This post is a call to action to anyone responsible in some way for a child's health (parent, grandparent, aunt, uncle, cousin, nanny, teacher, etc.) and comes on the heels of our live children's event this coming Sunday 3/15 from 2-5p. See here for details. The post below is excerpted from my book and was also featured in India Currents. We'll cover more specific children's topics in future posts like what to do with abnormal cholesterol in kids. Shally (pediatrician and children's chapter co-author/my wife) and I are so committed to improving children's health that we have released the children's chapter of the book for free to anyone who signs up for the newsletter….if you don't want the newsletter, just cancel it, but keep the chapter and please use it and spread the information to anyone you think will benefit.
Children Mirroring Adults
I sat in my medical clinic the other day reviewing lab results I had just received for an Indian patient with abnormal cholesterol and prediabetes. It was the typical pattern of high triglycerides (a type of cholesterol), low HDL (healthy cholesterol), and elevated blood sugar that I was used to seeing in my adult South Asian consult practice. Interestingly the pediatrician sitting next to me was also reviewing lab results which she happened to share with me. An identical pattern of lab abnormalities appeared in both our patients with only one striking difference. My patient was 37 years old and her patient was only 8.
As a community of highly motivated Indian parents, we often push our children to start acting like adults from an early age. We want them to speak, write, learn and behave like adults, and in an effort to do this we enroll them in all types of extracurricular activities to advance them beyond their age. Free playtime is often perceived as a waste of time, sleep is compromised so kids can finish their school work and extracurricular work, and meals and snacks have become fast, processed, nutrient deficient choices so kids can be quickly shuttled to school, piano practice, soccer, math enrichment, etc.
In a frenetic effort to get children to behave like adults and perform academically far beyond their years, we are neglecting the fact that our kids are also being metabolically and medically accelerated into adulthood by developing conditions like Type 2 (aka “Adult Onset”) Diabetes and high cholesterol. Most pediatricians, like my wife Shally, were never thoroughly trained to treat conditions like Type 2 Diabetes, abnormal cholesterol, and fatty liver because these diseases were not supposed to appear in children. Thirty years ago in the US there was not a single documented case of Type 2 Diabetes in adolescents. Today there are nearly 60,000 adolescents in the US with Type 2 diabetes. By 2050, it is estimated that 1 in 3 Americans will be diabetics. These statistics are even more dire for Indians who have a significantly higher prevalence of diabetes and heart disease than most other ethnic groups.
So how do we prevent today’s youth from leading an even longer life of chronic illness and disease than any generation before them? Often the first seeds for insulin resistance, the process leading to most diabetes and heart disease, are planted during an unhealthy pregnancy. South Asian women have a staggeringly high incidence of gestational diabetes (diabetes during pregnancy) due to extremely unhealthy pregnancies characterized by inactivity and a very high carbohydrate, nutrient-deficient diet. This typically results in a low birth weight baby, a very common occurrence in South Asians. When parents see their babies fall below what they consider to be a normal growth pattern, they panic and overfeed their children to “catch up.” Unfortunately overfeeding infants and children rapidly is a major risk factor for insulin resistance, often perpetuated not just by parents, but extended family members and caretakers who think chubby children are healthier children. I still recall our first trip to India with our twin sons with many relatives commenting on how they looked malnourished despite them growing perfectly fine according to all standard measures. Comments like these are often interpreted as a case of failed parenting, often forcing parents to overfeed their children.
Be sure to ignore this type of pressure from family members who may impart distorted perceptions of what is healthy for your children. Stick to interpreting growth curves accurately with the help of your pediatrician and responding with appropriate dietary and lifestyle changes to ensure children follow a normal growth pattern. Unfortunately not only is overfeeding a problem, but the foods used to over feed South Asian children tend to lack sufficient vegetables, nutritious protein sources and healthy fats. Nutrient deficiencies, including low vitamin D, iron and B12, further contribute to impaired growth and are possibly related to insulin resistance. There is a dearth of diversity in the diet of today’s South Asian kids who are typically fed empty calories in the form of chapatis and rice, or quick and convenient fast foods, restaurant foods, processed foods and snacks.
Parents too easily succumb to the dietary demands of children, who are innocent and have no insights into the impact of the foods they eat to their health later in life. Parents must be in charge of what their children eat, just like they take charge in other areas of their life. How many of you who are currently struggling with obesity, diabetes, or heart disease would have wanted your parents to insist on a healthier diet and lifestyle that may have prevented you from developing these same conditions? Why wouldn't you do the same for your own kids, especially armed now with the knowledge that most of our parents and grandparents never had? Today with all of the available resources on nutrition and so many healthy food choices, we as parents have no excuse for not creating healthier lifestyles for our children.
Start with one meal like breakfast. Breakfast cereals or frozen waffles may be convenient, but they provide excess sugar and no substantial nutrition. Can you incorporate more egg-based breakfasts or yogurt with nuts and berries or can you add a handful of nuts and berries to a breakfast cereal with the least amount of sugar? If you need help deciding on the best brands, read my post on a fantastic app here that can identify healthier cereals, yogurts and numerous other foods. Egg yolks are fine and if you don't believe me, read this prior post and if you still fear full fat dairy, read this. If you feed your kids toast, pick a sprouted grain bread and spread a high quality nut (choose almond over peanut butter) or seed butter onto it. Every time you choose or prepare a meal or snack for your child, have zero tolerance for sugar and trans fats and choose foods that are a mix of protein, fiber and healthy fats. Introduce vegetables as early as possible to children and don’t give up if they reject them. A specific vegetable often needs to be re-introduced several times before a child develops a taste for it. Keep in mind that it is virtually impossible to get children to like vegetables if they are consuming excess sugar. Taste buds adapted to sweetened foods and beverages often don’t find vegetables appealing.
In addition to poor eating habits, inactivity has become the norm. Sedentary behavior is a problem in kids from all ethnic backgrounds, but unfortunately South Asian children are leading the pack. A study done in the UK by the British Heart Foundation found that South Asian children were the least physically active out of all ethnic groups. Schoolwork, academic enrichment, and recreation primarily in the form of video games are some of the key culprits. Participating in periodic sports like recreational soccer, basketball, or tennis does not make up for the type of baseline daily physical activity that used to define childhood. Children were meant to play frequently in neighborhoods, parks, playgrounds and school yards rather than on tablets, TVs and smart phones. Unfortunately much of this behavior is modeled after exceedingly sedentary parents. Active efforts must be made to incorporate regular physical activity and play into the lives of children. Family activities also need to re-focus on physical activities (hiking, sports, etc.) and spending time outdoors rather than being confined to restaurants, movies and other sedentary events.
The current collective health of our children is in crisis mode. I fear the implications of a new generation of teenagers and young adults increasingly burdened by chronic disease. If you, as an adult, have not been able to motivate yourself to make the necessary lifestyle changes, please use your love and commitment to your child as a lever for health transformation. As parents we do everything possible to ensure a safe and comfortable living environment for our children. We often say we would like to give our children opportunities that we lacked during our own childhood. The ability to be a healthy child who has the greatest chance of being disease-free in adulthood must be one of those opportunities.