A new book by a bariatric surgeon examines how childhood obesity is becoming rampant in urban India

Every year, the number of parents visiting my clinic for consultations for their obese children increases. When bariatric surgery started making inroads in India twenty years ago, children never visited bariatric surgeons. At the risk of repeating myself, I reiterate that the advent of liberalisation has changed that, owing to the easy accessibility of ready-to-eat foods that are high in calories.

The lack of open spaces for children to play and many other social reasons act as factors that result in weight gain. Currently, I receive at least one new paediatric patient in my clinic for advice each week. Parents of children as young as eighteen months have dropped by for a consultation; less than 5 per cent of them require surgical intervention.

A study giving a snapshot of physical activity and food habits among private school children in india states, “Lifestyle changes concomitant with globalisation, economic development and access to technology are often implicated in concerns related to the emergence of obesity and chronic diseases in India. New behaviours, such as eating processed foods and eating out, have been associated with obesity among children aged 5-19 years. Families are increasingly able to purchase televisions, computers and gaming systems, and children spend leisure time in sedentary activities indoors.”

Emphasis on education also affects physical activity, since children spend considerable time studying. Simultaneously, changes related to globalisation, economic development and technology have contributed to major improvements in health. For instance, changes in food production and prices increase the availability of energy-rich foods, addressing India’s persistent problem of underweight individuals.

On 22 November 2011, I performed bariatric surgery on an eleven-month-old child named Zoya Khan, at Mumbai’s prestigious Breach Candy Hospital.

She was the youngest child to undergo bariatric surgery in India. the operation stoked a debate in society, but i firmly believe i have helped the child lead a normal life, given her genetic obesity. Much transpires within the body beyond the accumulation of fat; the excess weight can systematically destroy the body.

Check the skin of morbidly obese children and you will notice deep folds. their hands and legs seem like stubs in comparison to their trunk. Many of them cannot fit in chairs and need broad sofas to feel comfortable. Several among them also develop a condition called tibia vara, also known as Blount’s disease. the condition causes the knee bones to appear angular and bent due to excess weight on the tibia or shin bone. Their movement is restricted which, in a sense, adds to their sedentary lifestyle and worsens their weight problem, creating another vicious cycle.

Visits from such patients have a sad ring to them because these children are too young to realise that their health is at stake.

As the adults discuss obesity- related problems and cures, they play with their parents’ mobile or some hand-held personal gaming device. This underlines the fact that screens dominate our leisure time and the physical and mental alertness in real-time has reduced. Children increasingly opt to engage with gadgets for entertainment, and physical activity is taking a backseat in the era of development and globalisation.

Parents are often motivated by external factors – the child’s appearance, hostile looks their child receives from strangers, the teasing, etc and not necessarily the implications of a bad diet on health. This reflects a poor understanding of the various dangerous effects obesity can have on a child.

Weight gain and loss is common amidst growing children. But recognising the numbers that cause ailments is crucial. The only way to raise awareness regarding this is through health programmes aimed at educating parents on the health of their children.

I have obtained permission from parents to chronicle their child’s battle with obesity. It is interesting to note that none of the parents or the children can pinpoint when exactly obesity took over their lives or what it is that they were doing so wrong that weight gain never stopped. Obesity stealthily creeps into people’s lives and there are seldom any alarms that can notify the exact moment when weight gain converts to an ailment. The stories are alarming, but each demonstrates that the human spirit can get around most challenges.

We cannot, of course, forget Emam Husain, the Egyptian woman who wore the unhappy crown of being the world’s heaviest woman weighing around 500 kilograms. She stopped standing or walking at the age of 11. She had a genetic mutation that affected her metabolism and led to weight gain. But her story underlines why the medical field needs more research and effort to stop every form of obesity and its various contributing factors.

Obese children often tell me that other children don’t want to play with them because they are too slow at a game or unable to keep pace with others while running.

Such occurrences can psychologically affect them. Social stigma leads to lack of self-confidence, depression and a sense of rejection. It is said that older obese individuals who suffer from chronic depression are five times more likely to commit suicide than people who are not obese.

It is important that parents prevent their kids from reaching that stage. They can begin by underlining the need for proper nourishment to lead a mentally and physically healthy lifestyle.

Urbanisation and industrialisation have immensely contributed to increasing children’s energy intake while decreasing their energy expenditure, thus promoting obesity. The challenge lies in formulating policies that address how best to change this built environment in a positive manner in order to maintain children’s energy balance and prevent excessive weight gain.

The reluctance of policymakers to regulate the food environment is a direct consequence of the belief that people’s food choices reflect their true desires. The reality is that food choices are often automatic, and, in children, they are driven by the effects of mass media, family habits and peer pressure.

In an article examining the prevalence of obesity in adolescents and children, a clear example of this influence was shown through the placement of candy/chocolates near cash registers at supermarkets. This is a widely acknowledged promotional strategy called “impulse marketing”.

The article states:

“Impulse marketing encourages spur-of-the-moment emotion-related purchases that are triggered by seeing a product or a related message. it works by placing goods at prominent locations in supermarkets. For instance, end of the aisle or at the cash counter. these are seen to account for about 30 per cent of all supermarket sales. the common belief is that those who respond to impulse marketing lack self-control and should learn how to resist such marketing strategies. But these tactics psychologically manipulate the buyer into making purchases that often include chips, sugary food and drinks. However, anyone who has visited a supermarket will know that most last-minute purchasing decisions are made quickly and automatically without substantial cognitive input.”

it is important that policymakers also intervene to dismiss food advertisements with misleading messages. Instant noodles are promoted as a healthy food choice even though their main ingredient is refined wheat. They are artificially fortified with nutrients and marketed as a “source of essential nutrition”. Health drinks, granola bars and cornflakes that are packaged as diet foods often pack in alarming quantities of sugar.

Even if the buyer is aware of misnomers that prevail in fast foods, the choice to buy fast food is impulsive. Whole foods like fruits, vegetables and whole grains require more thought. This can be attributed to the fact that instant foods offer instant gratification. they are cheap and less tedious to prepare and consume. this, again, boils down to the responsibility of authorities to regulate what masses have access to and how nutrition can be facilitated through better policies.

Policymakers need to understand the effect of these marketing strategies – employed to increase sales – in relation to public health and limit the types of foods that can be displayed in prominent end-of-aisle locations and move foods that could promote chronic diseases to locations that are not easily accessible.

Excerpted with permission from Generation XL: Tackling and Preventing Childhood Obesity in India, Sanjay Borude, eBury Press.