A WEIGHTY THREAT
The number of overweight and obese Pinoy kids is rising at an alarming rate
The good news is that there are fewer underweight Filipino kids now. Some people may take it as a sign that malnutrition in the country is becoming less pervasive. Unfortunately, they are only half right.
Why? It is because the bad news is that the number of overweight and obese Pinoy kids--the other face of malnutrition--is rising at an alarming rate, and is threatening to be a major public-health problem. Worse, it may turn out to be an epidemic.
And if the surge in the prevalence of overweight in the under-five age group is any indication, the problem now starts very early in childhood. Just consider: the 1998 National Nutrition Survey of the Food and Nutrition Research Institute (FNRI) gave a one-in-250 (0.4 percent) prevalence for overweight in the under-five population. By the time the 2003 survey was conducted, it was found that nearly four out of every 250 kids (1.4 percent) are overweight. This translates to a near quadruple rise in just five years.
Meanwhile, 2003 saw a 1.3-percent prevalence of overweight in the six-to-10 age group. Although there are no prevalence data from 1998, this was still a big leap from--in fact, a doubling of--the 1989-1990 record of 0.1 percent. As for adolescents (11 to 19 years old) the numbers are also rising, from an already high 2.9-percent prevalence in 1998 they bloomed to 3.5 percent in 2003.
At first this jumble of numbers may not seem to translate to anything concrete in the lives of most Pinoys. But the message is unmistakable--Pinoys are getting fatter, and each new generation of Pinoys is fatter than the one before it. In effect, health problems associated with overweight and obesity are about to step up their bid to do damage, and people are uncertain whether they are prepared for that.
More alarming is that very few people are aware that there is an obesity problem in their midst. Worst of all, there remain a large number of Pinoys who don't think obesity is a problem in the first place.
There is a host of factors that are bringing this on. Drs. Mary Jean Villa-Real-Guno and Grace Uy of the Philippine Pediatric Society (PPS) say that several studies have given clues. There is the tendency to physical inactivity--even physical-education classes, they note, are being relegated to the sidelines in school curriculums. There is the growing consumption of fast foods and instant foods, which are often high in empty carbohydrates, sodium, and not much else. Considering how convenient fast food is and how cheap and filling instant foods are--and maybe considering how attractively they are advertised--Pinoy families have taken to them quite well.
And inevitably, noncommunicable diseases associated with overweight and obesity are taking quite well to the health of Filipinos, especially as they grow older. In the past decade diseases of the cardiovascular system have become the leading causes of morbidity and mortality in the country. Other associated conditions such as hypercholesterolemia and type 2 diabetes--and it must be noted how type 2 diabetes used to be called "adult-onset" diabetes, when now its victims are getting younger--are also climbing up the list of killers.
There are psychosocial consequences as well. If in early childhood overweight and obese kids are thought of as cute, the perception does not hold when they enter adolescence and adulthood. They become subjects of ridicule, and in effect many of them suffer from low self-esteem and depression and develop eating disorders. In effect, they register poor performance in school and productivity.
Villa-Real-Guno, who chairs the PPS Committee on Nutrition, points out how difficult it is for obese kids to square down as they grow old. "Children who are obese by 10 years old have a two-thirds chance of being obese in adulthood," she says. Uy, chair of the PPS Obesity Working Group, agrees, adding that this becomes more difficult if other members of the family, especially the parents, are overweight. "It's not only in the genes," she says, but if parents are themselves obese, they are likely to pass on their habits to their kids.
This is why interventions must begin at home. Parents have to play a major part in ensuring that their kids are eating correctly and are getting their share of physical activity--and that they, too, are setting a good example. More importantly, good habits must be inculcated in kids as early as possible.
Jin Paul de Guzman
IT AIN'T SWEET
For kids to have diabetes
High-energy diets and sedentary lifestyles are slowly taking their toll on children and adolescents who are falling prey to diabetes induced by obesity. What was considered a disease of middle age is now appearing in younger people.
Recent studies show that the prevalence of type 2 diabetes is growing alongside that of obesity. The International Diabetes Foundation estimates that its worldwide incidence will increase from 150 million in 2000 to 300 million by 2025. The number of children with type 2 diabetes has increased tenfold over the past two decades in the United States. The prevalence is estimated at 4 per 1,000 among 12 to 19-year-olds, higher among certain ethnic subgroups like the Pima Indians, among whom the prevalence is placed at 51 per 1000. Prevalence is also predicted to increase in Europe as childhood obesity becomes more common. In Asia, childhood type 2 diabetes is becoming more frequent because of the "westernization" of lifestyles.
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Type 2 diabetes involves a prediabetic phase of steadily worsening insulin resistance and the onset of ?-cell failure. Other risk factors are family history of type 2 diabetes, obesity (especially visceral), hyperin-sulinemia, poor diet, and lack of exercise. In some cases, complications are already present at the time of diagnosis. In Japan, 36 percent of schoolchildren with type 2 diabetes already have evidence of retinopathy upon diagnosis.
The principal goal in the management of type 2 diabetes in children is to normalize blood glucose to reduce the risk of such diabetic complications as retinopathy and nephropathy.
As in adults, management of type 2 diabetes in children begins with diet modification, exercise, and other lifestyle changes. However, adequate long-term glucose control is often not achieved by lifestyle modification alone. Oral antidiabetic therapy will be required for most patients.
One drug that has been shown effective in controlling blood glucose among diabetic children and adolescents is metformin (Glucophage). Glucophage acts by improving insulin sensitivity, increasing glucose uptake into skeletal muscle and reducing hepatic glucose production.
Glucophage has been shown effective and well tolerated in a double-blind, randomized, placebo-controlled 16-week trial in 82 (10 to 16 years) adolescent patients with type 2 diabetes.1
The results showed a statistically significant reduction in fasting plasma glucose and glycosylated hemoglobin (HbA1C) in favor of Glucophage compared with placebo (Figure 1).
A six-month, randomized, placebo-controlled study2 evaluated the action of Glucophage (1000 mg/day) on insulin sensitivity in 29 overweight (mean BMI 40 kg/m2) adolescents (mean age 15 years) who had a close relative with type 2 diabetes (a risk factor for glucose intolerance). Compared with placebo, treatment with Gluco-phage‚ was associated with clinically and statistically significant improvements in:
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Plasma glucose: mean change of -0.5 mmol/L (-10 mg/dL) on Glucophage‚ (p < 0.02) vs. +0.3 mmol/L (+5mg/dL) on placebo (not significant)
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Plasma insulin: mean change of -12.3 mU/mL on Glucophage‚ (p < 0.01) vs. -1.6 mU/mL on placebo (not significant)
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Body mass index: mean change of -0.5 kg/m2 on Glucophage‚ vs.+ 0.9 kg/m2 on placebo (p < 0.02 for Glucophage‚ v. placebo)
Glucophage has been approved by the Bureau of Food and Drugs for children 10 to 17 years old with type 2 diabetes. It is the only oral antidiabetic drug approved for pediatric use.
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