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I sat in my medical clinic reviewing lab results I had just received for an Indian patient with abnormal cholesterol and pre-diabetes. 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. Inter-estingly the pediatrician sitting next to me was also reviewing lab results which she happened to share with me. An iden-tical pattern of lab ab-normalities 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 chil-dren to start acting like adults from an early age. We want them to speak, write, learn and behave like adults, and in an ef-fort 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, pro-cessed, 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 aca-demically far beyond their years, we are neglecting the fact that our kids are also being metabolically and medically acceler-ated into adulthood by developing condi-tions like Type 2 (adult onset) Diabetes and high cholesterol. Most pediatricians were never thoroughly trained to treat conditions like Type 2 Diabetes, abnormal cholesterol, and fatty liver because these dis-eases are not supposed to appear in children.
Thirty years ago in the United States there was not a single documented case of Type 2 Diabetes in adolescents. Today there are nearly 60,000 adolescents with Type 2 diabetes. By 2050, it is estimated that 1 in 3 Americans will be diabetic. These statistics are even more dire for Indians who have a sig-nificantly 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 resis-tance, the process leading to most diabetes and heart disease, are planted during an un-healthy pregnancy. South Asian women have a staggeringly high incidence of gestational diabetes (diabetes during pregnancy) due to extremely unhealthy pregnancies character-ized by inactivity and a very high carbohy-drate, 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 certain 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 dis-torted 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 pro-tein sources and healthy fat. 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 chapatisand rice, or quick and convenient fast foods, restaurant foods, processed foods and snacks.
Parents succumb too easily to the dietary demands of children, who have no insight into the impact of foods on 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 obe-sity, 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 condi-tions? 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 sug-ar? 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 bever-ages often don’t find vegetables appealing.
In addition to poor eating habits, inactivity has become the norm. Sed-entary behavior is a problem in kids from all ethnic backgrounds, but unfortu-nately South Asian children are leading the pack. A study done in the United Kingdom by the British Heart Foundation found that South Asian children were the least physi-cally active out of all ethnic groups. School-work, academic enrichment, and recreation primarily in the form of video games are some of the key culprits. Participating in periodic sports like recreational soccer, bas-ketball, 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. Physicians have started prescribing activity monitors like pedometers and Fitbits, recommending adults and chil-dren walk 10,000 steps daily. Family activi-ties also need to re-focus on physical activi-ties (hiking, sports, etc.) and spending time outdoors rather than being confined to res-taurants, movies and other sedentary events.
The current collective health of our chil-dren is in crisis mode. I fear the impli-cations of a new generation of teenagers and young adults increasingly burdened by chronic disease. As parents we do every-thing possible to ensure a safe and comfort-able living environment for our children. Parents often say that they would like to give their children opportunities that they lacked during their own childhood. The ability to be a healthy child who has the greatest chance of being disease-free in adult-hood must be one of those opportunities.
Ronesh Sinha, M.D. is the author of “The South Asian Health Solution,” a culturally tailored book on health for South Asians. He is a physician for the Palo Alto Medical Founda-tion who sees high risk South Asian patients, he blogs at southasianhealthsolution.org, and co-hosts a South Asian radio show on health.