To feed or not to feed
The human race varies in shape and size, unlike articles manufactured on a conveyor belt. As people look around, they worry about this difference in weight. Parents are perturbed by thin children, and want them to gain weight. Actually, both ends of the spectrum — very thin and very fat (BMI over 30 or under 18.5) — can face health problems and need help.
Obesity, which once seemed a problem of developed countries, has arrived with a bang in India. We are now home to 3.7 per cent of obese men (around 9.8 million) and 5.3 per cent (around 20 million) of obese women in the world. India also has 40 per cent of the global underweight population. About 42 per cent of our children below the age of 5 are thin.
Being over or underweight is not just an aesthetic problem — obesity is associated with lifestyle diseases such as diabetes, hypertension, arthritis, stroke and an increase in the incidence of many cancers.
Being “thin” may result in stunted growth in children as well as failure to attain their full physical and mental potential. In underweight people all age groups, essential nutrients like amino acids, vitamins and minerals may be deficient. This may produce inadequate muscle mass, weak osteoporotic bones and anaemia. The immune system may not function efficiently so that frequent infections are common. Underweight women are more likely to suffer miscarriages during the first three months of pregnancy. Children carried to term are likely to be underweight and anaemic.
A low BMI can be normal in a person genetically predisposed to be thin. It can occur with infections such as tuberculosis, cancer, untreated diabetes, an overactive thyroid gland, gastrointestinal and liver disease.
People can also have emaciation, an extreme form of low weight with a gaunt appearance, loss of subcutaneous fat and lack of energy. It is caused by severe calorie restriction. The starvation may be due to poverty, infestations with intestinal parasites, malignancy and infections. It can be due to psychiatric illness or eating disorders like anorexia nervosa.
Parents worry about children who look thinner than their peers. Babies should ideally double their birth weight at the end of the fifth month and triple it by the first birthday. A child who was 2.5kg at birth should be 7.5kg on their first birthday. One who was 3.5kg at birth will be 10.5kg. Although both are normal, one child will appear bigger than the other. After the first birthday, 2-3 kilos are gained a year till puberty, when there is a growth spurt. Weight gain depends on the appetite, which in turn is controlled by a centre in the brain.
Most of the time, children spontaneously regulate their appetite and instinctively know how much food should be consumed. This mechanism fails if there is force feeding, if the child is a finicky eater who does not like the food, or if there is stress and conflict while eating. Allergy to milk or other food may cause stomach pain and refusal to feed. There may be undiagnosed gastrointestinal reflux.
The value of exercise cannot be underestimated. At any age, 60 minutes of continuous physical activity will help to control weight, working off the excess calories in the obese and increasing the appetite in the underweight.
• By the age of two, children should be eating the same things as the rest of the family
• Meals should be eaten at fixed times
• Food should be eaten at one place, the dining table, and not all over the house or in front of the television
• Force feeding, scolding and beating should be avoided to reduce stress
• Children require six meals a day as their stomach size is small
• Avoid more than 400ml of milk per day
• Avoid sugar-laden snacks
The writer is a paediatrician with a family practice at Vellore and author of Staying Healthy in Modern India.
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