Obesity in children

Obesity in children can lead to Type 2 diabetes. Diabetes nurse educator, Christine Manga, shares how parents can prevent obesity.


Obesity stats

Africa is ranked as having the highest rate of obesity in preschool children in the world. South Africa was also listed as one of the top countries that have obesity issues. These stats were presented in  October 2016 at a World Obesity Day presentation.

If the current rate of increase continues, by 2025, there will be approximately 3,91 million overweight (BMI 25-29,9) and obese (BMI > 30) school children. This would result in 120 000 children with impaired glucose tolerance (pre diabetes) and 68 000 with overt diabetes.

Childhood obesity also carries other health risks:

  • Breathing problems, such as sleep apnoea and asthma.
  • Joint and musculoskeletal discomfort.
  • High blood pressure and high cholesterol which are cardiovascular risk factors on their own.
  • Fatty liver disease and heartburn.
  • Psychological and social problems, including discrimination and poor self-esteem.

Birth to Twenty

A study, Birth to Twenty (BT20), conducted in Soweto, showed that obese children between the ages of four and six were 42 times more likely to be obese in their teens, compared to their peers of normal weight. Childhood obesity is also a strong predictor of adult obesity. Once obesity in childhood is established, it is very difficult to treat. But it is not impossible.

Cause of childhood obesity

The causes of childhood obesity are complex. The most obvious causes are overeating and under exercising. Other reasons obesity may occur include: sleep deprivation, poverty, and genetic predisposition as well as social and environmental components.

As much as psychological issues can be caused by obesity, they too can lead to obesity. Kids who are stressed, bored or depressed may become emotional eaters. Certain cultural beliefs about body shape may further exacerbate the obesity pandemic.

Exercise and dietary recommendations

With under activity being one of the major contributory factors, it is worth noting the WHO exercise recommendations. Children in the five to 17 year age band should be getting a minimum of 60 minutes of exercise a day. This can be incorporated into play and sport.

The other main contributor of obesity is over eating. An average calorie intake for a child of the following ages should be:

  • 2 – 3 years = 1000 per day.
  • 4 – 8 years = 1200 per day.
  • 9 – 13 years = 1600 per day.
  • 14 – 18 years = 1800 per day.

These calories should include no more than 100 calories from added sugars. This equates to 25 grams of sugar or less than six teaspoons a day.

It is very easy to overshoot these numbers, considering that a 330ml can of Coke contains seven teaspoons of added sugar and contains 139 calories (already more than the daily quota for added sugar). While a medium chocolate muffin contains 364 calories.

Poverty

Poverty also plays a huge role as energy dense food (often high in unhealthy fats) cost less than the healthier, low energy dense options, such as fruit, vegetables and protein.

Energy dense food contains high levels of calories per serving. These foods tend to fill you up, but often have poor nutritional value. They will usually contain hidden sugars, fats and salt.

For more information on the nutritional value of food, read the food labels on the packaging. Fatsecret South Africa is a very helpful website and can be downloaded as an app.

Sleep deprivation

Sleep deprivation is associated with poor eating habits and significantly increases the risk of becoming obese. The National Sleep Foundation recommends that three to five year olds should get between 11 to 13 hours of sleep a night, while six to 13 year olds should get nine to 11 hours.

So, how do parents prevent children from becoming obese?

Firstly, we need to lead by example. Parents are the single biggest influence on their children. We need to make healthy food choices as often as possible. Don’t keep high sugar and fat foods at home. Let your children learn that there are healthy everyday foods. These should be readily available where possible.

Then, there are ‘sometimes’ foods; these should not be kept at home or readily available. Be aware of the foods that are being advertised on TV and social media. Children are susceptible to this conditioning.

Packing lunch boxes

When packing a lunch box, make one swap a week to replace the unhealthy options until eventually you have a nutritious box packed. For example:

  • Swap dried fruit, which is high in calories and sugar and easy to over consume, for a fresh fruit.
  • Add a crunchy vegetable; they add colour and are high in nutrients.
  • Replace a cold drink with water. Flavour it by putting in a few berries or cucumber and mint.
  • Let your child experiment. Shift from white bread to whole grain.
  • To keep your child interested, try to vary between rolls, pita and regular bread.
  • Change the filling from jam or chocolate spread to a protein, such as cheese, egg or a nut spread.
  • If you are unable to make school lunches at home, get involved with the school tuck shop. Even if you are physically unable to help out, make suggestions of foods that should be offered and those that should not be.

Do not use food as a reward

Praise your child when making healthy food choices. Do not use food as a tool to bribe, punish or reward behaviour. It can cause an unhealthy relationship with food.

Eat as a family at a table

Where possible, sit together as a family to eat. Avoid eating in front of the TV or computer as this leads to mindless eating and often over eating.

Encourage activity

Encourage your child to take part in sport. Activity is of paramount importance in preventing obesity.

Obesity is preventable and it is a parent’s responsibility to assist in preventing it.

eating time budget

MEET OUR EXPERT


Christine Manga (Post Grad Dip Diabetes and Msc Diabetes) is a professional nurse and a diabetes nurse educator. She has worked with Dr Angela Murphy at CDE Centre, Sunward Park since 2012.


Two auto-immune diseases, two healthy children


Not even two auto-immune disease – Type 1 diabetes and Graves’ disease – stopped Tara-Lee De Wit from starting her family. She shares this journey with us.


Tara-Lee De Wit (28) lives in Hopefield, Western Cape with her husband and two children, Madison (6) and Kayden (4 months).


Auto-immune disease 1: Type 1 diabetes

In October 2007, at the age of 18, Tara-Lee would walk in to work with two bottles of juice, a bottle of water, a whole-wheat sandwich and fruit. However, the contents of this lunchbox would never sate her appetite. The scale shocked her with the fact that she had lost 6kg. “Considering how my calorie intake had increased over the past two weeks, I knew something was wrong,” she says.

What followed was a five-day stay in hospital and a diagnosis of Type 1 diabetes. Here, she was taught how to inject her stomach and thighs with insulin, and the importance of drinking water to flush ketones out of her system if she experienced a hyperglycaemic episode. “I was dreadfully shocked. No one in my family had diabetes. Let alone Type 1. But as I learnt, it is not hereditary. Thinking about it now, it seems scary, but in the moment, you do what you must do. You have no choice,” explains Tara-Lee.

Obviously, the teenager was overwhelmed but took her diagnosis in her stride due to her being a naturally disciplined person. “I learnt and researched as much as I could about my condition. Diabetes would not own me; I was adamant about that,” she adds.

Auto-immune disease 2: Graves’ disease

At 25-years-old, then a mother of one, was plagued with an abundance of symptoms: heart palpitations, heart rate constantly above 100bpm, constantly anxious, slight tremors in her hands, and then a goitre (swelling in the neck due to the enlargement of the thyroid gland). It was diagnosed as Graves’ disease, where the thyroid gland produces too much thyroid hormone (hyperthyroidism).

“During my research after my diabetes diagnosis, I read that when you’re diagnosed with an auto-immune condition, it is likely you can have more than one. However, I was still quite stunned. Once again, I read up as much about Graves’ disease and the thyroid as I could. Interestingly enough, both diseases I have are the rare ones. Hyperthyroidism affects up to 5% of people between the ages of 20 – 40 years old. Whereas hypothyroidism – where the body operates at a much slower rate, slow heartbeat, lacklustre, no energy, more prone to depression – is much more prevalent. Just like Type 1 only accounts for 10% of all diabetes, and is diagnosed mostly in children and young adults.”

Treatment

Currently, the 28-year-old takes Actrapid and Protaphane, injecting four times a day (Basal-bolus regime). The amount of insulin she takes is dependent on whether she is exercising, sick, and what she eats. “It allows me to change it accordingly to my lifestyle which is great. I am in control,” Tara-Lee says. For her thyroid, she takes 2,5mg of Carbimazole. Her thyroid is at optimal levels now.

Conflict of auto-immune diseases

If Tara-Lee’s thyroid hormone levels are high, then it interferes with her blood glucose control. But during this time, if it occurs, she takes extra insulin, until the thyroid medication starts working. “It takes about two weeks until you see a difference in thyroid levels,” she explains.

Pregnancy 1

Despite being a scared 22-year-old with Type 1 diabetes, the young mother had a very good pregnancy. “I knew I was doing everything I had to, to ensure the health of my baby remains at optimal levels. I had a consistent 6% HbA1c, and when Madison was born, my HbA1c was 5,4%. Madison was a bit bigger than normal, but babies born to diabetic mothers are known to be bigger when born. After a five-day hospital stay, Madison and I could go home,” she says.

Pregnancy 2

Tara-Lee had her second child, Kayden, this year July. The pregnancy was planned. Before conception, she worked with the endocrine unit at Tygerberg Hospital to ensure her HbA1c and thyroid levels were exactly where they should be. This took six months, then the married couple got the go ahead. Two months later, Tara-Lee was pregnant.

Describing this pregnancy, Tara-Lee says, “Despite a high blood pressure scare, all went well thankfully. Kayden was just growing exponentially and a decision was made to take him out via C-section at 37-weeks’ gestation. My big boy shocked all the doctors when he came out at a whopping 5,1kg! I was told he would have some lung immaturity (wet lungs), but we had no choice. He was on oxygen for a couple of days, and after all checks were done we went home after 11 days in hospital.”

You do what you have to do

With both pregnancies, Tara-Lee had to travel 300km every two weeks to the hospital. She did this for nine months, sometimes every week. She had much more foetal monitoring scans than someone who doesn’t have a high-risk pregnancy, and her HbA1c and thyroid levels were checked every 4-6 weeks. Commenting on this, Tara-Lee says, “You push through… you do what you have to. The team at the hospital was amazing; they helped me complete my family: two healthy babies even though I have two auto-immune conditions.”

10 years of being a diabetic

When Tara-Lee was asked how she feels looking back at her diagnosis 10 years ago, she responds, “I do not give much thought to the fact that I am diabetic. It is part of who I am. I always have my glucose meter with me, a roll of sweets in my bag, in the car, in my pocket…for that emergency hypo. I constantly carry my small bag with my insulin pens around with me.”

“But, in the beginning…in all honestly, the first thing I was concerned about was pregnancy. I knew it would probably be a huge undertaking, but was aware that pregnancy and diabetes can happen. Dr Google gives numerous horror stories. I remember searching online and in book stores for a story of a young South African woman with Type 1 diabetes, and her successful pregnancies. But I didn’t find any. This is what motivated me to share my story…for women in the same position I was…they need to hear the positive stories.”

Knowledge is power

“I am fully aware of what my body is susceptible to due to these two conditions I have: possible deteriorating eyesight, more prone to infections, take longer to recover when sick, kidney function must remain optimal etc. However, I take care of my body. This is what everyone should be doing anyway though.”

She goes on to say, “Diabetes is nothing to be afraid of. Knowledge is power. To this day, if someone finds out I have diabetes, they immediately say, ‘Oh, you are so thin, so which one do you have then?’, or ‘You don’t look sick!’ I hate hearing this. Yes, I do not look sick at all. I can do anything and be anything I want to be. Diabetes does not restrict me in any way.”

Exercise

The mother of two walks as much as she can, teaches hip-hop dancing to toddlers. She started cycling off-road, which she hopes to intensify soon. “I look for any excuse to remain active, even though I have an office job. Exercise releases the good endorphins. It is so important!”

Diet

“I eat whole wheat low-GI bread and the low-fat version of everything. Twice a day I drink a green smoothie, and make salads in summer. Three fruits a day is my goal, and I supplement with Provitas and cheese or peanut butter. However, I am not a saint –  I enjoy my father-in-law’s lovely Sunday roasts! I just remove the skin from the chicken,” Tara-lee explains.

MEET OUR EDITOR

Laurelle Williams is the Editor at Word for Word Media. She graduated from AFDA with a Bachelor of Arts Honours degree in Live Performance. She has a love for storytelling and sharing emotions through the power of words. Her aim is to educate, encourage and most of all show there is always hope. Feel free to email Laurelle on editor@diabetesfocus.co.za