Why they are no longer eat­ing bal­anced di­ets

Pack­aged food is fast re­plac­ing bal­anced diet among school­child­ren, es­pe­cially in ur­ban In­dia, warns the lat­est study by Cen­tre for Sci­ence and En­vi­ron­ment

Down to Earth - - FRONT PAGE - SONAM TANEJA, AMIT KHU­RANA

OUR SCHOOL­CHILD­REN are in­creas­ingly be­com­ing over­weight or obese. In the ab­sence of a con­sol­i­dated study, cer­tain spo­radic sur­veys con­ducted in dif­fer­ent parts of In­dia over the past decade sug­gest that 2.914.3 per cent chil­dren in the coun­try could be obese and 1.5-24 per cent over­weight. The prob­lem has par­tic­u­larly as­sumed a pub­lic health con­cern in ur­ban ar­eas. A 2011 study by Je­hangir Hos­pi­tal in Pune and ucl In­sti­tute of Child Health, Lon­don, shows that 30 per cent of chil­dren liv­ing in ur­ban ar­eas are obese or over­weight. In a 2017 study pub­lished in the Indian Jour­nal of Pub­lic Health health ex­perts in Gu­jarat say 33 per cent of chil­dren study­ing in af­flu­ent schools of Ra­jkot are obese or over­weight.

Child­hood obe­sity is a mat­ter of se­ri­ous con­cern be­cause chil­dren who are over­weight or obese grow up to be over­weight or obese adults, says Aanuja Agar­wala, di­eti­cian at the All In­dia In­sti­tute of Med­i­cal Sci­ences in Delhi. Be­sides, child-

hood obe­sity is also a fore­run­ner of metabolic syn­drome, poor phys­i­cal health, res­pi­ra­tory prob­lems and non-com­mu­ni­ca­ble dis­eases (ncds) like hy­per­ten­sion and glu­cose in­tol­er­ance (type-II di­a­betes). ncds typ­i­cally oc­cur later in life. Till three decades ago, they were not a paed­i­tri­cian’s con­cern. But they are now be­gin­ning to ap­pear among chil­dren, says Rekha Har­ish, head of pae­di­atrics depart­ment, Gov­ern­ment Med­i­cal Col­lege, Jammu.

What could be the rea­son for this re­cent surge in obe­sity and ncds among chil­dren? Ex­perts like Seema Gu­lati, chief project of­fi­cer (nutri­tion) at the Di­a­betes Foun­da­tion of In­dia, say ex­ces­sive con­sump­tion of food high in salt, sugar and fat is the main cul­prit for obe­sity and ncds among chil­dren. Does this mean our chil­dren have stopped eat­ing right? Has their life­style un­der­gone a sea-change in re­cent decades? To un­der­stand this, the Cen­tre for Sci­ence and En­vi­ron­ment, Delhi-based re­search and ad­vo­cacy or­gan­i­sa­tion, re­cently con­ducted an on­line sur­vey, Know Your Diet (knowyour­diet.org). Over 13,200 chil­dren in the age group of 9-17 from 300 schools across the coun­try par­tic­i­pated in the sur­vey and pro­vided in­for­ma­tion re­lated to their daily habits. About 90 per cent of them were from ur­ban ar­eas.

The re­sults show that 93 per cent of the chil­dren eat pack­aged food and 68 per cent con­sume pack­aged sugar-sweet­ened bev­er­ages more than once a week; 53 per cent con­sume th­ese prod­ucts at least once a day. While 56 per cent of the chil­dren con­sume pack­aged sweet prod­ucts like choco­lates and ice-creams more than twice a week, 53 per cent con­sume pack­aged salty food like chips and noo­dles and 49 per cent pack­aged sugar-sweet­ened bev­er­ages like soft drinks and pack­aged juices at this rate. Al­most 27 per cent of the school­child­ren con­sume prod­ucts churned out by fast food out­lets, such as burger and pizza, more than once a week. Such foods may not be pack­aged in the strict sense but are ul­tra pro­cessed and high in fat, salt or sugar (hfss).

Worse, older chil­dren are more likely to con­sume pack­aged food. As per the re­port, 59 per cent of the chil­dren between 14 and 17 years con­sumed pack­aged food or bev­er­ages at least once a day. The share drops to 51 per cent and 35 per cent in chil­dren in the age groups 11-13 years and 9-10 years re­spec­tively. “I could mon­i­tor my son’s diet till he was 12 years old. But now, his in­take of choco­lates and colas has in­creased,” says Nan­dita Lak­sh­manan, mother of a 15year-old. “He now drinks 1.5 litres of colas every week,” adds Lak­sh­manan, a pub­lic re­la­tions con­sul­tant in Ben­galuru.

The sur­vey also ex­poses high de­pen­dence of chil­dren on pack­aged break­fast ce­re­als and milk-food drinks. Some 83 per cent of school­child­ren con­sume milk with milk-food drinks, such as Bourn­vita, Com­plan and Hor­licks, while 69 per cent con­sume corn­flakes or strawberry flakes. Break­fast ce­re­als are pro­cessed and pack­aged foods which con­tain chem­i­cal food ad­di­tives which can be harm­ful to health. Hence, th­ese pack­aged ce­re­als should not be pre­ferred over freshly made op­tions like idli and poha. On the other hand, milk-food drinks con­tain very high amounts of sugar. For ex­am­ple, a serv­ing of

Older chil­dren are more likely to con­sume pack­aged food. As per the re­port, 59% of the chil­dren between 14 and 17 years con­sumed pack­aged food or bev­er­ages at least once a day. The share drops to 35% in chil­dren in the age group 9-10 years

Bourn­vita (20 grams) con­tains 14.2 g of sugar. This is suf­fi­cient to ex­haust over half of one’s daily up­per limit of added sugar as rec­om­mended by the World Health Or­ga­ni­za­tion. “High con­sump­tion of sugar is also bad for the teeth. Bac­te­ria in the mouth con­vert sugar into acid which dem­iner­alises the enamel and leads to tooth de­cay,” says Sangeeta Saikia, who heads the den­tal depart­ment at Guru Gobind Singh Hos­pi­tal, Delhi.

Ac­cord­ing to the cse sur­vey, the con­sump­tion of non-pack­aged hfss food is low when com­pared with pack­aged hfss prod­ucts. 35 per cent chil­dren con­sume street foods like samosa more than once a week. This is also the rate at which 40 per cent con­sume sweets, such as mithai and cake; and 30 per cent con­sume con­cen­trate based bev­er­ages like sherbat and syrup.

A whole­some and bal­anced diet com­pris­ing min­i­mally pro­cessed food is de­sir­able for good health, says HP S Sachdev, pae­di­a­tri­cian at Si­taram Bhar­tia In­sti­tute of Sci­ence and Re­search, Delhi. How­ever, cse sur­vey shows that the fre­quency at which chil­dren in ur­ban In­dia are eat­ing nu­tri­tious food is far from ideal.

The guide­lines of the Na­tional In­sti­tute of Nutri­tion, Hy­der­abad, shows that chil­dren and ado­les­cents should have sta­ple foods like ce­re­als and mil­lets three to six times a day. Veg­eta­bles, which are es­sen­tial source of vi­ta­mins and min­er­als, should be con­sumed two to five times a day; milk and milk prod­ucts that come packed with protein, cal­cium and other es­sen­tial mi­cronu­tri­ents two to three times a day; and pulses and other protein-rich foods like eggs, fish and meat two to three times a day. Chil­dren should con­sume fruits one to two times a day. But cse sur­vey shows that 41 per cent of the chil­dren con­sume ce­re­als and mil­lets on less than six days a week. About 65 per cent of chil­dren con­sume fruits on less than six days a week, while 40 per cent con­sume veg­eta­bles on less than six days a week; 5 per cent chil­dren eat veg­eta­bles al­most every day but limit it to just one meal. Milk and milk prod­ucts are con­sumed by 43.5 per cent on less than six days a week. Some 31 per cent of chil­dren who par­tic­i­pated in the sur­vey are veg­e­tar­i­ans. Of them, 64 per cent eat pulses less than six days a week. About 49 per cent of the chil­dren who con­sume non­veg­e­tar­ian food, eat ei­ther egg, meat, fish or pulses less than twice a day.

What dic­tates their choice

The sur­vey also delves into the rea­sons re­spon­si­ble for the eat­ing habits of school­child­ren. Even though 91 per cent chil­dren carry lunch from home, 40 per cent carry pack­aged food to school al­most daily. “Junk food is pop­u­lar among chil­dren be­cause it is tasty, con­ve­nient and eas­ily avail­able. The con­ve­nience fac­tor is so cru­cial that some­times par­ents re­quest us

to al­low chil­dren to carry pack­aged food from home,” says Anu Bha­tia, vice prin­ci­pal, St Ed­mund’s School, Jaipur. The school has re­cently re­stricted the avail­abil­ity of most un­healthy food items in the school.

Ad­ver­tise­ments are an im­por­tant trig­ger. “Chil­dren make for a highly im­pres­sion­able au­di­ence and mar­keters use it to lure them to­wards un­healthy food,” says Har­ish Bi­joor, an ex­pert in brand and business strat­egy. Th­ese cam­paigns cre­ate the per­cep­tion among chil­dren that pack­aged hfss food is tasty and tempt­ing. In re­al­ity, they are high in fat, salt or sugar and ul­tra pro­cessed.

The worse fac­tor is schools are play­ing a ma­jor role in mak­ing hfss food avail­able to chil­dren. In Fe­bru­ary 2015, while hearing a case by Uday Foun­da­tion for Con­gen­i­tal De­fects and Rare Blood Groups, the Delhi High Court had di­rected the Food Safety and Stan­dards Author­ity of In­dia (fssai) to en­force its guide­lines to re­strict the avail­abil­ity of hfss food in schools and nearby ar­eas. It has been two years but the guide­lines are still in the draft stage. They re­strict the avail­abil­ity of com­mon hfss food items, such as chips, sugar-sweet­ened bev­er­ages and in­stant noo­dles, within schools and in 50 me­tres around it. The guide­lines also sug­gest that a can­teen pol­icy should be im­ple­mented based on colour cod­ing. Green cat­e­gory (healthy) foods should con­sti­tute 80 per cent of the food items avail­able in the can­teen; red cat­e­gory (com­mon hfss foods) should not be made avail­able in schools; and yel­low cat­e­gory (foods that should be eaten spar­ingly) could be made avail­able in small por­tions and less fre­quently. Af­ter the or­der, states like Pun­jab, Na­ga­land and Ma­ha­rash­tra banned junk food in schools. But the cse sur­vey shows that the re­al­ity is grim. A large per­cent­age of chil­dren, who con­sume pack­aged food more than twice a week, eat it at schools or buy the prod­uct from school can­teens or stores lo­cated in the vicin­ity. cse re­searchers say it is high time fssai en­forced th­ese guide­lines.

There is also a need for re­stric­tions on en­dorse­ment of hfss pack­aged food by celebrities. Even though the Food Safety and Stan­dards Act, 2006 has pro­vi­sions to pro­hibit ad­ver­tise­ments that are mis­lead­ing, it does not mon­i­tor the ads di­rectly. Food ad­ver­tise­ments are largely sel­f­reg­u­lated through the Advertising Stan­dards Coun­cil of In­dia which is an in­dus­try as­so­ci­a­tion but does not have any puni­tive power of its own.

Given the ris­ing bur­den of obe­sity and ncds, en­dorse­ment of hfss food by prom­i­nent sports icons, ac­tors and TV personalities must not be al­lowed in the coun­try. There should also be strict reg­u­la­tions on the broad­cast tim­ings of ad­ver­tise­ments, par­tic­u­larly those pro­mot­ing hfss prod­ucts, that tar­get chil­dren. Such reg­u­la­tions are al­ready be­ing fol­lowed in other coun­tries. Brazil, for in­stance, pro­hibits any form of mar­ket­ing com­mu­ni­ca­tions in­tended to per­suade chil­dren and ado­les­cents to con­sume a prod­uct or ser­vice us­ing strate­gies, such as celebrities, comics or an­i­ma­tions. In Ire­land, celebrities, char­ac­ters and personalities from chil­dren’s pro­grammes can­not be used to ad­ver­tise food prod­ucts tar­get­ing chil­dren. Nor­way pro­hibits the mar­ket­ing of food and bev­er­ages di­rected at chil­dren un­der 18 and advertising in con­nec­tion with chil­dren’s pro­grammes on TV, ra­dio and tele­text. In South Korea, TV advertising for spe­cific food cat­e­gories is re­stricted to chil­dren un­der 18 be­fore, dur­ing and af­ter pro­grammes shown between 5 pm and 7 pm and dur­ing chil­dren’s pro­grammes.

While In­dia needs to learn how to reg­u­late food ad­ver­tise­ments, it also needs to strengthen its nutri­tion la­belling laws. There should be laws man­dat­ing la­belling of salt, added sugar, sat­u­rated fat and trans­fats. Per serve nu­tri­ent in­for­ma­tion should be men­tioned along with per­cent­age con­tri­bu­tion to the rec­om­mended daily allowance (rda). An easy-to-un­der­stand front-of-pack la­belling sys­tem to dis­play the most im­por­tant in­for­ma­tion like en­ergy, salt, sugar and fat and per­cent­age con­tri­bu­tion to rda should be de­vel­oped (see ‘Claims we buy’, Down To Earth, 16-31 Jan­uary, 2017).

Above all, parental guid­ance and in­ter­ven­tion can re­frain chil­dren from be­ing lured to­wards hfss foods. An­gad Datta, 12-year-old stu­dent in Gu­ru­gram, says he loves piz­zas, burg­ers, chips and choco­lates. “Since junk food is not avail­able in my school and my par­ents are very strict about my diet, I eat it only oc­ca­sion­ally,” says An­gad whose jour­nal­ist par­ents en­sure that he is also in­volved in cook­ing to un­der­stand healthy eat­ing be­hav­iour.

De­spite the Delhi High Court or­der, the Food Safety and Stan­dards Author­ity of In­dia is yet to en­force guide­lines restrict­ing the avail­abil­ity of junk food in and around schools

One in every two chil­dren con­sumes pack­aged food or bev­er­ages at least once a day

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