The Obese and Unhealthy Child

The Obese and Unhealthy Child

“Metabolic syndrome? In children? In teens?”

Yes, you heard it right. The prevalence of metabolic syndrome, also known as MetS, is on the rise. Its incidence goes hand in hand with the rising trends in childhood obesity. MetS involves a set of metabolic abnormalities (insulin resistance, hypertension, abnormal lipid profile) associated with obesity. MetS is typically associated with an increased risk of cardiovascular conditions. It is difficult to have a clear-cut definition for MetS in children and adolescents due to racial/pubertal differences, environmental factors and an incomplete understanding of what causes this condition. MetS is a risk factor not only for heart disease but also type 2 diabetes, polycystic ovary (PCOS), hormonal imbalances and fatty liver disease. Given the spectrum of problems it can lead to, let us try to understand what MetS is.

What is MetS?

Defining the condition is not very easy. What historically began as a concept has over 40 definitions today! Most of the definitions take into account abdomen girth (waist circumference, hip to waist ratio), BMI, measured blood pressure, blood sugar values and lipid profile (Triglyceride level and HDL cholesterol). The cut off values for these have been formulated by several international confederations and consortia.

What causes MetS?

A few attendant conditions that are present with MetS are insulin resistance, obesity and inflammation. Insulin resistance is the body’s non-reaction to insulin which raises sugar levels. This leads to inflammation in the body. With obesity, the abnormal fat distribution majorly contributes to the development of MetS.

What are the contributory risk factors for MetS?

• As stated earlier, obesity is strongly associated with MetS. Obesity is diagnosed based on BMI which is calculated from one’s weight and height. A BMI over 95th percentile for age is termed obese. A BMI between 85th to 95th centile is considered over-weight.
• Fat around the abdomen area (Abdominal or central obesity) is particularly harmful as it is connected to MetS as well as heart conditions. The waist to hip ratio is used as a marker for the same.
• Breastfed babies have reduced risk of MetS.
• Children who were big babies and whose mothers had gestational diabetes during pregnancy have an increased risk of MetS.
• Family history of MetS increases the risk of the same in children.
• Lifestyle, diet and exercise are important modifiable factors that are associated with MetS. Sedentary lifestyle, screen dependency, junk foods consumption and lack of outdoor play increase the risk considerably.

How can we prevent MetS?

The concept of eating healthy should be stressed from childhood. A balanced wholesome diet with lots of fruits and vegetables is recommended. Intake of chicken, fish, nuts and lean meat is advised. Avoid fizzy drinks, foods that contain trans fats, fried foods, processed foods, foods with high salt and sugar content. Encourage intake of fiber foods (pears, oats, quinoa, broccoli, berries, lentils, bananas, greens, citrus, beets, nuts).

Make sure children get enough physical activity for at least 3 – 5 days a week. Outdoor play, good sleep routines and a regulated screen/gadget use result in positive changes.

While we do have drugs for treating hypertension, dyslipidemia and type 2 diabetes, treating obesity with drugs in children is challenging as there are not many options. Bariatric surgery for weight reduction in children is not recommended and is advised only under extreme circumstances.

Hence as pediatricians, we focus more so on the prevention of MetS. We identify risk factors and red flag signs early on; children with risk factors, once identified, are monitored regularly and appropriate preventative services are rendered to help them stay healthy and grow up to be healthy, happy adults!