Growing incidence of childhood obesity in suburban Bengaluru

A study by a team of Azim Premji University faculty looked more closely at this issue by tracking the height and weight of primary school children in 16 government schools of Anekal Taluk, Karnataka Visiting a Government school between 12:30 and 1:30 anywhere in the country, with very few exceptions one would witness a heart-warming scene: primary school children from Classes 1 to 8 being served a hot meal.

For many children, this is the only meal they will have all day. The delight on their face as they enjoy the meal, which is in most cases is a simple rice and sambhar or roti and dal, is something that would make any observer moist-eyed.

The national Mid-Day Meal Scheme is the largest school feeding programme in the world, meant to address the pernicious issue of Classroom hunger. This is important because poor nutrition in school-age children can result in serious problems in their physical, cognitive and emotional development. Yet, while there is data tracking nutritional outcomes of children under 5 years of age (National Family Health Surveys, for example), we know little about the nutritional status of school-going children.

A study by a team of Azim Premji University faculty looked more closely at this issue by tracking the height and weight of primary school children in 16 government schools of Anekal Taluk, Karnataka. The schools are located in the south-eastern periphery of Bengaluru city, adjacent to a sprawling information technology hub.

The study was initiated in 2016, measuring the height and weight of children studying in Class 1, 3 and 5. The measurements were repeated in 2018 for the same children who had now progressed to Class 3, 5 and 7. 442 such students were included in both measurement cycles: 229 girls and 213 boys. Using the WHO Growth Reference (2007), students were categorized by their Body Mass Index (BMI) as normal, thin and overweight/obese; and by height as stunted and normal.

What the data tell us

Between 2016 and 2018, boys have faced a substantial change in their nutritional outcomes. In 2016, more than 75 per cent of the boys were in the 'normal' category; by 2018, this reduced to about 50 per cent. Many more boys joined the 'thin' category, up from about 21 per cent to 27 per cent. And – most significantly –the percentage of boys who are overweight or obese has increased five times!Girls have remained more steady, with a marginal increase in the proportion of girls with normal BMI, and a small change in the proportion of those at the extremes, either thin or overweight/obese.

Looking at the whole group, the study found some fluctuations in the proportion of children in the three categories. However, the one consistent pattern that emerged was in the increased proportion of overweight/obese children between 2016 and 2018. Only 2.8 per cent of Class 1 students were overweight/obese in 2016; but by the time the same group reached Class 3, this had increased almost four times to 11.1 per cent. Similarly, 3.3 per cent of Class 3 students were overweight/obese in 2016; by the time the same group reached Class 5 in 2018, that proportion had ballooned to 13.1 per cent. Almost 15 per cent of children currently in Class 7 are overweight/obese.

Why has this happened?

Both these findings require an explanation: why are boys experiencing greater extremes of either thinness or overweight as they grow older as compared to girls? And why is there a consistent pattern of increasing obesity as children grow older?

The socialisation of boys and girls may have some to do with why boys have significantly different nutritional outcomes. Boys have greater freedom to go out and play; this means two things: one, their after-school meals at home become irregular, and two, they have greater access to junk food. Girls largely stay home and have more regular access to home food.

Increasing overweight and obesity could be for any number of reasons. Some of it could be explained by the carbohydrate heavy diet provided by the Mid-day Meal Scheme, paired with a largely sedentary school curriculum that demands long hours of study without much physical activity. Other factors could be greater disposable income, easy access to ready-to-eat snacks and drinks, increased frequency of eating fast food due to the hectic schedule of parents (especially mothers), and omnipresence of media (particularly television) pushing junk food.

Obesity in childhood is a significant risk-factor for chronic disease later in life: diabetes, heart disease and cancer; as well as psychological conditions such as low self-esteem, anxiety and depression.

What can be done?

This data calls for a re-examination of the response to the nutritional needs of school children. The Mid-Day Meal Scheme is an essential intervention, providing food for many children facing hunger as a daily reality. But food is not only about fulfilling a daily quota of calories. It is about providing a diet that is diverse and rich in nutritive value. This means moving away from staples such as white rice or wheat – the predominant components of the school mid-day meal – and incorporating foods such as millets and whole grains, beans and legumes, fruits and vegetables in season, eggs and dairy products.

This will have cost implications, definitely; but it is one of the best investments that the government will ever make.

A well-nourished child today will not only be happier, healthier and benefit more from schooling; but will also be free from a huge personal and financial burden due to chronic health problems later in life.

(Shreelata Rao, The author is Faculty,Azim Premji University)