Sun, 03 Sep 2000

More RI children battling the bulge

By Bruce Emond

JAKARTA (JP): Check out an upmarket mall on a Sunday and watch as a veritable army of little children carrying a few extra kilograms marches by.

Diminutive nannies can be seen struggling to keep in hand not so little moppets who are eagerly clutching burgers or candy. The toy giveaways and kids' specials bring the children in to the fast-food restaurants dotting the malls, but it is the greasy treats which keep them coming back for more.

Chubbiness in children has long been associated with wealth and health in Asia, including Indonesia; a sign that parents were able to keep their offspring amply fed come feast or famine.

Although the view persists in some circles, more parents are realizing that an overweight child may well grow into a fat adolescent, with the excess weight becoming even more difficult to shed as the years go by.

"People still want chubby children, particularly in some ethnic groups like the Tapanuli (Batak) and Chinese communities," said pediatrician Dr. Widagdo from the School of Medicine at Trisakti University in West Jakarta.

"I sometimes have parents come in who want their children to be bigger although the kids are normal weight. There is the misunderstanding that bigger means healthier."

The health dangers include an increased risk for heart disease and diabetes in later life, although Widagdo said juvenile diabetes remained a rarity in Indonesia. Australia's ABC television network recently reported on a study which found that some children eating a high-fat, high-caloric diet showed premature signs of hardening of the arteries.

Pediatrician Dr. Abu Purwanto said it appeared there were increased rates of obesity among children from upper-income families.

"The impression is that, yes, more children from the middle class and upper class are getting fatter," said the doctor, whose practice is in Kebayoran Baru, South Jakarta.

Both pediatricians blamed changing diets and a more sedentary lifestyle for the expanding waistlines of affluent Indonesian children.

"People are eating a lot more high nutrition food, even when sometimes they don't need it," Purwanto said. "Instead of regular full-fat milk, they give a high-protein milk to their kids. And then the children spend their time playing PlayStation instead of going out to play soccer."

Widagdo said the economic crisis, which led to nutritional deficiencies and malnutrition among many children from low-income families, also appeared to zap the ballooning weight of his middle-class child patients.

"Before the crisis, I would say about 2 percent to 4 percent of the middle-class children I saw were overweight. Now it's about 1 percent. But it's still around the same percentage of up to 4 percent among children from upper-income families."

He said it was important to determine if children were overweight because of extra fat or whether they were naturally muscular.

Dieting kids

The fat of the land usually have fat pocketbooks as well. Seeing a very large opportunity, a host of diet centers and programs have emerged in recent years, promising to help the overweight, including children, in the battle of the bulge.

"The percentage of our children as clients in Indonesia ranges from 5 percent to 8 percent," said Aileen Chua from slimming center Marie France Bodyline. "Over the years, there has been a gradual increase in children taking up slimming, nothing drastic."

Chua agreed with the doctors that diets high in fat and a lack of exercise were major contributors to obesity among children. "Outdoor games and sports are very good ways to keep children fit and healthy."

She said parents were sometimes also to blame through mistakenly equating heaviness with health.

"Parents (have an) inclination to keep their children fat and chubby for 'cuteness', and think that fat equates to growth. With such encouragement from parents, it's easy for the child to become obese. When this happens, only then do parents realize that it's a serious problem."

All three said parents played an important role in guiding their children onto the right path for better health.

"It's very difficult with children," Purwanto said. "We have to show their parents the standards for ideal weights, and show them where their children are. We give them an education about the quantity and quality of food that their children need."

It is also important for parents to remember they are dealing with sensitive, impressionable children when helping their children diet.

"John", now in his early 30s, said his mother's hysterical reaction to his few extra kilograms when a child led to a chronic struggle with his weight.

"I remember it clearly like it was yesterday. I was about 8 and I wasn't supposed to have a second piece of cake but I sneaked back into the kitchen anyway. When my mom caught me, she went ballistic, telling me I would be so fat by the time I was 20 if I didn't go on a diet."

He eventually became anorexic and then bulimic. "Today, I am obese and it's really hard for me to make that distinction between when to eat out of hunger because I spent so many years repressing the urge."

Chua said parents could show their children through doing.

"Parents should help educate their child on the importance of eating healthy and choosing the right food, and avoiding overeating. Parents should also encourage their child in doing some form of natural exercise."