“My children don’t eat enough,” is a sentence you might have heard. Later on, you look at the children only to realise that they are in all possibilities, overweight. A second wave of realisation hits you, when you notice that often, parents don’t realise that their children are more than ‘healthy’.
Peymané Adab, a professor of public health at the University of Birmingham, has been working on charting obesity prevention and management programmes for about 20 years. She has also studied parental responses as an important factor guiding these programmes. “There is definitely underrecognition of obesity,” she says. “Part of it is that we base our judgment on what’s normal, what’s around us, and as more children become obese and overweight you compare and say: ‘My child isn’t that overweight.’”
It’s not so surprising that today, the percentage of kids becoming obese between ages 5-10 has increased exponentially. What’s sadder is the fact that most of the adults turn a blind eye to this problem. A study published in the British Journal of General Practice concluded that parents don’t tend to categorise their children as overweight till they are in the 99.7th percentile, which is dangerously obese.
“Some parents don’t think children can be overweight,” says Adab. “They talk about puppy fat, and they think the children will grow out of it. They don’t see it as something that becomes established – and yet the evidence is that it does track through [into adulthood].” However, even after considering different growth rates, normally puppy fat is lost after toddlerhood.
Post 3 years of age, recognition of overweight children is done by the National Child Measurement Programme (NCMP), which considers the children’s Body Mass Index (BMI) twice: when the child is four or five, and again at 10 or 11 years of age. But this approach underestimates body fat in south Asian children (who show high levels of obesity in childhood), and overestimates it for black children.
Also, NCMP poses another problem. It was established to study trends, not to act as a screening measure. Hence, there’s no proper way to deliver results to the parents. “Some local authorities contact families of the children who were overweight and try to get them to engage in services; some don’t do anything other than send a letter,” says Adab.
It’s also difficult to figure out a way on how to deliver the message. Changing the words has not been very helpful. “It’s an impenetrable problem,” says Adab, adding that we’re used to eating sugary and oily food, that we have normalised it.
So how do you decide what and how much should children eat? One way is to describe the ghastly consequences of consuming oily food, but it could turn out to be problematic with the tendency to instil complexes. “It is a difficult balance, but I don’t think we should be saying there are taboo foods that we shouldn’t have,” says Adab.
Placing restrictions on access to unhealthy food might not necessarily work. “Some studies do find an association, but we recently completed a study and found there isn’t an association when you adjust for children’s weight at the start. It could be that parents are restricting because their child is overweight, rather than the restricting causing the weight,” Adab says.
The focus has thus, shifted from weight to lifestyle. “There is very little evidence that weight management programmes lead to unhealthy behaviours,” says Adab, “but there is always a concern that children will slip into eating disorders. It is still an area that is underresearched, but on the whole most weight management programmes don’t result in unhealthy behaviour if they are done properly.”
More adults encourage following a positive, healthy living for their children. Instead of altering their diet completely, they work around dining tables, or the portions taken, switching off the TV and so on. Physical activities also form a major part of their plans.