No one likes being the odd one out. Unfortunately, an overweight child often is. Research shows that in the sometimes cruel world of children, overweight kids are more likely to be socially shunned than kids with other physical challenges. Add to that the fact that an overweight child is more likely to be an overweight adult - and subsequently faces higher risk of heart disease, diabetes, cancer, arthritis and other diseases - and it becomes painfully clear that obesity during childhood needs to be prevented.
Like adults, more and more children in Asia are having trouble maintaining an appropriate body weight. In many Asian countries, one in ten children is now overweight. The figure jumps to one in five children in some urban areas. Why is childhood obesity on the rise and what can we do to prevent it?
Evaluating the causes
Speaking at the Food-based Dietary Guidelines and Nutrition Education meeting in Malaysia in July 1998, Dr James Hill, Department of Paediatrics, University of Colorado, Health Sciences Centre, said there is very little understanding on how and why childhood obesity develops. "While there are strong genetic determinants, the genetic composition of the population does not change rapidly enough to warrant the level of increase in obesity seen over the past two decades."
Attention turns therefore to the classic energy balance equation - energy "in" must equal energy "out" if weight is to remain stable.
While overeating has traditionally been blamed for weight problems, nutrition surveys in children in the United States suggest that energy intakes amongst most age groups have remained approximately the same over the last decade. Research from the United States and Canada shows a downward trend in childhood physical activity with older children, particularly girls, becoming less active.
Dr Georgia Guldan, Department of Biochemistry, the Chinese University of Hong Kong, has studied food intake and physical activity patterns in Hong Kong children aged 9 to 12 years.
"Most children at this age spend the day involved in light to very light activities," she said. "Only about one in five participates in any moderate or vigorous physical activity."
"According to the United States National Association for Sport and Physical Education, pre-adolescent children need at least 60 minutes of physical activity a day, broken up into periods of ten to fifteen minutes," said Dr Guldan.
Getting kids to move
Part of the solution to the growing weight problem in children is increasing their activity levels. But this is often easier said than done. In many Asian cities, high-rise living and lack of adequate space and equipment restrict opportunities for physical activity.
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Other factors influencing physical activity include:
A child's attitude to physical activity.
Enjoying physical activity is perhaps the most powerful psychological influence according to Dr Hill, emphasising that fun and pleasure are key to successful physical activity programmes.
A child's confidence in his or her ability at sports, games and active play.
Peer influences. According to Hill, peer influences outrank parental influences, as children grow older. But there is no ignoring the critical role of adult modelling and support in keeping kids active.
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Communicating to children
To effectively communicate to children about nutrition and physical activity it is necessary to have some insight into what they know and believe about these subjects. "For younger children, adult modelling and parental involvement is important when talking about healthy lifestyles," said Dr Guldan. "In older children, peer group influence plays a bigger role, with active participation by children in self-assessment and feedback leading to better understanding and commitment."
Dr Hill has identified a need for policy makers to be made aware of the growing trend in childhood obesity so that programmes can be made available to arrest the trend.
"Healthcare professionals, community leaders, school teachers and parents can all play an active role in encouraging children to adopt healthier lifestyles today for a healthier tomorrow," he said.
Physical activity: Do Asian children get enough?
A recent survey conducted by three study centres in Asia examined physical activity patterns in children. The survey was undertaken in 8 to 10-year-old children in Kuala Lumpur, Jakarta, Bogor and Manila. The results highlight low levels of physical activity among Asian children. In particular:
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Less than one in four children participate in sports, outdoor games or physical exercise daily.
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The most common leisure activities are playing computer games, reading and watching television.
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In general, children have physical education lessons at school only once or twice a week.
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Girls are less active than boys at all ages.
This survey was undertaken by: The Food and Nutrition Research Institute, Manila, Philippines; The Institute for Medical Research, Kuala Lumpur, Malaysia and the Bogor Agricultural University, Indonesia, and was supported by ILSI S.E. Asia.
