with Centre for Nutrition Education and Technology, at Victoria University Health Care Centre, says lifestyle changes, is crucial in addressing obesity in children.

This, he says includes feeding children on foods that have less fats and sugars.

Daily physical exercises that keep children active can also help them to burn any excess fats that may have accumulated. Physical activities that children can engage in include jogging, walking, playing outdoor games, swimming and other interesting sports.

“However when parents notice signs of their children being overweight, they need to visit a nutritionist, with whom they can design a diet and exercise plan,” says Mpiima.

He, however, says children should also be involved in drawing such a plan. Counselling should also be undertaken for overweight children to try and build their self-esteem.

“This goes with the parents being good role models to their children by ensuring that they too eat healthy and practice active lifestyles. One of the best strategies to reduce childhood obesity is to improve the diet and exercise habits of the entire family,” Mpiima says.

Meal plan
Mpiima says having a consistent meal plan is also critical in dealing with obesity in children.
“The meal plan should ensure that children do not eat late into the night, but also balance the kind of foods that they eat throughout the day,” he says.

Mpiima, however, says the best way to prevent childhood obesity from happening is to ensure mothers breastfeed their children, right from the time of birth, up to the age of two.

“Breast feeding prevents many health problems including obesity, which may show up either in child or adulthood,” says Mpiima.

The global picture

According to the World Health Organisation (WHO), childhood obesity is a global problem that is steadily affecting many low and middle income countries, particularly in urban settings.

Globally, in 2013, the number of overweight children under the age of five, was estimated to be over 42m. Close to 31m of these were living in developing countries such as Uganda. If current trends continue, WHO says the number of overweight or obese infants and young children globally will increase to 70m by 2025.

WHO says overweight and obese children are likely to remain obese into adulthood, and more likely to develop non-communicable diseases and conditions such as diabetes, insulin resistance (often an early sign of impending diabetes) and some cancers.

Obesity causes breathing problems such as sleep apnea and asthma. Obese children and adolescents also have a high risk of suffering from social and psychological problems, such as discrimination and poor self-esteem, which may continue in adulthood.

However, WHO also says most of these diseases can be largely prevented if parents help their children to make healthy lifestyle changes.

Quick tips to prevent obesity in children
Currently, there is no dietary recommendation for children and adolescents on how to prevent childhood obesity. However, the World Health Organisation (WHO), says the following steps are essential.

•Early initiation of breastfeeding within the first hour of birth.
•Exclusive breastfeeding for the first six months of life and the introduction of nutritionally-adequate and safe complementary (solid) foods at six months, together with continued breastfeeding for up to two years or beyond.
•Limit regular intake of fats, salts and sugars in high quantities.
•Increase consumption of fruits and vegetables, as well as legumes, whole grains and nuts.
•Engage in regular physical activity (60 minutes daily is recommended).

Fast food and childhood obesity
Health experts say obesity results from a combination of lifestyle and dietary factors that lead to energy imbalance. Fast foods are typically high in calories, fat, saturated and trans fat, sugar, carbohydrates and sodium (salt).

The amount of fast food a person consumes also plays a major role in developing obesity. If a person frequently eats fast foods, they increase the calorie overload in their body. Although some calories can be burnt in metabolic activity and everyday tasks, a person cannot get rid of excess fat if they exceed their daily calorie limit and do not engage in daily exercise routines.

An average diet to maintain body weight accommodates about 2,000 calories per day, divided among three meals.

If one fast-food meal contributes half of that daily total, the rest of the diet may push a person over the limit and the body will store the excess calories as fat. Obesity that results from eating fast foods full of saturated fats, such as burgers and fries, can dramatically increase the risk of developing heart disease and type 2 diabetes.

SOURCE: Daily Monitor

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