Childhood Obesity

Living Well in Myanmar

When children get too big

Childhood obesity is a public health epidemic that is well established in many Western countries and will likely be a threat to Myanmar in the coming years. The Centers for Disease Control in the US has found that one third of the nation’s children are overweight or obese. An unhealthy weight in childhood puts kids at increased risk of developing later in life high blood pressure, high cholesterol, diabetes, liver disease, musculoskeletal problems and possibly cancer.

Researchers in Italy recently examined and ran blood tests on 600 newly overweight children between the ages of 2 and 6.  They found that 40 percent had at least one abnormal blood sugar, cholesterol or blood pressure finding.  Furthermore 30 percent of the kids already had a buildup of fat deposits in the liver.

Children become overweight due to a complicated mix of reasons, including poor family eating habits, easy access to unhealthy foods, increased wealth, low levels of physical activity and societal perceptions of a “healthy” weight. Although doctors and publichealth policymakers are keenly aware of the implications for national wellness and health budgets, so far no population-wide interventions have been proven to stem the tide of childhood obesity.

In my personal experience caring for Mexican migrant workers in my clinic in California, parents often describe their children with pride as buengordito, which loosely translates to “nice and chunky”. If parents struggled for food in their own childhood, perhaps they are inclined to think of being overweight  as a sign of new personal prosperity.

I have not observed this belief pattern as often in my time working with families in Yangon, and it is not useful to assume two cultures are similar because they are both predominately poor. But we can safely hypothesise that an emerging middle class in Myanmar might perceive overweight children differently than health practitioners.

Support for this hypothesis comes from a research study published earlier this year in Pediatrics. The authors compiled data from 69 studies involving 16,000 children across a wide range of countries and concluded that 51 percent of parents with an overweight or obese child thought their child had a normal weight. The underestimation of weight was more likely to occur for children who were less than 5 years old. At this early stage of child development, this misperception is particularly dangerous since kids who are overweight in kindergarten are five times more likely to be overweight at 12 years old.

Last week the same medical journal, Pediatrics, published more worrisome data showing that over the last 20 years parents have become 24 percent less likely to identify a weight problem in their children.

Unfortunately Myanmar is positioned to suffer from the dreaded “double burden” of disease in the coming decades.  This happens when a developing country that is still attempting to address infectious diseases like malaria and tuberculosis – which have largely been controlled in developed countries – is faced increasingly and at the same time with lifestyle-modulated non-communicable chronic diseases such as diabetes, heart disease and cancer.

Obesity in Myanmar will be a strong contributor to most chronic diseases and threatens to develop in childhood for those born into an emerging middle class. Deciding where and how to allocate resources in the face of the double burden will be the greatest challenge facing Myanmar’s public health decision-makers and the international agencies that often control the purse strings. 

In the meantime there are several things parents can do to prevent or respond to an overweight child:

·      Focus on drinking mostly water, or water with a tiny bit of juice. There are no health benefits to drinking juice and usually it leads to consumption of excessive calories.

·      Restrict milk consumption to 1-2 small glasses per day of low-fat milk.

·      Eat three regular meals per day, including a healthy breakfast. Any additional snacks should be eaten at the same table or location as meals.

·      Snacks should consist of  fruits and vegetables rather than processed foods.

·      Aim for outdoor activity every day. Total screen time (TV, computer, phone, etc) should be less than 2 hours per day. 

At the same time, doctors have a responsibility to review a child’s weight and height at every visit, and be willing to discuss what can be a sensitive issue.  As obesity rates in many communities grow, misinterpreting a child’s weight as normal becomes more likely.  Parents might also be intimidated by the stigmatization of obesity and be afraid to label their child as overweight for fear of reduced self-confidence or bullying. 

Increasingly it looks like dietary habits in early childhood, and perhaps even in-utero, greatly influence dietary behavior in later life. Researchers in Australia recently found that parents who enforced nutritious eating between age 12-16 months had children who were less likely to become overweight through their growing years and thereby less likely to suffer from the chronic diseases mentioned above. Helping parents understand the risks of obesity becomes essential as it increasingly appears that lifetime food habits begin early in life and impact the long-term health of children  © Christoph Gelsdorf 2013