Pooja Wadhwa of Delhi is a conscientious mother. She makes sure her kids Sheetal, 13, and Neil, 8, take homemade tiffin to school. At home, she serves them wholesome meals. But there is no way she can ensure they don't eat anything else. “The school cafeteria has muffins, pasta, hot dogs, noodles and spring rolls. Like others their age, my kids, too, love these kinds of food,” says Wadhwa.
Restricting access to junk food remains a challenge for parents since it is marketed incessantly and is available almost everywhere, including school premises. This may, however, change soon. The ministry of women and child development is working on a proposal to ban junk food in school premises across the country. This means that both Indian snacks like samosas and chole bhature, and fast food options like French fries, burgers, pizzas and colas will soon disappear from the school canteens.
There is also a plan to ban the sale of food high on fats, salts and sugar in and around schools. The proposal, if implemented, will be a step towards checking children's intake of junk food and creating awareness about healthy eating. “We have constituted a nutrition board, which includes senior members from various institutes like the AIIMS, to define what junk food is and to identify the items to be banned,” said a ministry official.
In March, Food Safety and Standards Authority of India submitted guidelines to the Delhi High Court for “making available quality and safe foods in school” after Uday Foundation filed a PIL seeking a ban on the sale of junk food in and around schools as well as a ban on its promotion and advertisement.
But why such a hue and cry over junk food? The fact that junk food is low on nutritional value is known. Not many people, however, are aware about the harm it causes to the body. A study by Scripps Research Institute in Florida showed that high levels of chemical preservatives, hydrogenated oil or trans fat, High Fructose Corn Syrup (HFCS) and monosodium glutamate (MSG) were present in junk food and these altered the function and activity of the brain quite similar to the way cocaine does. So, it is almost like an addiction.
The chemicals create havoc in the body, affecting growth and development, and lead to weight gain. Trans fat clogs the walls of the arteries, making the passage narrower over time, while high salt is linked to high blood pressure. And high sugar causes mood swings and insulin resistance.
Between 2006 and 2009, the number of obesity cases in kids increased from 9.8 to 11.4 per cent. In a study conducted in Delhi, one in every five children and adolescents was found to be overweight. “Earlier, every kid who came to us with diabetes was assumed to be suffering from type 1 diabetes,” says Dr Dheeraj Kapoor, consultant, endocrinology and diabetes at Kokilaben Dhirubhai Ambani Hospital in Mumbai. “Now we see kids as young as 7 and 8, who are suffering from adult onset of diabetes, that is type 2 diabetes and insulin resistance. While we do check them for hormonal imbalances like for hypothyroidism, but in majority of cases, it is the imbalance in the diet and exercise ratio which is the root cause.”
Eating junk food occasionally should not be a problem but the fact is that most parents don’t realise how often their kids indulge in junk food, says Dr Shashank Shah, bariatric surgeon at Fortis Healthcare in Mumbai. “Almost 50 per cent of times, whatever the kids are eating is junk food. An examination of tiffins of school kids showed that less than 30 per cent brought healthy tiffin,” he says.
The effect of junk food is not restricted to just weight gain. “There are so many cases that I have treated of kids with mood disorders, aggression, depressive and even suicidal thoughts, which were linked to junk food consumption,” says Rachna Chhachhi, nutritional therapist.
Since junk food is high in calories but low in nutrition, the brain is deprived of the fuel that is essential for its normal functioning. As a result, its functioning gets altered causing mood fluctuations. Poor nutrition also causes hormonal imbalance.
What has aggravated the situation is the easy availability of junk food. They are stocked in the supermarkets, kept in refrigerators at home and are available even in the school canteen. Most kids get pocket money today. So, they don't need their parents to buy them fast food, they do it themselves.
“It is not only the urban elite but even the middle and lower classes, which have succumbed to it,” says Shobha Shukla, managing editor of Citizen News Service, who is also a gender and health activist. “Eating bread or double roti, as we call it, for breakfast is more a norm now rather than exception. Packet chips and carbonated drinks are the other favourites among kids.”
The parents, too, do not monitor the intake of junk food if their child is not overweight. “They need to understand the difference between watching weight and being healthy,” says Dr Haresh Mehta, interventional cardiologist at Lilavati Hospital in Mumbai. “A person who looks hefty may have more muscle and bone mass while a lean person may have excessive fat percentage which is unhealthy.”
Advertising and marketing have an important role to play in luring kids towards eating junk food. “The food industry is aware of the fact that the only segment where junk food holds the maximum appeal is children, who with their pester power, are surely going to get in the revenues,” says Harish Bijoor, brand and business strategist.
Most big brands have developed strategies to appeal to this particular category of consumers. From using popular cartoon characters and celebrities to offering freebies, these companies keep innovating to remain relevant to their consumers. “If the advertisements stop, kids would also stop asking for junk food. But we have ads reminding them of junk food almost every other minute,” says Wadhwa.
Despite the alarming rate at which cases of childhood diabetes and other diseases are being reported, no guidelines have so far been formulated to keep the promotion of junk food under check. “Advertisements today are made in a very attractive way to lure kids and even young adults,” says Dr Anoop Misra, chairman, Fortis-C-DOC, Delhi, and president of National Diabetes, Obesity and Cholesterol Foundation. “Self-regulation has a very limited role to play, especially in the case of children. Further, with aggressive advertisement strategies, it is difficult even for adults to ignore them.”
With increasing awareness, parents are, however, slowly learning to read the fine print. But the advertisers have also found a way to go around that. They promote the product as being healthy and low on trans fat, even when some of them are not.
Research by a Delhi-based NGO, Centre for Science and Environment, on 16 fast food brands found their labelling to be riddled with inaccuracies. Top Ramen Super Noodles claimed to be trans fat-free, yet the study found it contained 0.7gm of trans fat per 100gm. Similarly, Lays (Snack Smart) claimed to be trans fat-free when the study found 3.7gm of trans fat per 100gm. The companies, however, refuted the allegations.
Even if the information mentioned on the food packages are accurate, unless they are explained in terms of their daily requirement, they are not useful.
While experts agree that the government needs to get tough on labelling and promotion of junk food, it is ultimately the parents who have to be proactive about their children’s health. “The change has to happen at the dinner table,” says Abhishek Sharma, yoga and fitness expert. “Parents should set an example by eating healthy.”
Mumbai-based Vinita Contractor, 38, feels cooking healthy meals at home is not rocket science, but it requires some thought and effort. She has devised a plan for it. At the start of every week, she sits down with her sons—Ahaan, 8, and Sohm, 6—to plan the breakfast menu, which includes dishes like nachni pancake, rajgira porridge and eggs.
She also takes extra effort to cook snacks at home that are made from whole wheat so that she doesn't have to depend on packet food and expose her kids to trans fat and preservatives. “I get a lot of flak for doing this. Some people think I am going to the other extreme, but I don’t let it affect me,” she says. “I know my kids are benefiting in the long run.”
Schools also need to do their bit to promote healthy eating, not just by educating the students about the importance of having healthy food, but also by keeping healthy food items in the canteens.
“We do advise our students on healthy food choices,” says Vladimir Kuskovski, principal of Oberoi International School in Mumbai. “For instance, we don't allow any sugar snacks, but encourage fruit snacks. We also send regular communications to early-year parents to educate them on what should or should not be included in food brought from home.”
Manju Yagnik, vice chairperson of Nahar Group, which runs the Nahar International School in Mumbai, says they have a clear policy on food. “We do not serve junk food or aerated drinks,” she says. “The food served in the school is vegetarian, made of whole wheat and nutritious.”
India is facing the problem of both over and undernutrition at the same time. With the gradual rise in the non-communicable disease burden, we can no longer ignore the problems arising from unhealthy eating habits.
While passing the law is the first step, its implementation is equally important. In 2012, Uttar Pradesh announced the ban of junk food in and around school premises. But it was soon forgotten. “When they have not been able to prevent the sale of tobacco products within 100 yards of school premises [as the law demands], implementing a ban on junk food seems like a tall order,” says Shukla.
There is also a lackadaisical attitude towards labelling. “We have been working on the labelling issue since 2010 but there is little that has been achieved till now. India hasn’t even thought about regulations on advertising of junk food,” says Amit Khurana of Centre for Science and Environment.
Not all is lost yet. Our childhood obesity figures are nowhere close to that of developed countries. If we act now, we can prevent the future generation from going down a similar line. One can start by keeping junk food off the dining table and reintroducing our regular traditional fare. So, say goodbye to pastas, burgers and samosas, and say hello to rajma chawal and idli sambar.
HEAVY BURDEN
Sagar Balani's birth weight was normal. But by the time he was 7 years old, Balani weighed over 100 kilos with a BMI of 80 (22.5 is considered normal). When kids his age were busy playing, Balani could not even move or lie down. He suffered from diabetes and had high blood pressure and cholesterol levels.
His family was initially not worried about his weight gain, but when he crossed 100kg, they were alarmed. They tried everything to help him lose weight but in vain. Finally, they consulted Dr Shashank Shah, bariatric surgeon at Fortis Hospital in Mumbai, who suggested a gastric bypass surgery.
Balani was 8 when he underwent the procedure. He is the youngest person in India to go under the knife to lose weight.
Outside Shah’s clinic, I meet 8-year-old Rani (name changed), who weighs 65 kilos. She suffers from sleep apnoea and diabetes and her cholesterol levels are high.
While bariatric surgery should be considered as the last option, especially in children, doctors are seeing an increasing number of parents inquiring about the surgery for their kids. “I see five to seven morbidly obese kids a month and operate on about 24 kids a year,” says Dr Ramen Goel, senior metabolic and bariatric surgeon at Hinduja Healthcare in Mumbai.
The effects of obesity, Goel says, are felt in phases. The first phase is characterised by childhood obesity, phase two by the emergence of obesity-related co-morbidities, phase three by medical complications with serious health risks like death in middle age and phase four by the changes that are transmitted across generations. “India is currently in phase three,” says Goel. “We are reporting heart attacks at a young age with comorbidities like liver cirrhosis, fatty liver and a shorter life expectancy.”
DON'T OVERFEED
By Anita Jatana
The idiom, you are what you eat, holds true for both adults and children. In fact, focusing on nutrition during childhood, the formative years, is of prime importance since children are growing, developing bones, muscles and blood.
Growth must be monitored regularly so that weight issues can be identified early and intervention initiated to prevent long-term adverse consequences.
There is prevalence of obesity in 11 per cent of children in the age group 6 to11 and BMI>95th percentile. This increasing trend of obesity in children is a significant and alarming public health problem. The longer a child is overweight the more is the likelihood of his being overweight in adulthood.
The consequences of obesity in childhood include psychosocial difficulties, negative self-image and health consequences like early manifestation of cardiovascular risk factors and diabetes.
At the other end of the scale is undernutrition, which is leading to deficiency of macro or micronutrients and compromised rate of growth. So, good eating habits established in the formative years will help children in optimising their health now and in later years.
DON’T REWARD WITH JUNK FOOD
By Bhakti Samant
Junk food is anything that is tasty, convenient and fashionable. It includes burgers, pizza, fries, noodles, pakoras, samosas, namkeen, chips, chocolate, soft drinks and packaged food.
One reason why children end up eating junk food is that working parents are hard-pressed for time. They depend on ready-to-eat packaged food or fast food.
Another reason is the aggressive marketing by the companies selling such products. Fast food ads featuring popular cartoon characters promote unhealthy dietary practices and kids end up being on a diet high in fat, sodium and added sugar.
Worse, junk food is now widely available in schools through a variety of outlets.
Children today have no time for recreation or sports as they are overburdened with homework and tuition classes. Zero physical activity and an unhealthy diet put the children at the risk of obesity and other allied diseases.
The eating habits of the parents play an important role in inculcating good habits in children. For example, parents who are obese or have unhealthy eating habits set a wrong example for their kids. Then there are parents who use junk food as a reward.
Worldwide, obesity trends are a serious public health concern as they act as an independent risk factor for cardiovascular diseases and significantly increase the risk of morbidity and mortality.
Childhood obesity is a global phenomenon affecting all socio-economic groups, irrespective of age or sex. Many comorbid conditions like metabolic, cardiovascular, psychological, orthopaedic, neurological, hepatic, pulmonary and renal disorders are seen alongwith childhood obesity.
A multidisciplinary, multiphase approach, which includes dietary management, physical enhancement, restriction of sedentary behaviour and an overall lifestyle modification, is required to bring it under control.
Here is a sample menu that would make sure that your child stays away from junk food.
Early Morning: One glass of toned milk (3 per cent fat milk)
Breakfast: Homemade snacks like poha/upma/oats upma/daliya upma/vermicelli upma/thepla/omelette with one chapati.
Mid-morning: Fruit or a few almonds with walnuts or buttermilk. (Fruits to be consumed in between meals. It helps in reducing the starving time between the meals and healthy fillers.)
Lunch: Vegetable salad with phulka and cooked vegetable and dal or vegetable salad with veg pulav/biryani with kadi or veg-stuffed paneer paratha with curd or grilled chicken/egg rolled in chapati or vegetable salad with veg paneer pulav with kadi.
Evening: One cup toned milk with one tomato omelette cooked in non-stick pan/one moong dal chilla/boiled chana chaat/steamed sprouted chaat/sprouts bhel/moong dhokla/khakra chaat/kurmura bhel (no sev) with lots of vegetables. (All the options are rich in proteins and low on fat, hence healthy.)
Midevening: Fruit or a few almonds with walnuts.
Dinner: Same as lunch.
Bedtime: One glass toned milk. Total fat intake to be limited to 500ml/person/month.
Note: This is only a sample plan. Portion size will vary depending on age, recommended dietary allowance, physical activity pattern and calorie goal.
Samant is senior dietician at
Kokilaben Dhirubhai Ambani Hospital, Mumbai.
STICK TO SMALLER PORTIONS
By Rachna Chhachhi
It is sad to look around and see what could have been beautiful teenagers with lovely hair and skin, and energetic, lithe bodies, actually looking like plump swarms of pimples, with bodies and skin marred by bad eating habits. Today’s generation is probably the ugliest that urban India has ever seen, when in reality, these kids are taller, have better features and access to quality nutrition.
Everyone knows eating junk food is bad. Parents are worried about it and children are irritated about not getting it. And, yet, there is a lack of understanding among parents and teenagers about its repercussion.
Effect of junk food:* Soft drink consumption is associated with aggression, depression and suicidal thoughts in adolescents and younger children in addition to attention problems and withdrawal behaviour.
* The moment the child hits puberty, a lot of hormonal changes occur in his/her body. The hormonal fluctuations can get aggravated with junk food, leading to hormonal imbalance, polycystic ovary syndrome, obesity, acne and hair fall in girls, and aggression and stunted height in boys.
* Kids and teenagers with a history of asthma can get more frequent attacks with colas, processed meats, white flour, sugar, bottled dressings, bread spreads and instant noodles. In fact, elimination of these has shown to make asthma disappear in kids hitting puberty.
A lot of these problems carry into the twenties, with cases of depression due to poor body image, a compromised stomach lining leading to IBS (irritable bowel syndrome) and early onset of lifestyle diseases like type 2 diabetes, hypertension and high cholesterol.
Ideal dietAn ideal diet for teenagers can go a long way in eliminating or minimising the problems. A way to inculcate good habits in kids is by setting an example as a parent: if the parents cook and eat fresh, nutritious, homemade food, then that would be the only kind of food available to teenagers when they open the refrigerator in the middle of the night.
Given below are some options.
BreakfastIt should always be a combination of a protein and a complex carbohydrate. It releases the sugar slowly in the blood, leading to lower hunger pangs at lunch. The fibre in the complex carbohydrate ensures excretion of toxins.
Some healthy options
* 2 full eggs (a lot of parents think eating egg white is “healthier” which is wrong, as the yellow is a powerhouse of nutrients) with whole-wheat toast
* Whole-wheat cereal (not cornflakes as corn is a simple carbohydrate) with yoghurt
* Oats made as upma.
SnacksThere should always be three meals and two snacks to pre-empt bingeing. One snack of mixed fruits, between breakfast and lunch, and a second snack of mixed nuts, between lunch and dinner, will curb the cravings for the packet of chips.
Lunch and dinnerIt should be a good mix of protein, fibre and complex carbohydrates.
Some healthy options* Fish curry with brown rice and a bowl of a seasonal vegetable
* Stir-fried tofu with seasonal vegetables and rice
* Rajma, brown rice and vegetable
* Raw salad (without cabbage and broccoli as these need to be cooked) with chicken or low-fat cottage cheese with extra virgin olive oil and a whole-wheat toast
Tips and tricksWhen eating out, there is always a healthier option available like grilled vegetables with durham wheat pasta; grilled fish or chicken with vegetables; idli sambar; parantha-sabji, or yoghurt smoothies.
Stop stocking cold drinks, juices and chips in the house. Replace these with healthy options.
Stop overfeeding. ‘Finish what’s on your plate’ is the worst diktat any mother can give to her child. Instead, serve small portion sizes so that food wastage is minimal. It also prevents overeating.
Chhachhi is a nutritional therapist specialising in
the treatment and reversal of chronic lifestyle diseases
in adults and children.
GOOD EATING HABITS* Ensure proteins like dals, besan, paneer, egg, cheese, chicken and soya are included and meals are not carbohydrate and fat dense.
* The meal should be low in saturated fat, trans fat, sugar and salt.
* Avoid soft drinks, sweetened juices and energy drinks.
* Opt for whole grains rather than refined cereals.
* Give at least one serving of fruit, three to four serving of vegetables, two serving of milk, four to five serving of cereals and one to two serving of non-veg or dal every day.
* Do not let the child skip breakfast as it affects cognition and school performance.
* Eating together as a family in a happy and relaxed atmosphere is important.
* Discourage watching television while eating.
* Don’t overfeed children.
Jatana is chief dietician at
Indraprastha Apollo Hospitals, New Delhi.
GLOBAL WARNINGBritain: With 26 per cent of its population obese, Britain banned junk food in schools in 2005. And, in 2008, it banned ads aimed at children below age 16.
The United States: The US department of agriculture banned the sale of junk food in schools from July this year. Items with more than 35 per cent fat cannot be sold. Only water, no-fat milk, 100 per cent fruit or vegetable juices are allowed to be sold.
Mexico: As part of its anti-obesity campaign, Mexico has banned junk food in all public, private and elementary schools.
Hungary: Imposed fat tax on food high in salt, sugar, carbohydrates and fats in 2011. Carbonated drinks, alcohol and drinks with caffeine were also taxed.
Denmark: Implemented a fat tax on junk food in October 2011. Surcharge is levied on products like butter, bacon, milk, cheese, ice cream if they contain more than 2.5 per cent of saturated fats.
Bitter bite
Junk food has high sodium content, which leads to hypertension and high cholesterol. It can cause heart disease in the future.
Deposition of cholesterol leads to hardening of blood vessels and atherosclerosis even in young patients.
Chemicals in processed food cause various allergies, especially respiratory.
According to a study by Dr Sundeep Salvi of Chest Research Foundation, women who consume junk food during pregnancy had a higher chance of having kids with asthma.
Lack of fibre in junk food leads to constipation.
Eating calorie-dense food results in sudden increase in blood sugar levels. So the body secretes insulin, which brings the levels down. Because of this sudden rise and fall in sugar levels, the body becomes insulin-resistant, which leads to diabetes and polycystic ovary syndrome.
Since junk food is not nutritious, kids become deficient in micronutrients like
iron and vitamins A, B and C.
Weight gain makes kids lethargic. Studies have shown high levels of depression, especially in boys and low self-esteem in girls due to obesity.
A study published in the Lancet found that in 64 per cent of children with Attention Deficit Hyperactivity Disorder (ADHD), an unhealthy diet was the likely the culprit.
Source: Dr Tanu Singhal, consultant paediatrics at Kokilaben Dhirubhai Ambani Hospital; Dr Ramen Goel, senior metabolic and bariatric surgeon at Hinduja Healthcare; and Shireen Hamrapurkar, counselling psychologist
