Age of junk food: Children grapple with obesity

Oct 15,2023

Aggressive, unregulated marketing of ultra processed foods and unwalkable cities have resulted in an increase in obesity among children.
Deccan Herald:  
Last Updated 15 October 2023, 01:39 IST

Bengaluru: A little after the pandemic, Shrikanth K, a gym instructor in Bengaluru, was alarmed to see an increasing number of children, even as young as seven or eight years of age, enrolling at gyms to manage obesity. The pandemic-induced lockdowns had forced children to lead sedentary lives. 

“In a city like Bengaluru parents are worried about kids’ safety while playing outdoors. They believe that the gym is a regulated and safe space,” Shrikanth says. His gym, situated in R R Nagar, designs specialised programmes for children. 

This dangerous development is only an indication of a national increase in obesity among children. According to the National Family Health Survey (NFHS-5), the number of children who are overweight has increased from 2.1 per cent in 2015-16 to 3.4 percent between 2019 and 2021. As many as 4.2 percent of children in urban areas and 3.2 percent in rural areas are identified to be overweight, as well. 

Among the 32 lakh children enrolled in anganwadis in Karnataka, close to two lakh children below six years are overweight and obese as of September 2023, according to data from the Ministry of Women and Child Development. This is on par with the national figures of 6% of children (about 43 lakh) in anganwadis being obese. 

The ubiquity of junk food is one major reason behind such an increase, according to Dr Arun Gupta, pediatrician and convenor of National Advocacy in Public Interest (NAPi). “Ultra-processed food, which is not food per se but products derived from food, are becoming more available and are being aggressively advertised. The first harm from it is weight gain with an eventual risk of diabetes,” he explains.

Ultra-processed food has become so common that parents are quick to substitute these foods for a meal as it is easy to access and inexpensive. For instance, Pushpa (name changed), an anganwadi teacher from Ballari, explains, “Many daily wage workers have no time to cook for their children in the morning. In several cases, parents feed their children biscuits and tea before sending them to anganwadis, even though teachers keep explaining the ill effects of junk food to both parents and children.”  Earlier this year, NAPi, in coordination with Breastfeeding Promotion Network of India (BPNI), released a report on the realities of the consumption of ultra-processed food in India.

The report provides a glimpse into marketing of junk food and its impact on child health. “Aggressive marketing promotes products high in fat, sugar and salt foods or ultra-processed foods. This contributes to poor dietary behaviour in children continues later in life. Increasing junk food consumption makes our diets unhealthy, thus contributing to diet-related non-communicable diseases,” the report states.

For this report, NAPi conducted a qualitative study of 43 pre-packaged food products and their advertisements across various media platforms. “It was found that total sugars were high in 31 products, total fat was high in 29 products, and sodium was high in 19 products. Additionally, eight products exceeded the thresholds for all three nutrients of concern,” the report says. 

In July this year, the World Health Organisation released a set of recommendations to protect children from harmful marketing of such products. Among its recommendations, the organisation has urged countries to implement policies to restrict marketing of foods high in saturated fatty acids, trans-fatty acids, free sugars and salt. It also recommended that the government put in place a nutrient profile model to classify foods that should be restricted from marketing.

Causes and consequences:  While persuasive advertising is one aspect, childhood obesity can be caused due to a number of reasons. Public health expert Dr Sylvia Karpagam explains that the reasons behind obesity could start from infancy. Formula foods and baby drinks can cause weight gain and these have not been adequately studied or regulated. “Formula foods are pushed even by paediatricians claiming that mothers do not have ‘enough’ breast milk.

It is known that children fed on formula tend to be larger than breastfed babies. It is important to ascertain what percent of children are being given formula foods as also ultra-processed foods with high levels of transfats, salts, sugars and additives,” she observes.   Later, hectic school schedules leave children with little energy for physical activity after school, points out Shrikanth. Even in gyms, “ensuring children’s regularity is a challenge as they are sapped of all energy by the time they reach the gym,” he says.  That, coupled with parents’ concerns about children’s safety, further pushes them to a sedentary life inside their homes, he adds. 
An unpublished study on elite schools in Bengaluru by Dr Asha Benakappa, paediatrician and former director of Indira Gandhi Institute of Child Health, as part of which 1,577 children were screened for cardiometabolic risks, finds that 17.6 percent of the children were obese while 28.9 per cent were overweight. Obese children are likely to develop insulin resistance.  “It takes eleven years to build insulin resistance and another equal number of years for diseases like hypertension, pre-diabetes, type 2 diabetes and cancer to develop,” she says.  Many schools have identified obesity as a growing concern and are undertaking efforts to ensure that healthy foods are available in their canteens.
“The menu is overhauled from time to time after consultation with students of all age groups. Snacks sold as breakfast are varied daily and the lunch on the menu is healthy. Junk food like chips and aerated drinks are not available in the canteen and are not encouraged on campus,” says the principal of an unaided school in Bengaluru. 

Design of cities:  However, childhood obesity is not limited to food consumption alone. Dr Rebecca Kuriyan Raj, Professor and Head, Division of Nutrition, St John’s Research Institute identifies that child environment, including school, home and neighbourhood, are equally influential factors for weight gain. Dr Rebecca was the corresponding author of a research paper on the walkability index of cities and its association with childhood obesity which elaborates this phenomenon.  In Bengaluru, 13 percent of schoolgoing children were overweight, while 5 percent were obese, according to this paper.   “Neighborhood walkability, the capability to support walking for multiple purposes such as availing transport, shopping, recreation for children, and commuting to school has shown to promote physical activity and prevent obesity. Increased walkability characteristics have been associated with lower body mass index (BMI) score in children and in adults,” the report says, stressing the need for structured urban planning. 

Undernutrition and obesity:  As data from the Women and Child Development Ministry shows, obesity is no longer an “elite problem” and has pervaded all strata of society. While anganwadis in Bengaluru Urban have 4 per cent obese children, those in lesser-developed districts such as Chamarajanagar and Yadgir have 6 per cent and 7 per cent of obese children respectively.  The general assumption is that the children in anganwadis are underweight. Hence, this data might seem strange at the outset.
Jyotsna Sripada, Research Associate, Centre for Child and the Law, National Law School of India University offers insight into this curious trend by pointing out that “malnourishment” includes both undernutrition (conditions such as underweight, stunting, wasting and severe wasting) and overnutrition (overweight and obesity). “As part of the current policy landscape, anganwadis are designed to address undernutrition. The take-home ration for children below three and supplementary nutrition provided for children between three and six years contribute to only a small portion of the recommended daily allowance for children,” she explains. 

Further, children belonging to vulnerable and marginalized sections are often trapped in a vicious cycle of poverty, malnutrition, and disease as access to nutrition and health-related services is grossly impeded by factors such as geographical location, socio-economic and cultural determinants, household dynamics, and gender, she adds.  Obesity is also not merely related to weight and even thin children could be obese, Dr Rebecca points out. Measuring obesity by body weight alone is a myopic view of the issue. Even thin children could have accumulated more body fat and have abnormal blood biomarkers.

Policy: For instance, the Comprehensive National Nutritional Survey states that abdominal obesity is an important indicator for increased risk of morbidity and mortality from non-communicable diseases.  “Abdominal obesity can occur even at normal BMI levels and can be diagnosed in childhood and adolescence,” the report says. The Indian population has a disposition for greater truncal adiposity, which is a less healthy way to store body fat. 
This poses higher risk of non-communicable diseases, the report further states. As per the survey, 2 per cent of children and adolescents in the country had abdominal obesity (measured by waist circumference). 
When it comes to policy interventions to tackle obesity, especially among children from vulnerable sections of the society, Dr Karpagam warns against the misconception of ‘overnutrition’ associated with being ‘overweight’ and calls it a “fallacious point of view”.  “Obesity still means that the child is not receiving adequate nutrition or is receiving the wrong kinds of food. There has to be qualitative data on food consumption by children, failing which, the response by policymakers will be that ‘children are becoming obese so there is no need for social schemes or other nutritional interventions,” she cautions.