Unchecked junk foods consumption, sedentary lifestyles, lack of outdoor physical activity and tech addiction are pushing an entire generation of urban middle class children to pile on kilos that seriously damage health and well-being – Kiran Balimane & Cynthia John. 

A deadly paradox signalling deep social inequality and pervasive injustice is looming over Indian society. On the one hand, several authoritative studies of United Nations agencies including Unicef India, UNDP (United Nations Development Programme) and WHO (World Health Organisation) indicate that 19 percent of contemporary India’s 130 million children under age five are severely malnourished and 35.5 percent of them are in danger of stunting and brain damage because of poor nutrition.

On the other hand, several studies have been warning that childhood obesity is steadily rising within India’s 400 million-strong ‘fast expanding’ middle class. A new study published in the globally renowned UK-based Lancet on March 4 — World Obesity Day — indicates that India is confronted with a childhood obesity epidemic. According to the ‘Global Burden of Disease Study BMI Collaborations’, an estimated 12.5 million children (7.3 million boys and 5.2 million girls) aged between five-19 years in India are grossly overweight, cf. 0.4 million in 1990. The study predicts that by 2050, India will host the second largest number of obese children in the five-14 years age group (30 million) and the highest number of obese young people in the 15-24 age group (39.6 million).

These alarming statistics have sent shock waves within the country’s productive middle class as also parents, educators and even somnolent government establishment. In a rare health-centric address to the nation on World Health Day (April 7), Prime Minister Narendra Modi described obesity as a “silent epidemic” and exhorted citizens to “get fit, eat mindfully, and work together to build an obesity-free India”, because obesity is the first manifestation of several life-threatening diseases.

A recent study published in the Indian Journal of Medical Research warns that “childhood obesity is a forerunner of metabolic syndrome, poor physical health, mental disorders, respiratory problems and glucose intolerance”. Other associated health risks include high cholesterol, high blood pressure, cardiac problems, diabetes, polycystic ovaries and irregular menstrual cycles in adolescent girls, mobility problems, sleep apnea, and liver dysfunction.

Unhealthy diets, unchecked junk foods consumption, sedentary lifestyles, lack of outdoor physical activity and tech addiction are pushing an entire generation of urban middle class children to pile on kilos that damage health and well-being. “Childhood obesity is increasing at an alarming rate in urban India. This is primarily because of unhealthy food choices, consumption of junk and packaged foods and lack of physical exercise. Consequently a rising number of children are developing health problems such as Type 2 diabetes with high risk of suffering hypertension and cardiac problems in later life,” says Dr. Tejan Bhatt, paediatrician at Sanidhya Hospital, Rajkot.

Dr. Bhatt warns that the propensity of an exploding number of urban middle class children to eat junk and unhealthy foods bodes ill for Indian society. “Over the past few years, a gradual shift towards children consuming foods high in added sugars, saturated fats, and sodium — fast foods and sugary drinks — and a sedentary lifestyle, is threatening the wellbeing of urban Indian households. In many middle class households, there’s also a lot of peer pressure to consume junk food and parents prefer to hand children a packet of wafers rather than invest time in preparing a fresh snack. Moreover, children are spending more time playing video games and watching reels instead of engaging in physical games and on-field games. It’s time parents realise that obesity is the first step towards many life-threatening diseases. Educated middle class parents in particular need to set an example by encouraging children to eat healthy and lead a physically active life,” says Bhatt.

Traditionally, within Indian society, the cute, plump child with chubby cheeks is endearing and seldom regarded as unhealthy. Parents, family, friends and acquaintances tend to compliment chubby children and disparage skinny ones prompting parents to overfeed them. Dr. Bhatt believes this parental mindset needs to change — “Thin, active children can be healthy”. He advises parents to take the first step to provide children healthy meals, opportunities for outdoor play and restrict their digital screen time.

Reduced physical activity and neglect of outdoor play is emerging as one of the biggest contributory factors to childhood obesity. According to a 2023 PUMA-Nielsen sports survey, contemporary Indian children spend less time playing sports than adults. They spend a mere 86 minutes per week on sports and fitness-related activities against the World Health Organisation (WHO)-recommended minimum of 420 minutes cf. Indian adults who invest 101 minutes per week in physical activity.

Another more recent (2024) survey — the 12th Annual Health Survey of the Bengaluru-based Sportz Village, which has designed a plethora of play and sports activities for school children — indicates poor fitness levels in school children across India. The survey which covered 73,000 children of seven-17 years age in 250 cities and towns countrywide found that two in five children don’t have a healthy BMI (body mass index), three in four children don’t have required aerobic capacity and three in five children lack adequate upper and lower body strength.

“Children’s play and physical activity time is reducing every year resulting in poor fitness levels. Foolishly, school leaders and parents tend to regard sports and physical education as non-essential and not as important as academics. Therefore, less time and energy are devoted to physical activity resulting in poor health of children. Schools and parents need to provide opportunities for children to engage in formal games and sports. There’s no shortage of studies concluding that regular structured physical activity not only improves physical health and reduces risk of obesity but also positively impacts mental health and academic performance of children. Our Annual Health Survey has conclusively proven that schools enforcing formal, age-appropriate sports programmes benefit by way of children’s improved physical health and learning outcomes,” says Saumil Majmudar, an alumnus of IIT-Bombay and IIM-Bangalore and founding CEO and Managing Director, Sportz Village, one of India’s pioneer sports education companies which runs its EduSports programme in 600 schools countrywide.

In the new millennium, the poor physical activity record of children within the fast expanding middle class has become worse with the dawn and high noon of the Internet and social media. With children increasingly glued to computers, smart phones, tablets, gaming consoles, etc, their social interaction and outdoor playtime has reduced substantially, contributing to the global obesity epidemic.

“Children’s gaming habits on tablets and computers negatively affect their physical activity levels. Children keep their energy inside instead of spending it outside by staying in front of the computer, tablet, TV or phone, which leads to a sedentary lifestyle,” says social media specialist Deniz Unay in an interview with Turkish news media (Anadolu Agency).

Grave damage to health and mental well-being apart, obesity has deep psychological impact upon growing children. Overweight children are usually subject to bullying and body shaming, resulting in depression and low self-esteem. Incremental projection of ‘perfect’ role models on social media escalates negative perceptions of body image, further prompting them to avoid group activities and social events. “Obesity is not just a physical health problem; it’s a damaging emotional experience for teens and pre-teens. Obese children experience low self-esteem, negative body image, bullying, social isolation, anxiety and academic challenges,” says Rajat Soni, youth and parenting coach, and author of Unjudge your Teenager (2020), who recommends valuable coping strategies to overcome psychological damage related to weight gain and obesity issues.

Suman Srinidhi, a Bengaluru-based certified Master Life Coach, business mentor, nutritionist and founder of Muladhara — Foundation of Life, believes that countering obesity necessitates a multipronged strategy involving eating right, maintaining a physically active lifestyle and most important, parents setting the example by practising healthy lifestyles. “Switching to healthy eating, following exercise routines, reducing digital screen time, etc requires resolve and determination. The complexity of school and work schedules, influences and pressure from media and friends, and easy access to junk food, make it difficult to implement lifestyle changes. Nevertheless, it’s important that parents lead by example and support obese children to reduce weight while helping them cope with the social and psychological effects of obesity. By proscribing crash diets and food fads that interfere with children’s natural metabolism, parents should support sustained fitness rather than the sole goal of weight loss,” says Srinidhi, who recommends a ABC plan for parents to help overweight children become mens sana in corpore sano (a healthy mind in a healthy body).

With childhood obesity attaining epidemic proportions in middle class India, the onus is on government, media, schools and parents — in whom children repose full trust and faith — to evolve strategies and curriculums to address pervasive malnutrition of the great majority of children and roll back the obesity epidemic set to debilitate the country’s relatively more productive middle class.

The ABC plan to combat child obesity

Suman Srinidhi, a Bengaluru-based certified Master Life Coach, business mentor, nutritionist and founder of Muladhara — Foundation of Life, suggests an ABC plan to parents to enable overweight children to become fit and healthy.

A: Acknowledge the problem

Childhood obesity is determined as per children’s BMI (body mass index) percentile. Children with a BMI of 5 percent are underweight; 5-85 percent of healthy weight. BMI of 85-95 percent indicates overweight while children with BMI above 95 percent are classified as obese.

If your child is in the 95 percent BMI category, it’s a parental obligation/duty to help her progressively move to the overweight slab and then healthy weight category. This requires making dietary changes at home by introducing healthy, home-cooked foods. Avoid putting children on crash diets which could lead to negative health consequences such as increased risk of cardiovascular disease, Type 2 diabetes and metabolic dysfunctions. Moreover, don’t force children to eat as much as you think they should. Let them decide the quantity of food to consume. As a parent, you decide the quality of food they eat, not quantity. This balance prevents obesity.

B: Be the change you want to see

Usually, children dine with their parents at home. Therefore, parents need to model healthy eating habits, choosing nutritious foods at home and when eating out. Moreover daily physical exercise should be mandatory for all. Make weight loss reduction not only your child’s but a family challenge. Here are four daily activities your family should practice continuously.

• Eat at least one meal together, without any digital distractions. Dinner is the best option. Eat by 8 p.m, leaving at least two hours for digestion before bedtime. While dining en famille, proscribe all mobile phones, tabs, etc, encouraging open conversations and mindful dining.
• Introduce food replacements. Start by gradually replacing junk/outside food with healthy home-cooked meals. Educate children about life-long benefits of healthy meals. Ensure that every meal includes nutrients that are essential for children’s growth and development. Ideally, a balanced meal should comprise cereal grain, protein and vegetables. The cereal could be rice, wheat or millet; protein could be dal, pulses, meat, eggs, and any vegetables or fruits. Additionally, if your child wants dessert, the best choice is fresh fruit or a homemade pudding comprising fruits, dry fruits, and milk.
• It’s important to stock the kitchen and refrigerator with healthy, unfussy foods such as fresh fruits and vegetables, yogurt, hummus, sprouts, roasted nuts (almonds, walnuts, pista, cashew, peanuts, etc), dry fruits (raisins, figs, dates, black currants, etc), puffed rice, roasted channa, and corn. Aerated beverages, biscuits, cookies, fries, namkeen, sweets, chocolates, bakery items, pastries or other high fat/high salt/high sugar are best unpurchased. Consult a nutritionist to draw up a healthy meals plan.
• Take a daily 10-minute post prandial (after dinner) walk. Post dinner, clear the table/dinner, etc, and step out together as a family, for a short walk around the block. Start with a ten-minute walk building up to a 30-minute daily walk.
• Outdoor activity. On weekends go on a trek, sign up with a weekend sports club, or dance studio. Physical activity leads to healthy weight loss.

C: Consistency is key

Small deeds done daily leads to amazing results. Consistency is key. There will be days when children will refuse to follow healthy meal plans and parents’ efforts don’t show on the weighing scale. The solution is to persist with healthy meals and diets strategy. Consult your doctor regularly for advice.

5-2-1-0 strategy

Rajkot-based paediatrician Dr. Tejan Bhatt prescribes a 5-2-1-0 per day strategy to combat childhood obesity.

• 5 — Ensure servings of five vegetables/fruits per day in children’s meals
• 2 — Restrict children’s digital screen time to less than two hours. It should predominantly be for schoolwork
• 1 — Ensure children participate in physical activity for at least 1 hour
• 0 — Totally prohibit consumption of sugar sweetened beverages

Coping with the psychological impact of obesity

Obesity profoundly affects children’s health and mental well-being. According to the US-based National Institute of Health, obese children experience low self-esteem, poor body image, social stigmatisation, bullying, depression and anxiety, eating disorders, and struggle with class and homework. While parents should provide healthy meals and diet plans and supervise physical activity regimens, it’s also an important duty to support children to cope with the psychological and emotional consequences of obesity. Rajat Soni, youth and parenting coach and author of Unjudge Your Teenager, offers useful advice.

Acknowledge your child’s qualities beyond physical attributes.

Children have multiple intelligences. Enable them to discover and develop their special intelligences.

Set small, actionable goals.

Encourage children to set start, mid, and end goals to attain pre-determined weight loss and BMI targets. Celebrate the achievement of every goal to build self-confidence.

Encourage a growth mindset.

Encourage children and adolescents to accept setbacks as learning opportunities instead of failures. Reflective practices, such as journaling and one-on-one conversations with empathetic parents, enable personal growth.

Encourage reflective questions.

Reflective questions help children find answers to problems within themselves. Ask reflective questions to encourage self-awareness and initiate positive dialogues. For instance, “When you think about your body, what are your sentiments? What are the prime factors behind those sentiments?” Such reflective questioning enables children to explore their internal emotions and external pressures.

Challenge negative introspection.

“If you caught yourself thinking something negative about your physical attributes, how can you convert it into a positive attribute?” Such positive introspection helps overweight children develop self-confidence.

Explore external influences.

“What messages do you think social media and peers convey about the ‘body beautiful’ and how does that affect you?” Such introspection encourages children to challenge social and other media stereotypes.

Building a positive self-image.

It’s important to teach children to develop a positive self-image. Teach them to remember their good qualities and practice kindness, care, compassion, and empathy.