Breaking the obesity cycle: a piece of cake?
▶ Melanie Swan discovers the diet and exercise necessary to prevent and reverse fatty liver conditions alarmingly common in children
Obesity among children is expanding at an alarming rate, according to the latest statistics released following World Anti-Obesity Day earlier this month. “It is estimated that about 40 per cent of children in the UAE are either overweight or obese, and obesity increases their risk for a host of serious conditions, including high blood pressure, high cholesterol, type 2 diabetes, breathing problems and fatty liver disease,” says Dr Sherif El-Refee, a consultant paediatric endocrinologist and diabetologist at Imperial College of London Diabetes Centre. Of these, non-alcoholic fatty liver disease (NAFLD) is on the rise; the prevalence of the disease in the paediatric population is estimated at between three and 12 per cent globally, but this can be as high as 70 to 80 per cent among obese children.
Fortunately, experts say much can be done for both prevention and treatment at home. Dr Sara Suliman, endocrinologist and diabetologist at the Imperial College London Diabetes Centre, says food choice in children is strongly associated with what they eat and are exposed to from a young age. “Parents have more influence on children than doctors. For children to lose weight and reverse the adverse effects of the condition, the whole family needs to make lifestyle and dietary changes.”
Victoria Tipper, a nutritionist in Dubai, says parents can take the lead by avoiding keeping items such as soft drinks and sweets in the house, but that children must be part of the process, too. “We have to empower children to make their own healthy choices, and promote mindful eating and body wisdom so they are able to get in tune with their body,” says Tipper. “This is a powerful educational tool to keep for life and can be done by asking questions such as: ‘How did you feel after you had that fizzy drink? Did you have a lot of energy and then feel tired?’
“It is also important to stop using foods to reward children or to help improve their moods or appease them. This teaches them to become emotional eaters, which is not healthy.”
Both parents and children must learn to read food labels, Tipper says, because added sugar is believed to be present in 74 per cent of packaged foods. “We all know that cakes, biscuits and sodas are high in sugar, but we can also find it in surprising places such as bread, pasta sauces and flavoured yoghurts, especially low-fat varieties.”
Look instead to a Mediterranean diet, which is naturally low in the fruit sugar fructose, and high in healthy fats such as olive oil, nuts and seeds, avocados, fish, fruits and vegetables. Tipper says reducing fructose helps to reduce fat and inflammation in the liver. The monosaccharide that is often added to sweeten foods and drinks, is most commonly consumed through sweetened drinks such as sodas, but even naturally sweet fruit juices are high in fructose. “Unlike glucose, fructose is totally metabolised by the liver, so overdosing on foods and drinks high in this sugar puts extra burden on the organ,” she says. Fructose has an addictive effect, making it especially difficult for children and adolescents to remove from their diets. According to a recent study published in Hepatology Communications, in the past 20 years, the consumption of fructose has increased by 300 per cent.
A colourful plate is essential in providing a variety of nutrients to help support liver function. Think purple beets, orange carrots, yellow peppers and red berries. The liver also needs adequate B vitamins, found in brown rice, wild salmon, leafy greens, beans and lentils and organic chicken, says Tipper. Sulphur is also vital to help the detoxification process, and is found in onions, garlic, shallots, eggs, and cruciferous vegetables such as broccoli, cauliflower, cabbage, kale and Brussel sprouts.
Although it can be hard to ask children to eat lots of fruit and vegetables, Tipper suggests a daily smoothie with apples or berries to sweeten it. The dietary fibre helps the body remove toxins and elongates feelings of satiation, which prevents overeating and weight gain. Fibre can come in the form of chia seeds, flaxseeds, beans and lentils, while fermented foods that contain good bacteria can also support detoxification. This includes homemade kefir, sauerkraut and kimchi. Cooking at home and swapping foods such as table sugar for coconut sugar can make a huge difference, too.
Diet aside, Dr Suliman says exercise is a major element in the prevention and management of the potentially chronic condition. “Aerobic or cardiovascular exercises have been shown to lower elevated liver enzyme levels in people with NAFLD,” she says. “As such, the best routine for people with the disease involves 30 to 45-minutes of cycling or 90 minutes of brisk walking or jogging, at least three times a week.”
Tipper agrees that increasing physical activity is a must, not only for weight loss, but also to sweat out toxins to help cleanse the liver. One form of exercise she recommends for children is trampolining, now widely available with parks across the country. “It’s great for liver and lymphatic health, and it’s a fun activity that won’t feel like a chore.” She also suggests that screentime be reduced to no more than two hours a day.
While no medication or supplement has been shown to be of significant value for the management of NAFLD in children yet, some natural lifestyle remedies are vital, says Dr Suliman. Regular exposure to morning sunlight is one easily accessible supplement, she says. “Some studies show that vitamin D deficiency may be related to more severe fatty liver disease. Your body makes vitamin D when you’re in the sun, so try to get as much natural sunlight as possible.” Detox baths using a few spoonfuls of epsom salts, sea salt or apple cider vinegar, also reportedly help liver function.