Tubby kids - the new age disease Mind Your Body, The Straits Times (Thursday, 8 January 2009)
By Dhany Osman More and more Singaporean children are becoming obese. DHANY OSMAN asks if something can be done to stop this trend Childhood obesity is one of the biggest health problems the world is facing. In 2007, the World Health Organisation estimated that 22 million children under the age of five around the world were overweight. Singapore did not escape this phenomenon. In March last year, then Minister of State for Health Heng Chee Chow said that the percentage of obese students from primary school to junior college had risen from 2.8per cent in 1994 to 3.6 per cent in 2007. This came amid other figures which showed that the total proportion of obese plus overweight students in the same group had actually dropped from 11.1 per cent to 9.5 per cent in the same period. Obesity in children can generally be measured using the standard body mass index (see box). The oft-cited factors of poor diet, lack of exercise and sedentary lifestyles remain the main reasons more children are becoming obese. To fight this unhealthy trend, the KK Women's and Children's Hospital (KKH) is launching an obesity management programme for adolescents. It will emphasise group activities to promote interaction and mutual support between patients. It will be launched at the end of this month. Its group-oriented approach will have another advantage - it will be more affordable than individual counselling sessions. Dr Kumudhini Rajasegaran, an associate consultant at KKH's general and ambulatory paediatric service, said that the hospital sees between 500 and 600 children a year, including new and ongoing cases, for obesity treatment. Experts say that childhood obesity is best managed in the following ways:
Emotional support Doctors say that family support is crucial in getting an obese child to lose weight. Parents play an important role in guiding their children to a healthy lifestyle, said Dr Chan Poh Chong, a consultant at the paediatrics department at National University Hospital (NUH). 'For obese children, exercising and eating together as a family are the mainstays of losing weight,' he said. In October last year, NUH started a weight management programme called Trees (Towards Right Eating, Exercise and Self-esteem) to help overweight teens. Despite the positive impact that school health programmes have had on obesity rates, Dr Chan said more can be done to address the psychological issues involved in obesity. Hence, the NUH programme includes psychological services to help patients set realistic goals and to stay motivated. Ms Frances Yeo, principal psychologist at KKH's psychology service, said that it is important for those working with obese children to discuss weight issues in a sensitive and respectful manner. 'Using threats, scolding, fear tactics or physical punishment will usually not encourage any positive behavioural changes,' she said. Managing diets Ms Suzanne Khor, a senior dietitian at KKH, said that obese children should eat a balanced diet that is high in fibre and low in fat and sugar. More high fibre foods like vegetables and wholemeal products should be consumed and high calorie foods like chocolates and fried foods should be limited. Naturally, food portions should also be kept small. 'When it comes to changing a child's diet, parents have to put on the brakes very gently,' said Dr Ho Ting Fei, a consultant at the Singapore Baby and Child Clinic. She has been running an obesity management programme since 2002. Simple steps like taking the skin off chicken and mixing brown rice with white rice can help encourage a healthier diet in children. She added: 'All this advice about sensible diet can apply to anyone. Don't just change the food for one person, change it for the entire household.'
Getting your child active While exercise may be one of the best ways to lose weight, parents will attest to how difficult it is to get kids to pick it up. Mr Michael Lim, a clinical exercise physiologist at KKH, said: 'Often, kids do not like to be told what to do by an adult. We need to empower them by getting them to identify ways that they can enjoy being more active.' Setting 'mini goals' is one way. This can be done by breaking up a 45-minute exercise routine into three 15minute blocks to make it seem more manageable. As body weight may take time to change, Mr Lim said that focusing on more immediate goals such as improving endurance and muscle strength can help encourage those who are just starting off. Mr Marcel Daane, a senior performance coach with the Speed Institute that trains young athletes, said playgrounds are good places for children to get some exercise. Simple play that involves running, jumping and moving side-to-side can help kids become more familiar with their bodies and build their confidence, he said. BODY MASS INDEX The standard body mass index (BMI) can be used to measure overweight and obesity in children. This figure is obtained by dividing a child's weight (in kilograms) by the square of the child's height (in metres). Unlike in adults, who have fixed cut-off points for obesity, this number is then plotted on a chart against the BMI percentiles of other children of the same age and gender. An estimated 22 million children around the world were overweight in 2007