By Dr Manpreet Sethi
Young Divij (name changed) is the apple of his parents’ eyes. He knows their smartphones and their neighboring supermarket inside out, is a good student and also learns robotics. All the signs of a happy 13-year old and the promise of a joyful life ahead. Look closer though and hidden beneath the piles of his tuition books and the folds of his burgeoning tummy, is the risk of Type 2 diabetes.
Between his parents’ readiness with the wallet, the availability of packaged foods and Divij’s own preference for PS-3 over football, he is sitting on a time-bomb. There was a time young children and teenagers almost never contracted Type 2 diabetes, which was then known as Adult Onset Diabetes. In the pre-millennial days when things were done the hard way, children ate home-cooked food and cycled or ran a good bit, the condition triggered only when people were in their 40’s or later. It is also middle-class India’s rise in disposable income and eating out that has triggered an epidemic of childhood obesity and its complications like Type 2 diabetes.
Currently, about 20 per cent of Indian children are overweight, a factor closely related to the increase in incidence of Type 2 diabetes in kids, some as young as 10 years old. According to a study done at AIIMS in 2013, the incidence of abnormalities in glucose metabolism among obese Indian adolescents is estimated at 6 per cent. Overweight children, especially those with excess belly fat, are more likely to have insulin resistance, which is a major risk factor for Type 2 diabetes.
In simple terms, insulin is a hormone produced by the pancreas, allowing blood sugar to enter cells for use as energy. Lifestyle factors such as an unhealthy diet and poor exercise levels tend to make our cells stop responding normally to insulin. To offset this imbalance, the pancreas starts to make more insulin, trying to get the body’s cells to respond and take in blood sugar. As long as enough insulin is produced through the pancreas working overtime, blood sugar levels remain normal. As lifestyle factors start to win the battle against the pancreas, blood sugar levels begin to rise, first after meals, then all the time. The stage is set for Type 2 diabetes. Type 1 diabetes, on the other hand, occurs due to the failure of the pancreas to produce insulin, the development of which is not directly related to lifestyle or dietary habits.
The only ways to spot insulin resistance initially are blackening and thickening of skin in body creases, especially the back of the neck and armpits, also known as acanthosis nigricans.
Functionally, therefore, obesity and in turn, diabetes, is caused by an imbalance between energy intake and energy expenditure, leading to increased body fat stores. Food trends contributing to this are high calorie density foods at home, school canteens, malls and markets, supersized portions, habits of frequently eating out and ordering in, advertising gimmicks in packaged food, and easier access to funds for children, along with readily available cheap packaged food at every nook and corner.
On the other hand, sedentary behavior, rampant use of touchscreens, motorised transport for even short distances, inadequacy of safe areas for physical activities, increased burden of academics and tuitions, all these contribute to a more sedentary lifestyle among children, resulting in poor energy expenditure, and leading to excessive weight gain.
Apart from the risk of developing diabetes, obese children run the risk of contracting other co-morbidities such as fatty liver, hypertension, and metabolic syndrome. Simple changes at individual and societal levels can prevent the development of this dreaded epidemic.
At the individual and family level, we need to ditch the cliché that a chubby child is a healthy child. An overweight child is someone who needs less videogames and more cycling. Dietary changes are basically about becoming more aware as parents. Watch and read labels of packaged foods and beverages carefully. Check for the carbohydrate and fat content compared with proteins, and whether there is ‘added sugar’. Reduce children’s exposure to sugary and deep fried foods.
Look for foods which contain unprocessed and unrefined grains, offer children a greater variety of homemade foods of different cuisines. Crucially, encourage the habit of drinking water instead of packaged and aerated beverages.
From the lifestyle perspective also, parents must prevent children from munching something all the time, reducing screen time altogether to an hour each day and making a ritual of physical activity. This does not mean our children must run the marathon, but their schedules must accommodate simple activities like playing in the park, cycling and generally, a preference for walking and using the stairs instead of the lift.
Schools also can play an important role in helping to curb this epidemic in the making. Banning of sweetened beverages and packaged foods in school canteens, making physical education compulsory, and by giving children lesser homework, will help them take the good habits back home. At the community level, we should encourage children to use the playgrounds and parks instead of making them ‘walking parks’ for adults only, create safe walking, cycling, and running tracks, and encourage children to develop sports skills.
From a regulatory perspective, it is high time there was effective restriction on advertising for packaged and junk food, and more honesty in disclosure of ingredients and processes. In case you’re doubtful, buy yourself a pack of french fries from the nearest fast-food chain, and store it in a glass jar. Watch how it promises to age a lot more slowly than you are. Not convinced? Check whether your PET bottle of 750 ml cola contains over 20 teaspoons of sugar. Calibrate that to India’s annual consumption of over 3 billion litres and ask where all that sugar goes.
Childhood obesity and diabetes of the young are ticking time-bombs in our society, where the pack and not the intrinsic value of the food item is increasingly driving consumption preferences. It’s also very preventable. The choice is right there, on that pack of cola, where the sugar content per 100 ml is disclosed in very small print.
(The writer is Paediatric Endocrinologist & Childhood Diabetes Specialist, Apollo Cradle Royale Hospital.)