Feeding an extra portion too much

the unwholesome way to growing them up

Editor’s note: As under-nourishment is receding and developing countries are moving up the economic ladder; the generation Z’s are getting overindulgent in fast food and sedentary lifestyles.

The effect is burdening and menacingly giving rise to several diseases. At this rate, halting the tide of obesity by 2025 may remain challenging unless and until the feeding behavior for children is addressed. The author digs deeper into how the problem gets initiated early in life, by looking at the world through his lens of numbers.

Laughing Buddha these days do wonder if it’s time to shed those extra kilos and become the modern age Zen.
Image credit Pixabay.

In the last couple of months, my wife and I have put on a few extra kilos, which we are keen to shed now. For this makes our aging bones toiling much harder, especially in lifting the increased weights up the staircase to our third-floor apartment. We were quick to attribute this condition to the harsh winter this time around and its attendant high level of air pollution in the national capital region, which prevented us from our usual outdoor activities in the morning. So, as the spring set in we have resumed our routine morning workouts.

In the park we visit, as we make the rounds, we, therefore keep ourselves particularly observant of the masses of living matter that other people are carrying on their feet so that we get some psychological comfort from the weight-comparing drills we do with the eyes.

Unlike Indians in general, people of our area are well known for their good physique and higher consciousness about the figure and shape of their own persons. Strangely enough, our eye estimation suggested, much to our satisfaction, that oversized figures have outnumbered, by a good margin, the wiry figures typical of this area. I got convinced, thanks to these pot-bellied visitors, of how the food industry has fatted here.

No, this opening narrative is no anecdotal evidence as my description may suggest; nor the result of an aberration of parallactic vision. It’s just an inset image within a bigger picture of nutritional transformation that people from all parts of the globe are being subjected to.

Yes, lopsided nourishment is what nutritional transformation is all about and evidently one of the ill effects of economic development causing drastic changes in food culture.

The Rapidly Growing Overfed

Created by the extremes of the food supply, the world we are living in now is polarized between hundreds of millions of unfed and overfed people. A research published in 2016 has revealed how the growing number of overfed people has brought about a new imbalance – offsetting the broader social, economic and medical concerns for the unfed and underfed population. The study shows an enourmous 167% rise in the number of obese people between 1975 and 2014 compared to only 35% fall in the number of underweight people during the same period.

Obesity increment rate has outpaced the decline of the underweight.
In the last 40 years, the number of obese people has increased by almost 2.6 fold from 105 million in 1975 to 641 million in 2014. Plotted by the author; Data Source: NCD Risk Factor Collaboration (NCD-RisC)

Overweight and obesity are defined as ”abnormal or excessive fat accumulation that presents a risk to health”. Generally, for an adult, these are measured by a person’s body mass index (BMI), which is a person’s weight in kilograms divided by the square of his height in meters (kg/m2). An adult with a BMI of 25 to 29 is considered to be overweight, while someone with a reading of 30 or more is obese. According to the World Health Organization (WHO), unfortunately, more women than men are tipping the scales at obesity levels. This could be attributed to several factors like lifestyle, economic conditions, racial makeup, and preexisting health conditions. Regardless to say obesity could consequently impact women’s reproductive health.

Concerns about the health and economic burden of increasing BMI have led to adiposity (i.e., a condition of being severely overweight or, obese) being included among the global non-communicable disease (NCD) targets, with a target of halting, by 2025, the rise in the prevalence of obesity at its 2010 level.

Age-standardized mean BMI in men (A) and women (B) by country in 1975 and 2014.
Data Source: NCD Risk Factor Collaboration (NCD-RisC)

Disease Burden: Obesity vs. Under-nutrition

Globally more people are obese than underweight – this occurs in every region except parts of sub-Saharan Africa and Asia. Overweight and obesity are also linked to more deaths worldwide than underweight. Although there’s been a focus on mortality, there’s a huge volume related to things that don’t really kill you. Jessica Hamzelou wrote in 2012 about a shift in disease burden.

In 1990, under-nutrition was a leading cause of disease burden, measured as the number of years of healthy life an average person could expect to lose as a result of illness or early death. Back then, a high body-mass index, or BMI, was ranked tenth. Now, under-nutrition has dropped to eighth place, while BMI has risen to become the sixth leading cause of disease burden.

Jessica Hamzelou

Morning shows the day

Childhood obesity threatens our younger generations, similar to what under-nourishment did in the past few decades. The prevalence of overweight and obesity among children (under-5) and adolescents aged 5-19 has risen dramatically from just 4% in 1975 to over 18% in 2016. However, this trend remained consistent for both the genders, unlike adults.

Standards of measuring overweight/obesity for children under 5 years of age are, however, different from those for adults and adolescents. Unlike BMI, this is measured from the weight-for-height distribution of a vast number of children. In the case of overweight and obese children, the weight-for-height lies in the higher extremes of this distribution.

One of the leading causes of childhood obesity is the larger portions fed in early childhood days, according to Hayley Syrad, from University College, London. Some parents may be over-feeding their children, and in the process driving them to a higher risk of obesity-related health hazards. So the problems do show up just in childhood when a healthy diet and healthy size of diet-portions are often lost sight of.

Studies show that overweight children are more likely to become overweight adults. Even birth weight tracks a person’s growth to adulthood: “A bigger baby is likely to be a bigger child and then a bigger adult”, researchers said. Dr. Clair McCarthy, of Harvard Health Publishing, predicted based on a new study in December 2017 that more than half of the children are going to be obese adults.

Not only are more than half of current children going to be obese by 35, but an obese 2-year-old has only a one in four chance of not being obese at age 35. If that 2-year-old is severely obese, the chance of being at a healthy weight at 35 is only one in five. By the time that severely obese child is 5, they have only a one in 10 chance of not being obese at 35.

Dr. Clair McCarthy, of Harvard Health Publishing

Over-nourishment – an effect of economic transition

The global burden of obesity and overweight has increased at an accelerated rate as the under-developed and developing countries have moved up the economic ladder and switched from traditional diets to western food styles, B M Popkin and L S Adair et al,. of the University of North Carolina observed. This Nutrition transition in case of children under 5 years of age has resulted in a great extent from the practice of feeding large meals that wouldn’t have been afforded otherwise by parents from lower income bracket.

The concern about the growing prevalence of overweight children, therefore, is no longer restricted to developed countries alone. With the economic situation improving in developing countries, child-feeding behavior is changing in these countries too.

We take the help of statistics for some of the developing countries to show how those who can afford to spend more on food are more prone to have overweight children. Compared to children from the families of the lowest echelon of income (termed 1st wealth quintile or 20% population of the lowest income), children from the 5th wealth quintile families (comprising 20% population with the highest income) are exposed to a higher prevalence of overweight, as the developing countries’ data shows.

The tendency and stimulus to feed large portions of meals that cause more harm to a child’s growth are linked to having enough money.
Plotted by the author; Data source- UNICEF’s Expanded Global Database on malnutrition 2019

Urban lifestyle impacts feeding practices

The phenomenon of the prevalence of overweight children being correlated with the economic condition of their parents is also discernible from the rural-urban differential of the prevalence. The fact that urban people are economically better off than rural people in countries of the developing world is reflected in how they feed their children.

Lack of capacity to afford and lesser accessibility to pre-prepared and packaged foods of low nutrition is a boon in disguise for people in rural areas of the developing countries. Children of rural areas as compared to urban children, therefore, are less exposed to overfeeding as may be evident from the prevalence differentials in some of the developing countries.

Overfeeding children is more of an urban trait.
Plotted by the author; Data source- UNICEF’s Expanded Global Database on malnutrition 2019

Rapid urbanization and improving connectivity, however, are quickly obliterating the rural-urban divide. A study has attributed the global obesity epidemic among adults to the rising rural-BMI.

…contrary to the dominant paradigm, more than 55% of the global rise in mean BMI from 1985 to 2017—and more than 80% in some low- and middle-income regions—was due to increases in BMI in rural areas…rural under-nutrition disadvantage in poor countries (being replaced) with a more general malnutrition disadvantage that entails excessive consumption of low-quality calories.

NCD Risk Factor Collaboration (NCD-RisC)

Educated mothers do them more harm

Data shows children being overweight is more prevalent where mothers of the children are more educated. Children by mothers having no education or primary education are less likely to be overfed than children of mothers having secondary or higher education according to estimates of the WHO-UNICEF-World Bank Group joint malnutrition database.

Female education in developing countries is positively correlated with the economic condition of people. So, the more educated mothers are likely to be from economically better off families and, therefore, have feeding behavior as of the higher  Wealth Quintal population. Education seems to have mattered little as the chart below shows for the selected developing countries. 

Mothers should know that babies and young children who are not overweight should eat until they are full rather than being made to finish everything on their plate.
Plotted by the author; Data source: UNICEF’s Expanded Global Database on malnutrition 2019.

To halt the increasing economic and health burden of obesity, the growing prevalence of overweight children can’t be set aside for the future. It needs urgent attention in developing countries and must not be allowed to slip out of hands. Focus on sensitizing the mothers to arrest the proliferation is the key.

Parents must practice responsive feeding or feeding when hungry

It’s a common mistake among parents to overfeed their toddlers, thinking it’s a necessary way of making sure they grow up healthy. Pressuring a child to eat is a feeding behavior that attracted the most attention of researchers. It’s the size of the portions of the feed forced upon children that matters in spoiling response behavior of children more than the frequency of feeding or feeding an extra Mars bar or an apple, said the researchers. A child should eat a child-sized portion, not an adult-sized one. Using smaller plates is one way to make this easier. For every extra 24 calories consumed during each meal, there was a 9% increased risk of becoming overweight or obese, studies found.

Forcing the child to eat raises the risk of weight gain by undermining the child’s ability to self-regulate food intake.
Image credit Pixabay.

If post-2000 trends of accelerated growth of overweight/obesity continue unabated, especially among children, the probability of meeting the global obesity target is virtually zero. Halting the growth has to happen from the beginning when the children will be tuned to regulate how their own appetite should be fulfilled, and mothers will stop pressing for an extra portion.

Author: Satyabrata Chakrabarti; Edits and blog design: Rituparna Chakrabarti

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