Make Indian parents better aware of growth charts to prevent obesity

Obesity is a serious multisystem disorder and to a large extent a permanent problem, especially if it develops in children before 5 years of age.1 2 So we should try to prevent it.3

About 30% of schoolchildren in urban India are overweight.4 As a paediatrician and paediatric gastroenterologist in urban India, roughly 80% of my practice caters to the middle and upper classes, which have enough disposable money for their children to eat as much as they please, of what they please, when they please. This includes a lot of junk food and sodas. Also, time spent on computers, tablets, and games consoles, not forgetting heavier textbooks and shrinking playing fields, may be responsible for the rampant childhood obesity in most cities.

Prevention of obesity starts with counselling women in pregnancy and continues through childhood using the growth chart (see www.cdc.gov/growthcharts/clinical_charts.htm). We need to teach pregnant women about the benefits of breast milk, appropriate responses to a crying baby, types of complementary feeding, and the importance of regular plotting on the growth chart. It is the last that is the most difficult but perhaps the most important.

In our culture, one thing that is sure to make a parent or grandparent happy is feeding a child and that child eating, whether by trickery or distraction (often cartoons on television), and if that does not work then by threat or even force. But why? Unfortunately, most people in India see a fat child as a “healthy” child and never as an “unhealthy” child. This stems from the generations of our population who were used to seeing famines, undernutrition, mind boggling mortality rates among children under 5, and a lack of medical care. A child who ate and grew fast could outrun the chances of dying early. Fortunately, many things have changed, but our thinking around feeding children (and the need for forced feeding) has not kept pace.

Too often parents tell me, “My child does not eat. My child is the smallest in his class. Yes, she eats when she goes out and can play as much as any other child her age can.” The clinical examination is almost always fine. In these situations I bring out the growth chart. I explain to parents the importance of the child staying within the appropriate growth centiles.5 And in most situations the child is happily plotting in the growth centiles where he or she should be. I also share with them the expected weight and height at the time of leaving school at 18 years of age by showing them projections on growth charts that have been constructed by measuring thousands of children in various age groups.

I point out on the growth chart that a 3 year old girl who is 13 kg today is expected to be 53 kg at 20 years. But were that daughter 5 kg heavier today, 18 kg, she may be some 90 kg at age 20, assuming she stays within the centiles.6

I have met no parents who want their daughter to be 90 kg when she leaves school. I am amazed that parents often don’t realise this may happen if they themselves are or were obese and have had to take drastic steps to lose weight. Unfortunately, it is usually too late when I show them the growth chart and projected weight.

We have failed to educate ourselves sufficiently about physical development. But we must pledge not to allow children to cross centiles in either direction.7 Indian parents and grandparents should be educated about the virtues of breast feeding, about appropriate complementary feeding, and, most importantly, against forced feeding.8 And they definitely need to stop comparing their child with the neighbour’s child, who may be obese.

Parents and healthcare providers need to be taught how to use standard weight and height charts so that they can plot these even if their paediatricians do not. If there is deviation from expected weight, they need to try to correct it immediately.

Asians, including Indians, also need to remember that because of our predisposition to higher rates of type 2 diabetes and cardiovascular disease there is a proposal to reduce the range of body mass index that is labelled as normal (BMI is a crude but simple assessment of fatness, defined as weight in kilograms divided by the square of the height in metres).9

One day an obese adult may sue his or her parents for overfeeding during childhood. So parents should watch out, as should paediatricians who don’t arm parents with this knowledge.