 Hi, I am Dr. Gurudath, pediatric nurse at Manipal Hospital, Vartur Road. And I am Dr. Suruchi, one of the pediatric endocrinologists here at Manipal Hospital, Vartur. Thank you, Dr. Suruchi. So, as we know, 4th of March is recognized as the World Obesity Day. So, we are actually using this opportunity to raise awareness and sensitize our parents and families regarding this problem of childhood obesity. So, over the next 15 minutes or so, we are going to talk about the problem of obesity, how much of a burden of the problem. We will talk about what is obesity and how do you define it, how do we identify it. And what are all the consequences for our children, those that are overweight are obese. And then talk about how do we seek help and what are the preventative strategies. So, Dr. Biru, we have been seeing more and more children who are obese. Why do you think that obesity is actually such a huge issue in the world we live today? Yeah, so we know from decades and decades malnutrition has been a rampant issue in our country. And thankfully, over the years, government has taken a lot of measures to tackle and combat this problem. And we seem to be getting better at it. But unfortunately, we seem to have gone the other way now. And we are seeing a lot of children and adults facing this problem of obesity. And it is really increasing at an alarming rate right now. And what we do know is that if it is not tackled urgently now, it can take a form of an epidemic, especially in the urban areas. And the other important thing, especially the childhood obesity is important because those habits and the behaviors that children develop in the childhood is something that they will carry on to becoming an adult. So those habits that cause obesity, if it is not tackled then the obese children will grow up to be obese adults. Given that you are generally seeing a lot and lot of children in the outpatient department, how do you actually define and identify these children that are coming to your consultation because it is a short consultation and you have to quickly pick them up? So how do we define it so that we can educate parents about it? So obesity has been very oversimplified. We think of it as just excessive body fat, both in the subcutaneous tissue as well as surrounding the organs. But for me, every clinic visit of a child is an opportunity to pick up a child who is either overweight or who is moving towards obesity or is actually obese. And then once we identify them, then a strategy is put into place as to how we manage this. Now how do we identify them? We have standardized charts called BMI charts and we also have growth percentile charts both by the Indian Academy of Pediatrics as well as the WHO. Now each and every child is plotted on these charts either during their when visits or sick visits. And it is these charts that help us identify if a child is moving on from an average weight, going into the overweight category and then into the obesity category. Now BMI in simple terms is body mass index which is the height to the weight ratio of a child. Now if your height-weight ratio is cute, then you can fall into the overweight and obese category. Now it's not a one-off measurement ever. One-off measurements never give an overall picture of how the child should be. So it's over a period of time you may have some previous measurements or we can follow up the child over a period of time to see what is the trajectory of their growth and then make a plan. If a child is overtly falling into the obese category then definitely a plan has to be put into place sooner. So identification is through charts and through objective measurements of the child. Yes absolutely. So as you correctly said it is something that we have to see the trends over time. Absolutely. As a pediatrician in the OPD when you are seeing so many well children what do you find are the consequences of obesity in a well child and do you think it is something that we really have to worry about? Absolutely. Obesity is worrying. Consequences of obesity are varied and they can be widespread as well. Now obesity consequences are not just physical. They can also affect the mental health of a child. Now in the short term obesity in a child can lead to physical ability issues. For example a child may find it difficult to participate in general physical activities that happen. They also may suffer for something called an obstructive sleep apnea. Children with obesity in the long term may develop certain metabolic disorders which is called the metabolic syndrome where their HBA1C may go up. Their triglyceride levels may go up. They may develop a higher blood pressure and yes I know it is surprising that I bring up HBA1C cholesterol and triglyceride in the context of children but more and more children over the age of 10 years who have been obese do develop these skewing of their blood reports and it is very important to identify them sooner so that we can manage them just like any other illness and we can bring these levels down so that this does not lead to long term cardiovascular consequences and type 2 diabetes. So overall obesity while it is leading to all these physical consequences I have to think about their psychological effects too. Children who are obese or overweight we know that do get picked at school can be bullied, they may have issues with their self-confidence they may have issues with their self-esteem and whilst we are looking at everything else the first thing we must do is stop blaming them and start treating them like a child with any other illness it is not their fault honestly we just have to manage it and we have to take them out of this situation and not add to the psychological effects of this condition. Absolutely I mean I think it can cause to social isolation as you said and as you rightly pointed out it can affect their self-esteem also so that is something that you know very eloquently elaborated about the well child but I find as an intensive it is an issue in the ICU setting also and also there is something in pediatrics as we all know all the medications are calculated based on the weight of the child so then there is an issue about should we take the actual weight or should we take the dry body weight so that is another confusion that continues to exist that is another issue that we face in the ICU even getting a breathing tube in case the child requires mechanical ventilation can be sometimes a difficult task for these children and finally there is certain conditions and those children with these conditions like a common condition like dengue we know the teenagers with dengue if they are obese their outcomes are far worse as compared to another child so it definitely has consequences in a well child as well as in a child who is ill in the critical care it's true I think obesity has where it started off is just what we thought with children just being overweight it is now panned out into an illness in a way that has affected every part and every aspect of their life starting from being well to being sick Absolutely so I think like any chronic condition we would talk about it and we would resolve it and try and find preventative strategies and in the same way instead of pushing it away it's important that we are open about it with our children and try and address it how do we actually know which child is going to become obese and why is it that only certain children become obese could you please elaborate on that point So when I see patients and outpatients it's important for me to recognize why a child is here am I the one identifying the obesity or are they coming because the parents have identified that their child is overweight and obese and most of the times the parents are looking for an answer do they have a thyroid problem does my daughter have polycystic ovarian syndrome is there a genetic condition because we are all overweight and is this something that runs in the family that eventually we do realize that whatever the causative factor is the coordination of life that has led to children now becoming obese and we are seeing that we have a higher population of obese children than we had earlier especially in the urban setup so why the question is why lifestyle issues do play an important part so our children are much more sedentary compared to what we were I mean I remember coming back from school and dumping the bag on the ground and running out to play and it would be difficult for my parents to pull me back home but now it isn't like that their lives are more sitting on a chair in front of a laptop screen time yes this is the change in times but at the same time we know getting out staying out playing is very important for their physical health but our children are sedentary and there is no other way I can put it that it is the modernization of life that has taken away the requisite for them to get out of the house to do something or even to socialize with their friends with social media so it is the sedentary lifestyle second I'm sure we have all noticed that our food has changed it's been a very slow change but it has definitely happened there are certain things that were treats for us which have now become very normal in our house we all have a biscuit box in our house we all have cakes we have some kind of snacks always ready and those are the quick foods we reach out to when we are hungry and it's not only the children it's us as adults we do it too so processed food has crept into our life on a daily basis whether it is cheese whether it is fizzy drinks whether it is sugary drinks anything processed food has crept in and processed foods are high calorie dense foods that give us empty calories and then contribute to the obesity and overweight of the child so processed food has done that the third thing which I think gets overlooked a lot is there is a lot of peer pressure and social pressure on the children to perform not only in academics but also overall in life you have to be cool and this leads to a lot of stress and pressure in these children and sometimes they go into a shell and prefer to be indoors now these children are also prone to obesity because food then becomes their best friend and we can't overlook that fact because we have more and more mental health issues now in children especially after the pandemic and the social isolation that it led to of the children so yes it is a problem all over the world it's not only India specific it's not only Bangalore specific but we are seeing it all over the world especially with modernization and modern behaviors I completely agree with you because as you pointed out there is the social factors urbanization there is the environmental factors of modernization of a diet which is the processed foods that has come into this one and also there is certain genetic and family so it's a complex interplay of all these different factors as you rightly said there is a lot of oversimplification saying if somebody is obese it's their problem it isn't because it's the environment and the social environment this one we have created for the child is what is contributing to it so if we can move on towards how do we actually prevent it what are all the strategies that parents can think about to prevent this is something that is very very important it is one of those medical conditions that truly defines what holistic healthcare is so it's not just the doctor who is going to help you out but as parents as anybody who is caring for the child you have to be a part of the process including the child, the dietitian, the psychologist any medical professional who comes into contact with the child needs to contribute to that well-being of the child at home what can you do as parents the first thing would be your lifestyle your entire lifestyle as a family unit sometimes needs to change for example when I say physical activity there are times when I have gone home I am too tired and I don't do anything I just sit on the sofa and I have my meal and go to sleep that's zero physical activity sometimes days in a row it takes a lot of effort for us to find that 60-90 minutes in a day for ourselves for our well-being for the physical form that we are in and to better it it's very important that we have physical activity now it doesn't mean a gym membership or enrolling into some kind of fancy club it's as simple as swimming, badminton basketball, running around so physical activity at least 5 days a week yes we have to do it and there is no excuse for it and if we do it our children will copy and they will do it as well second is food what we intake is very important I am not saying processed food has to become zero any other treat or any other indulgence it has to be exactly what it is it's an indulgence once a month once in 2 months maybe that should be more than enough but every day look at the plate and decide that this is a balanced diet I am eating and I am providing for my children it's very important to have this kind of family setting where everybody eats healthy everybody eats the same kind of food there is no special food for a child who is fussy because then they have to become a part of that healthy eating eat at the dining table eat as many meals as possible together talk during a family meal because that extends the meal time and satiety sets in and you don't gobble up your food faster if there are any issues in the background that are contributing to the obesity for example a thyroid disorder polycystic ovarian a genetic condition a psychological factor they all need to be addressed so here at Manipal Vartur we have a psychologist we have our dietitians who are very experienced in managing all of these conditions and together we do look after children in a holistic way so that each and every part of this illness is sorted out and the child can then feel supported in their journey through the obesity yes, absolutely so I think what we have discussed over the last 15 minutes are some very important points that we have spoken about wide spectrum of things but in summary I think it's important to know that it is not just on the 4th of March it is something that we have to inculcate through the rest of our lives and make sure our children get that important that most of the things we have discussed is actually common sense and it is very simple to follow and that is something that should become a second nature I think as somebody was saying that the best gift we can do to a gift to our children is to ensure that they don't get into any kind of obesity or overweight and we ensure that they follow the healthy eating habits and follow good behavior absolutely, absolutely thank you