Current status of school children?
Random surveys of 16000 city school children revealed shocking findings about the fitness status of city children.
· 26% of children are obese and likely to grow into adult obesity
· 12% of them have moderate to gross knock-knees and flat feet
· 84% of them are physically unfit to their age and body size
· 32% of them are not flexible enough to touch their toes
· 14% of them grossly underweight (mostly girls)
· 26% of them have poor dentition
· 78% of them like to eat sweets and non-vegetarian foods as their favourite dish
· 40% of them like to play computer games and like to remain indoors
· 26% of them like play out door games especially cricket
· 33% of them convey that they do not have proper playing facilities
· 11% of them have behavioural problems significant enough to cause poor performance in studies
With increasing burden of progressive ageing in India (By 2010 about 40% of population is above 40 years), the child health and fitness are critical for the country.
Obesity in children?
Obesity is state of the body, where lot of accumulation of fat leads to over weight. Now obesity is considered as an independent risk factor for many diseases indirectly, like diabetes, hypertension, hypercholesterolemia, hypertriglyceridemia, heart diseases, arthritis and cancer. Now we come across a significant number of obese children from higher to medium socio-economic group of families. Our research data shows about 26% of medically significant obese school children are seen their number may be very high in affluent schools (up to 50%).
Causes of Obesity in children?
The causes of obesity include low energy expenditure (lack of regular physical activities), high-energy intake (excess calories) and genetic (heredity) factors. Majority of these obese children (75%) ultimately grow into adult obese individuals. They are at risk for early disease if they have family history of Diabetes, High blood pressure and Heart disease. These children tend to be less active---more sedentary---more weight and it’s a vicious cycle. With the advent of refined foods, junk foods, the consumption of natural dietary fibre is reduced. Irregular food-habits also contribute further stress to the body leading to gradual deposition of adipose tissue in lose pockets of body.
What is the role of fat cells?
To smaller extent genetics play a role in acquiring excess fat, but influenced by bad environmental factors such as poor food habits, lack of exercise and metabolic disorders. There are three stages when active fat cell division takes place in the body. At the age of 3-6 months, two-three years, and during adolescence (12-16 years); this is the critical age where influence of environmental factors is at peak. Once child develops more fat cells in the body, size of the fat cells depends upon the availability of fat. So the more adipose cells the more the fat.
Childhood obesity has been on the rise around the world in recent years. In the US, almost one in four children is considered overweight. This incidence of obesity is some 20-30% higher than 15 years ago and has risen particularly rapidly among Hispanics, Afro-Americans and Indians. In Canada, the prevalence of overweight has increased more than two-fold, mostly at ages 7 to 9 years. In developing countries, even those where under-nutrition is still a major problem, childhood obesity is becoming a growing public health concern. The World Health Organization has recently defined obesity as a “Global Epidemic.”
Causes of Obesity in Childhood
The causes of obesity include low energy expenditure (lack of regular physical activities), high-energy intake and genetic factors. Majority of these obese children (75%) ultimately grow into adult obese individuals, and if they have family history of Diabetes, High blood pressure and Heart disease, their chances of getting these medical problems at much younger age is certain. For example, if both parents are diabetic, the chances of inheriting the disease is about 90%; but at the age of 60 years and above. In case of obese child who grows into obese adult may inherit Diabetes as early as 30-40 years of age. Obese children and adolescents often suffer ridicule and teasing, which leads to social isolation and low self-esteem. An emerging medical issue of particular concern is an alarming increase over the last decade in the prevalence of type 2 (“adult”) diabetes mellitus among obese adolescents. Dangers of childhood obesity include lethargy, poor performance in studies, and early precipitation of diseases like diabetes and heart problems.
Low Energy Expenditure (Less Physical Activities)
This is the major factor responsible for childhood obesity. These children tend to be less active and keep on storing energy in the form of fat, this in-turn makes them more lethargic and so on. It’s a vicious cycle, which is difficult to break. Large number of schools does not cater for good sports facilities (some of the schools even do not have 20 meters of walking space), and the children are burdened by competitive academics driving them spending more time in attending tuitions or coaching camps. At home irresistible television and computer games take of some more time in watching junk. Our children are left with no time for physical activities. More so children residing in multi-story complexes are deprived of the opportunities of playing. Average child of 8-10 years spends about 800-1000 kcal of energy for complete activities and consumes about 1000-1200 kcals intake of energy, that means they consume as much as small adult. If these physical activities including non-sports activities at home and school are cut down then there is a serious disturbance in metabolism of the child.
Our children have been spending an increasing amount of time in sedentary pursuits such as TV watching, computer games and the Internet. Among children and youth, a very strong association has been documented between the risk for obesity and the time spent on watching TV. Moreover, there has been drastic reduction in the amount of time devoted to physical education in many school systems and, due to safety considerations, parents are reluctant to send their children outdoors to play in unsupervised settings. Indeed, our society has been creating incentives for a sedentary lifestyle and disincentives for active pursuits.
Excess Energy Intake (High calorie Diet)
With the advent of refined foods, junk foods, the consumption of natural dietary fibre is reduced. Irregular food habits also contribute further stress to the body leading to gradual deposition of adipose tissue in loose pockets of body. In Indian context, the influence of overeating should not be overlooked. Indian diets have undergone tremendous transition over last two decades; whole Indian plate is replaced by many western refined junk foods i.e. McDonalds, Kentucky chicken and Pizzas. Indeed, the adjustment of eating habits is pivotal to success in any weight control program. It should be emphasized, though, that low-calorie diets are not recommended for most children during the years of growth.
How far Genetics are Responsible?
Research has documented hereditary causes for human obesity, but genetics cannot explain changes that have occurred in entire populations over such a short period of time. However it is seen in very small number of families, obesity is genetically inherited. But our habits are more often inherited. These families should take care of their lifestyle much more than others.
Prevention and Management of Childhood Obesity
Prevention is very important and should involve all the family members and the physician himself. Children should be watched for any sudden gain in body weight, decreasing muscularity, increase in waist-line, increase in skin folds. This should not be confused with the growth spurts, which occur in spurts.
The guidelines for the management are
1. Assessment and Goal setting
2. Increase in Physical Activity
3. Balanced Diet
4. Day to day activity planning
5. Monitoring for a long time
1. Assessment includes body composition to know the fat percentage in the body, individual skin folds measurement is very helpful to know the changes in the body periodically. Body Metabolic Rate should be estimated. Just knowing body weight is not the correct method to plan treatment for childhood obesity. Goal setting has to be very practical so that there is a motivation in following the programme.
3. Balanced Diet One should concentrate on a gradual shift to a balanced diet that includes a variety of food groups, including fruits and vegetables. A reduction in snacking on foods of high energy density between meals is useful, and also is the reduction in second helpings during a meal. A useful tool to prevent second helpings is “the rule of 20 minutes”: if the child completes the first helping and is still hungry, there should be a 20-minute pause. If the child is still hungry, provide a second helping. Usually, by the end of the 20 minutes the child will no longer feel hungry. One should read labels on food packages and avoid items that have a high fat content. Consumption of beverages that have a high sugar content -- juices and sodas in particular -- should be reduced. For example if you keep many bottles of coke in the freezer at home, child is forced to drink it, if only fruits and vegetables are home they will slowly adapt themselves and consume them. It is not correct to prevent one child from eating ice-cream while others enjoy in front of them. Change should be in the whole house itself. Make the child eat well before go for shopping so that child doesn’t bother to eat too much out side. Calories should not be restricted but dietary habits and the source of calories needs to be modified and continued for a long time
4. Day to day activity modification include sleeping sufficient hours (8-9), but avoiding excess hours on odd times in important. Placing a stationary cycle in front of a Television helps tremendously. Holidays should be spent more actively and care should be taken that diet doesn’t get too bad on those days.
Methods do not work
Following methods are widely employed all over the world without scientific evidence. Body fat is energy and can only be burnt by Physical exercise programmes and need very meticulous diet and life style modification.
· Mechanical Vibration
· Continuous Passive motion devices
· Heat clothing
· Cellulite cures
· Weight reduction clothing
· Weight reduction Oil
· Electrical Muscle Stimulators
· Spot reduction
· Diet supplements
· Only abdominal exercises
· Ayurvedic / other medications
The right method
Ø Know your fat content and skin folds (you may use Fat “O” Measure)
Ø Correct your timing of food, quantity of food, oil content, excess non-veg, and sweets
Ø Make a regular exercise programme, take medical advice if you have any hormonal imbalances (for young girls)
Ø Have a early and large breakfast
Ø Keep a 2 hour gap between dinner time and sleeping time
Ø Increase your domestic activities more than before
Ø Finally follow everything for a long time. Mind it, there is no shortcut
How much are you burning off? To burn 100 Kilo-calories, you need to
Walk slowly for 40 minutes
Walk fast for 30 min
Run for 16 min
Swim for 17 min
Climb stairs for 16 min
Play tennis for 14 min,
Row slowly for 33 min
Social Factors: -
With increase in awareness on family planning large no. Families having single child, this forces them for overprotection e.g. not allowing children to play and participate out side the premises with the fear of accidents / injuries. On the contrary, the single child syndrome allows the child to spend more hours in front of television and indulging in junk food habit.
Poor Fitness Levels:
Due to medium frame and average anthropometry, Indian children are not comparable to American and European counterparts. However, 84% of them could not run during 20-metre shuttle run to test their endurance, even minimum levels. There so many factors associated with these results but certainly indicators poor health in future. The relation ships between physical activity, physical fitness, demographic and cultural status, health and disease are complex, but this should not deter the scientists. Research must continue so that we face one of the greatest challenges for the future is to devise methods of encouraging sedentary and irregularly active Indians to become more active. Even in well-structured, supervised exercise programmes face lot of dropouts, in a case of child is more obvious as they get bored of single activity, hence variety of games and activities are encouraged.
As observed in our studies, many (32%) children are unable to reach their toes as early as 7-8 years of age. This warrants for adequate flexibility exercises to be incorporated to avoid future musculo-skeletal problems i.e. backache and neck pains. Children are to be taught about the right posture while sitting and during all activities. Ancient Indian games do offer lot of muscular qualities to improve i.e. kho-kho. Lot many children have adapted a lethargic attitude and some do not have the opportunity to play and participate.
Mechanical faults: -
Knock-Knees, Flat Feet are very commonly encountered in children making them less active hence put on more body fat. Since the time infant learns to stand and walk it is on very hard surface (tiled /concrete floors) putting them at risk of developing arch problems in their feet. After all our feet are not made of hoofs and the concept of carpets on the floor were suppose to protect our feet. So these mechanical faults make the child immobile and obese. Genetics do play a role, but much can be avoided with a preventive care.
Eating Habits: -
Most parents are worried about the eating and growth of children. There has been a great transition in availability of wide range of foods for modern child. But to a larger extent many traditional menus have been replaced by western refined and junk foods; the advantage is a short cut.
Many children do not have proper cereal rich breakfast in right quantity. Due to lack of time, long travelling, lack of awareness lead to missing of major meal / breakfast. Scientific studies have shown that school children without breakfast have shown irritability, lack of concentration, cranky behaviour and disturbances in metabolism. Large number of children (78%) like to eat simple sugars and more fatty substances, these habits may predispose to faulty habits of future. Lack of chewing of raw vegetables and fruits is detrimental to their dental health. Children need a great care in developing good eating habits and right discipline of exercise and diet. Parents and schoolteachers should be alert to notice the change in the children pertaining to health, growth and behaviour; can be easily corrected. Nutrition for undernourished and over nourished need expert advice and body composition assessment can give good information of the child’s nutritional status.
Conclusion:
It is evident that city children are not developing in the right sense especially their fitness is very poor; may pose serious physical, medical and psychological problems if adequate measures are not taken now. However some schools have taken positive steps by recruiting counsellors, dieticians, but the exercise and fitness remains to be the last priority, and many schools have no place to play or move around. Care must be taken to incorporate programmes, which helps to improve the fitness levels for the overall growth and development of the kid.
FIT-KID Programme
(First time in India)
What we offer?
We have a team of experts from various fields of Fitness, Nutrition, Behaviour, Graphology and Physiotherapy; we have specialised equipment by which we can measure
1. Amount of Body fat
2. Amount of Lean body mass
3. Obesity Grading
4. Assessment of Endurance
5. Assessment of flexibility
6. Assessment of Fitness
7. Assessment of Biomechanical faults
8. Assessment of Nutritional status
9. Assessment of behavioural problems
10. Hand writing workshop to teachers as well as students to
correct the personality traits
We offer the above services in the school
Based of the above results a detailed individualised advice will be given to each child
Contact: -
Prof. Dr. S Bakhtiar Choudhary, MD (Sports Medicine).
770A Defence colony, SainikPuri, Secunderabad AP- 500094.
Cell: 98491-36940
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