November 4, 2019

Childhood obesity, early nutrition and long-term health

Childhood obesity around the world

Childhood obesity is a significant phenomenon occuring worldwide. The number of overweight or obese infants and young children between 0-5 years old increased from 32 million in 1990 to 41 million in 2016. Childhood obesity is associated with serious health complications and premature onset of illnesses. The rising numbers of overweight/obese population is related to the escalating incidence of non-communicable diseases such as diabetes, hypertension and cardiovascular diseases, among others.

Obesity in Malaysia has reached epidemic proportions. The prevalence of obesity among Malaysian children below 18 years old was reported at nearly 12%.Malaysia is the most obese country in Southeast Asia, with 30.0% of the population being overweight and 17.7% being obese. The high prevalence of obesity and its associating comorbidities is detrimental to health and economy, both for the individual and the society as a whole.

CategoryBody mass index range (kg/m2)
Underweight< 18.50
Normal18.50-22.99
Overweight≥ 23.00
Pre-obese23.0-27.49
Obese I27.50-34.99
Obese II35.00-39.99
Obese III≥ 40.00

Adapted from Academy of Medicine Malaysia. Clinical Practice Guidelines On Management of Obesity. 2003.

Body mass index (BMI) is a measure of body fat based on weight and height. BMI is calculated by dividing body weight in kilogrammes by height in metres twice. For example, a person of 60 kg weight and 1.7 m height would have a BMI of 20.76 kg/m2 (60 / 1.7 / 1.7 = 20.76).

Diseases and complications associated with childhood obesity

Obesity in childhood is a major health risk. Obese children today are developing health issues previously observed only in adults. Problems associated with childhood obesity range widely from acute complications (e.g. type 2 diabetes, hypertension, hyperlipidaemia), cardiovascular and endocrine complications (e.g. insulin resistance, hypercholesterolaemia, coronary artery disease, polycystic ovary syndrome), certain cancers (e.g. colorectal, endometrial, breast, colon) and long-term issues (ischaemic heart disease, stroke, sudden death).

In addition to health problems, childhood obesity may also lead to psychological problems such as depression, eating disorders, and social isolation.Obese children may be bullied more compared to their normal-weighted peers, and develop poor self-esteem.These effects can last well into adulthood.

Impact of early nutrition on long-term health

Exposure to excessive nourishment and rapid weight gain in early childhood is closely related to the development of obesity and its associated disorders.

One study has defined three hypotheses on the possible path of development of obesity:

  • Exposure to excess fuels, especially glucose, during gestation leads to obesity after birth
  • Rapid weight gain in infancy leads to an increased risk of later obesity
  • A developmental ‘mismatch’ between sub-optimal nutrition around time of birth and an obesogenic childhood environment is related to a tendency of obesity

Thus, a World Health Organization report, “Ending Childhood Obesity”, addresses opportunities for effective prevention of obesity and its associated diseases at different stages, i.e. at pre-pregnancy and during pregnancy, in infancy, and early childhood, reflecting the three hypotheses described above.

Maintaining a healthy weight throughout childhood is better than attempting to reverse obesity. Many obese children eventually grow into obese adults; therefore early prevention is key.Here, parents play an important role in observing their children’s caloric intake and encouraging daily physical activity through exercise and play. Children should consume calories appropriate to their needs for normal growth and level of physical activity.

Excessive screen time contributes towards loss of physical activity in children. Proper monitoring of screen time is essential to ensure balance during playtime.

Nowadays, the selection of low-nutrient, energy-dense foods are endless, and these are often available for cheap. Parents must instill a healthy eating habit in children from the start, so that children may consciously make healthier food choices.

Parents and caregivers should teach children to eat well by encouraging good eating habits:

  • Serve plenty of vegetables, fruits and whole-grain foods
  • Find ways to make children’s favourite foods healthier
  • Reduce intake of high-calorie snacks and drinks
  • Choose lean meats
  • Consume reasonable portions of food
  • Choose water over sweetened beverages
The appeal of junk foods are in its taste (due to generous use of fats, sugar and salt), attractive packaging and often cheap price. Children can learn to appreciate the natural flavours of fresh, unprocessed foods if they are exposed to these foods from a young age.

Parents with normal weight are more likely to have children within the normal weight range as well, and vice versa. Children tend to imitate adults, so parents should keep in mind to set a good example for their children.

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References

  1. World Health Organization. Facts and figures on childhood obesity. Available at https://www.who.int/end-childhood-obesity/facts/en/. Accessed on 12 November 2019.
  2. Koletzko B, Brands B, Poston L, Godfrey K, Demmelmair H. Early nutrition programming of long-term health. Proc Nutr Soc. 2012;71(3):371-8.
  3. Ministry of Health. National health and morbidity survey 2015, vol. II: non-communicable diseases, risk factors & other health problems. Available at http://www.moh.gov.my/moh/resources/nhmsreport2015vol2.pdf. Accessed on 13 November 2019.
  4. Chan YY, Lim KK, Lim KH, et al. Physical activity and overweight/obesity among Malaysian adults: findings from the 2015 national health and morbidity survey (NHMS). BMC Public Health 2017;17(1):733.
  5. World Health Organization. Ending childhood obesity. Available at https://apps.who.int/iris/bitstream/handle/10665/204176/9789241510066_eng.pdf?sequence=1. Accessed on 8 November 2019.
  6. Academy of Medicine Malaysia. Clinical practice guidelines on management of obesity 2003. Available at http://www.acadmed.org.my/view_file.cfm?fileid=183. Accessed on 8 November 2019.
  7. Pandita A, Sharma D, Pandita D, Pawar S, Tariq M, Kaul A. Childhood obesity: prevention is better than cure. Diabetes Metab Syndr Obes. 2016;9:83-9.
  8. Centres for Disease Control and Prevention. Tips for parents—ideas to help children maintain a healthy weight. Available at https://www.cdc.gov/healthyweight/children/index.html. Accessed on 8 November 2019.
  9. Koletzko B, Brands B, Grote V, et al. Long-term health impact of early nutrition: the power of programming. Ann Nutr Metab. 2017;70(3):161-9.
  10. Ashakiran DR, Deepthi R. Fast foods and their impact on health. JKIMSU. 2012;1(2):7-15.
  11. Tanofsky-Kraff M, Haynos AF, Kotler LA, Yanovski SZ, Yanovski JA. Laboratory-based studies of eating among children and adolescents. Curr Nutr Food Sci. 2007;3(1):55-74.
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