Pulling their WEIGHT : The solution to Thailand's looming childhood obesity problem lies with weight-watching parents

Pulling their WEIGHT : The solution to Thailand's looming childhood obesity problem lies with weight-watching parents.

KANOKPORN CHANASONGKRAM

Tomorrow kids nationwide will be screaming, laughing and enjoying their big day - Children's Day 2007. Twenty years back, a Children's Day event in Bangkok would be packed with mostly tiny tots and petite youngsters while jumbo boys and girls were a miniscule minority. Today's Thai children are bigger and chubbier and this expanding pudgy population - spotted in schools, shopping malls and playgrounds - can't escape your notice. The increasing number of overweight and obese children, however, poses a national problem, say doctors, and the country may need to add a Fat-Fighting Day for kids to the yearly calendar.

"Childhood obesity is already an epidemic in some countries and it has been an escalating problem for Thailand since 1990," says Prof Pipop Jirapinyo MD, chief of the Nutrition Unit, Department of Paediatrics, Siriraj Hospital. "The Ministry of Public Health alone cannot effectively curb increasing cases of obesity and we need to involve various parties, from family units to the Ministry of Education, in a national policy to prevent an epidemic."

Many factors contribute to childhood obesity, explains Dr Pipop, and it also stems from social changes involving nuclear families and families with a single child, often indulged by parents and care-givers. A child may then develop unhealthy eating habits like overeating, all-day snacking and a preference for high-calorie food or junk food that lead to excessive intake.

Schools also play an important role in promoting a child's health and Dr Pipop hopes to see more options in food, like offering skimmed or non-fat milk to overweight kids, as well as more physical education classes.

Typically for Thailand, a lot of kids spend most of their time after school and at weekends loading their brain with special classes and tutoring instead of playing and getting physical. In addition, juniors may be glued to computer games and making themselves a couch potato in front of the TV. When calorie intake exceeds output, the imbalance leads to the accumulation of body fat and eventually obesity.

Dr Pipop points out that prevention starts at home and good parenting should result in healthy children who are neither thin nor fat. "Because of social values, we adore chubby children, who are regarded as healthy," he notes. "But a chubby child can easily become overweight and obese between kindergarten years to pathom 6. We estimate that obesity is a health problem for 12 percent of two-year-olds and 20 percent of pathom 6 students. Prevention of obesity should be reinforced during this vulnerable period."

Nong Puifai, a gourmand since the age of two, is an example of how the kilos can pile on. Now seven, she's 120-cm tall, weighs 36 kilos and has a bigger waistline than her slim mother. "We don't have anyone who's fat in our family except Puifai, who loves fried foods and eats twice as much as other children. She swims to exercise but after a swim she eats even more," says concerned mum, Praneet Kanjanopas. "When my daughter was four and overweight, I did consult a doctor who reassured that it wasn't a problem because children will lose their puppy fat as they grow up."

What Dr Pipop has observed is that for many fat kids there is a point of no return. Studies have suggested that 20 percent of obese two-year-olds and 80 percent of obese six-year-olds will grow up into obese adults. But weight-watching from the age of two can help keep obesity at bay. Yet many mums and dads may not be able to tell, by looking or weighing, whether their little darlings have looming obesity. A weight-for-height chart for Thais aged two to 19 used by doctors can evaluate who's a lightweight, mediumweight or a heavyweight.

"Parents should ask paediatricians whether their children's weight and height are within the normal range for their age," says Assoc Prof Supawadee Likitmaskul MD of Siriraj Hospital. "From four years of age till adolescence, a child's height normally increases around 4-6 centimetres and weight, 2-5 kilos per year - but if it happens to be 10 kilos then there's an urgent need for weight control."

If parents ignore the problem, they are putting their children at greater risk of obesity-related complications. Bird (not his real name), for example, was always a chubby child and his weight reached 70 kilos when he was 10. It increased to 100 kilos and by 13 he'd hit 140 kilos. Suffering from conditions like apnea and edema, he came to Siriraj Hospital for treatment and doctors found that he had heart and kidney disorders - as a result of being obese.

"What's alarming is that obese children may develop adult diseases like diabetes, high blood cholesterol, high blood pressure and heart disease," observes Dr Supawadee, who's head of the Division of Endocrine and Metabolism, Department of Paediatrics. "In the past, children below 15 were afflicted with type 1 diabetes (juvenile-onset diabetes caused by the pancreas producing little or no insulin). Today we have children getting type 2 diabetes (adult-onset diabetes caused by the body developing resistance to the effects of insulin), which normally occurs in those over 40."

Type 2 diabetes, however, can be prevented and treated by weight control and modifying lifestyle. If slimming is difficult for adults it's even more so for children, who can't do it by themselves. "We empower parents to help their children overcome being overweight and obese. Since 90 percent of obese cases are caused by overeating, we emphasise eating less and exercising more. Some families can do it while some can't," says Dr Supawadee.

To help kids get in shape, three years ago Siriraj Hospital initiated weight-control camps for children and the model is now being implemented by other public and private organisations. "Children can easily put on weight during school holidays. These camps can help control weight as well as teach kids about food and calorie content. They also get the chance to regularly exercise. If half of the participants succeed in adopting healthy habits, we consider the camp a success," says Dr Pipop.

Besides dieting camps, hospitals like Samitivej Srinakarin Children's Hospital now have a health and weight control centre with a gym and aerobic room exclusively for children. Slimming centres for kids seems to be the next health boom but Dr Supawadee emphasises that children don't want to be fat and they don't want to spend their holidays at an anti-obesity camp.

So what can adults do for them, starting on Children's Day? "Give them love and attention and teach youngsters how to live in moderation," Dr Supawadee says.

Bangkok Post
Friday January 12, 2007