Focus on Childhood Obesity & Type 1 Diabetes
CHILDHOOD OBESITY
Childhood obesity is a fast emerging global dilemma, not only in the developed western countries, but also in many developing Asian countries including India. In the U.S. a dismaying 32 percent of young people aged 2 through 19 were judged overweight or obese as measured by body mass index, with roughly half falling into each of those categories. In New Delhi, India alone, nearly one in five school children ages 10 to 16 are found to be either overweight or clinically obese.

‘The figures for India indicate that the rapid progress of urbanization and demographic trends is associated with unhealthy lifestyles and related non-communicable diseases with obesity leading the way!!’ (Vedavathi S, Jayashree R, RafiM: Prevalence of Overweight & Obesity in Affluent adolescent school girls in Chennai in 1981 & 1998. Indian Pediatrics, 2003;40;775-779 AND Kapil U et al: Prevalence of obesity among Affluent adolescent school children in Delhi. Indian Pediatrics:2002;Vol 39: 449- 452.)

WHY is obesity on the rise?
  		•  Children lead less physically active and increasingly more sedentary lifestyles.
  		• They are consuming high calorie and energy dense foods, junk foods. Eg: French fries, pizzas, desserts and unhealthy snacks
  		• Genetic predisposition.
  		• Lack of portion control
  		• Preconceived notion that a plump child is a healthy child
  		• Lack of understanding of the importance of BMI and WHR for a child

    Problems associated with childhood obesity.
  		• 50-80% of obese children will continue on into adulthood as obese adults and fall into the high risk group of Diabetes, Hypertension and Coronary Heart Diseases. Complications of adult obesity are made worse if the obesity begins in childhood as it is harder to treat in adults than in children. (Styne D.M: Childhood obesity and adolescent obesity: PCNA, 2001; 48: 823-847 AND Park K: Park's textbook of Preventive and Social Medicine: Banarsidas Bhanot Publishers, 18th Edition, 2005; 316- 319.)
  		• In addition to these diseases, the extra fat tissue causes hormonal imbalances leading to an early onset of menstrual cycles in overweight girls; this in turn may stop them from achieving their full growth potential.
  		• These children undergo social stigmatization by other children and parents who think that obese youth are lazy, unclean, and of lower intelligence.
  		• Young adolescents with eating disorders often start developing their restrictive eating patterns in order to avoid these strong negative images associated with being overweight and go through swings in excessive weight gain and loss.
    CAN IT AFFECT GROWTH?
    Unfortunately, Yes!! Childhood obesity causes reduced lung and alveolar capacity, poor metabolism leading to growth and developmental disorders. Reduced physical activity itself can cause reduced bone mass leading to flat feet, narrowing of the arches, knee pain, back pain, and irregular hip position. For most children, these pains and deformities will progress into adulthood with little chance for recovery.
    Dietary Guidance From Ms. Kanchan Saggi, For Your Overweight Child.
    Dietitian NutritionVista.com

    She says... I think, as far as a particular diet approach is concerned while treating childhood obesity, we should not restrict calories in a child's diet, as this could adversely affect the child's growth and development during the most impressionable years of their life and on the other hand be psychologically stressful too. Instead I suggest, it would be advisable if we could just focus on balanced diets, healthy eating habits, and active lifestyle patterns, with moderate caloric restriction which is basically done by cutting down on the fat intake without depriving them of nutrients. Here I sincerely believe that we should gradually adopt a diet that should not contain anything more than 30% of calories from fat by the time the child is about 5 yrs old.

    So our dietary approach should basically focus on:
  		• Improving activity pattern
  		• Making food choices healthy & enjoyable
  		• Understanding serving sizes
  		• Finally, let's stick to the basic caloric recommendation for children and advising them to cut down on junk foods, sugary snacks & beverages & fat laden snacks.

    By doing so we would be able to at least reduce 200 - 300 cal/day and thereby will be able to effectively reduce 1.5 to 2kg per month.(approximately) - a very gradual weight loss
    WHAT CAN A PARENT DO ABOUT IT?
    As with any other health problems, prevention is the key, and an effort must be made by the child and its parents to take responsibility. A rosy cheeked, plump toddler or child may look cute to the parents now, but childhood obesity is a long term risk for developing adult onset diabetes, heart disease or even cancer. Studies have shown that obese children, grow up to be obese adults making it imperative to inculcate healthy eating habits early, which will continue on into adulthood.

    Parents need to evaluate their child’s diet, level of physical activity and health status to ensure there are no hormonal imbalances causing the weight gain. Next, parents can take the following measures to start addressing the weight gain in a systematic, caring and constructive manner.

    1. There is nothing wrong with having a skinny child, provided they are eating healthy and are very active.
    2. Monitor your child’s portion sizes. Eg. If they are used to eating 4 pooris or half a plateful of rice, cut it down to 1 or 2 pooris maximum (fried Indian breads), or just 1 cup of cooked rice. If you always buy large fries and coke, buy 1 small fries instead with milk, or better yet, share even the small fries.
    3. Modify your recipes - Reduce the use of fats and sugars. Use oils like canola, safflower and olive. Always grill, broil or steam rather than fry. Always throw in vegetables wherever you can. Do not serve plain rice, serve it with mixed vegetables. If making chicken soup, throw in 1-2 cups of vegetables. Serve whole wheat chappatti and breads and avoid white flour (Maida) naans or white bread.
    4. Use the Food Guide Pyramid as a guide for servings, or refer to our June newsletter for serving guidelines for your country. Let our Serving Sizes page guide you. http://www.NutritionVista.com/Help/Serving-Sizes/Default.aspx
    5. Give a glass of water to see if they continue to be hungry
    6. Wait a few minutes before giving additional servings. A break allows for you and your child to determine if hunger or boredom is the issue.
    7. Make breakfast an important meal with whole grains, fruit and dairy, as it will sustain the child longer and prevent hunger from setting in earlier.
    8. Finally, set a goal of 30 minutes of continuous cardiovascular activity at least 4 times per week. Do this, as a family!!

    Obesity - What foods should my child avoid?
    Items & Quantity Caloric Value Fats (g) To burn these calories, you must**
    Donut with Rainbow
    sprinkles, 1 donut    		 255 Calories 12.22 g Play football/ soccer for 58 minutes
    French Fries (med) 384 Calories 20.36 Play tennis for 100 minutes
    Samosa with potato stuffing, 1 pc. 219 Calories 8.8g Jog for 69 minutes
    Veggie burger 380 Calories 19.7 g Play dodge ball for 69 minutes
    Strawberry Sundae-1 268 Calories 7.85 Ride your bicycle for 82 minutes, phew!



    For dietary guidelines on calories and fat % for children please refer to our JUNE newsletter.
    TYPE 1 - JUVENILE DIABETES

    Most parents are stunned and scared of a diagnosis of Diabetes for their child.

    There is no need to panic when your child is diagnosed with Type 1- Juvenile diabetes. You can use nutrition and exercise to combat this disorder and there is no reason why your child cannot lead a normal, healthy, balanced and very active lifestyle.

    The most important part to coping with this disorder is by following a methodical approach to the child’s daily diet. By coinciding timings of insulin injections to eating healthy, varied foods in strict proportions including few sweets, a stable blood glucose level can be and must be maintained.

    Causes: In type 1 diabetes, the immune system — which normally fights harmful bacteria or viruses — attacks and destroys the insulin-producing cells in the pancreas. This leaves little or no insulin in the body therefore leads to sugar build-up in the bloodstream.

    The exact cause of type 1 diabetes is unknown. Genetics may play a role. Exposure to certain viruses & auto-immune disorders are probable culprits, too.

    Symptoms:
  		• Increased thirst
  		• Fatigue
  		• Weight loss despite increased appetite
  		• Frequent urination
  		• Nausea &/or vomiting
  		• Absence of menstruation or irregular menstrual cycle
    Problems to look out for:

    Most important thing to remember is to avoid extreme variations in blood glucose levels due to a careless diet.

    Diet: A qualified dietitian is critical to help guide and teach you and your child as they grow. The appropriate amounts of carbohydrates, proteins, vitamins and other nutrients need to be understood. They can also help teach a child to understand the body’s responses and learn to recognize when an imbalance is happening and take the right precautions or seek immediate adult help.

    To keep your child's blood sugar on an even level, try to feed your child the same amount of food with the same proportion of carbohydrates, proteins and fats at the same time every day.
    The meal should:
  		• Include high fiber foods such as whole grains, pulses, vegetables, nuts and fresh fruits (in moderation).
  		• Avoid fatty, greasy foods with trans fatty acids, that means avoiding things like fries, samosas,
  		• Allow limited dietary cholesterol.
  		• Not include sweets, sugary products and desserts. The consumption of high sugar fruits such as mangoes, custard apples, chikoos & bananas must be monitored very closely.
  		• Allow limited sodium to avoid unnecessary complications. Protein intake may also need to be monitored in some cases.
    An inspiring story for parents of kids with
    Type 1 diabetes.

    By. Patrick Totty, Diabetes Health, March 2008.
    Scott Dunton, Diabetes at 16, and a nationally recognized Surfing Sensation at 21 read more
    FOODS FOR DIABETICS

    DIABETIC FRIENDLY DIABETIC UNFRIENDLY
    Those vegetables that your child can eat raw, should be eaten so, rather than cooked; onion, garlic, ginger, radish, spinach, kale, cucumber, carrot, tomato, cabbage and cucumber, Processed foods like cupcakes with white sugar icings, white flour and junk food, must be avoided.
    Moong, kidney beans which have been sprouted, and unripe banana which is cooked, are also good. Avoid sweets, glucose, fruit sugar, cakes, ice cream, chocolates, soft drinks, cream and fried foods.
    Fenugreek seeds which have been soaked in water are good for diabetic children. Try and abstain from sweets, ice-creams and chocolates, including the so-called sugar-free types. Avoid sweets, glucose, fruit sugar, cakes, ice cream, chocolates, soft drinks, cream and fried foods.
    Small helping of fish as it provides omega 3 fatty acids. Foods made from white flour, rye, corn, polished rice, bread, pasta, pastry, cakes, biscuits, pies.
    Provide skim milk, non-fat yogurt and non-fat cheese, plain yoghurt, avoid cottage cheese as they are high in carbohydrates. Starchy vegetables such as potatoes in particular; beet, carrots, peas, beans can be avoided
    Bitter gourd / biter melon juice can be given in very small quantities only if the child acquires a taste for it. Avoid concentrated dairy products, such as khoya, kheer, cheese, cottage cheese.
    Choose grilled, baked roasted or steamed food. Avoid fruits such as ripe bananas, mango, grapes, strawberry, custard apple, date.
    Choose water and calorie-free "diet" drinks instead of regular soda. Avoid fast foods, chips, ready-to-eat foods, snack foods and so called "health foods."
      Select a thin-crust pizza only and add vegetable toppings. 1 small slice only.
      Avoid creamy toppings, like mayonnaise.
      Avoid processed, refined fruit juices, as these are much higher in carbohydrates than fresh fruit. Moreover, they also lack dietary fiber.
      Avoid foods that are processed/ dried/ prepackaged as they would be high in sodium.

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