WHY IS MEAL MONITORING IN CHILDREN IMPORTANT IN SCHOOLS AND AT HOME

Obesity is now a big problem in our country both in children and adolescents. By definition of obesity, almost 35% of urban children in age group of 4-12 are found to be obese or overweight. This is largely due to wrong eating habits which are cultivated over a period of last few years due to strong commercial inputs coming from multiple food industry product-promotions.

Children are vulnerable, as they easily fall prey to the commercial gimmicks, and most of the time the children are out of control of the parents and largely spend their active time in schools, hence it is important to monitor their meals either served by the school canteen or taken from home as a tiffin or if they have an access to fast food. The frequency and contents of these foods must be stringently reviewed and reported to school & parents. Now the issue is very complex, the school is a place where there is a mixture of multiple cultures, children from diverse communities and cultural practices, including food dishes, come together and therefore it is impossible to give a simple nutritious diet in tiffin for him/her to consume because during lunch breaks all children tend to share tiffin with each other. It is therefore mandatory for school to take basic lessons on nutrition, diet constituents, and healthy food for body & mind of the child. This should be discussed in parent teacher meetings regularly.

Although some schools give lunches made by school canteens which are trained to give healthy, low fat, high protein diets, but this may be luxury for many schools and therefore it is the job of various responsible associations to disseminate this information from various platforms.

Besides known ‘obesogens’ in the environment, there are other extrinsic obesogens in the environment which are seen in chips, colas, packaged, processed and preserved food. The biggest   obesogenic factors are highly refined carbohydrates such as Maida found in biscuits, bakery products, pizzas, pastas and other processed food. Food stuffs which are grown on fertilizers and chemicals also contain many obesogens. Artificially fertilized grains which have innumerable chemicals, fish contaminated with mercury, chicken which are fed obesogens-loaded fodder, insecticide laden fruits, vegetables all contain extrinsic obesogens. In fact, water stored in plastic bottles is also discouraged as it is thought to contain extrinsic obesogens.

Third aspect is that the taste buds of a child develop in the early days of life, so simple home food that is a balance between protein fats minerals and antioxidants is crucial. These essentials can be derived from Bhakri, Chutney, Dal, Curd, Khichdi, Beans, Carrots, Tomatoes, Radish, Beetroot, Guava, Apple, Peach, Cherry, Plums, Papaya, Melons and spotted ripe yellow Bananas (rich source of Phosphates).

• Additionally, every child must consume half litter milk in various forms and at least one egg per day
• Groundnuts, Chana, Almonds, Walnuts in moderate quantity are also important to be consumed
• Simple sugars and salty foods are best avoided.
• Many children throw tantrums while drinking milk, however flavouring ingredients do not make the milk healthy, but are rather heavily laden with sugar.

Obesity leads to type 2 Diabetes in young and may lead to many other Dysmetabloic Syndromes including vulnerability for Ischemic Heart Disease and Hypertension, hence Childhood Obesity must be controlled on war footing. Healthy eating habits must be cultivated in early childhood at home, but with persistence, the child will develop an inclination to home cooked meals over packaged & sugar laden food.

Taste buds develop in early childhood, so children demand spicy tasty food that’s packed with masalas and artificial sweeteners, however these may become a way of life for many children. This has to be systematically controlled; continuous positive reinforcement is the key. Every child must be examined routinely every six months for weight, height, abdominal girth, chest girth (with inhalation and exhalation), and the joints & biomechanical abnormalities of feet to see if they will interfere with sports. All children must be encouraged to take part in sports; physical education and sports performance must be graded and become an important aspect of the curriculum.

Screen time, both from the computer as well as from mobiles, should not exceed more than three hours a day. Two hours of outdoor sports is a habit that must be cultivated at an early age.

Most important aspect to be kept in mind while planning annual curriculum is nutrition education in the school; two classes per week should be on nutrition. When taught well, students could take on the role of health ambassadors and help improve nutrition of others in the house as well. So, Obesity can be easily avoided if nutrition education is given priority at school.

List of the foods which a child can take

• To be consumed everyday – Khichdi, Chaas, vegetables, Carrots, Beans, sprouts, Chana, Rajma, Idli, Dosa, Uttapa, Coconut water, Lime water without sugar, yogurt without sweeteners, Cherry, Papaya, Apple, spotted yellow Banana, and plenty of water
• To be consumed occasionally – Chocolate, Ice Cream, sweets & desserts
• Total absence of food – sugar & energy-dense shakes, chips, and colas

Childhood Obesity is a major cause of concern in young and middle age; this is because there is a direct link between Obesity and Metabolic Syndromes like Diabetes, Hypertension, early heart disease and Dementia. Early control of Childhood Obesity will help prevent the Tsunami of type 2 Diabetes in our country.

~ Authored by Dr Anil Bhoraskar, Senior Diabetologist, SL Raheja Hospital, Mahim & Secretary, Diabetic Association of India (Scientific Section) ~