Prevent diabetes with early screening | Sunday Observer
Obesity in Lankan children has tripled in recent years leading to serious chronic non - communicable

Prevent diabetes with early screening

16 July, 2023

The current level of childhood obesity in Sri Lanka and its persistent rise has raised serious concerns among health officials prompting a warning there could be an epidemic of obese, pre-diabetic children across the country resulting in negative health impacts , if not nipped in the bud.

The Sunday Observer spoke to the Medical Coordinator of Suwa Diviya, an organisation dedicated to fighting diabetes, Dr. Chamari Pandithage to get her insights into what drives this disturbing trend in children. Her response: “Parents must cooperate. They can halt this worrying trend, by simply controlling their children’s diet and ensuring they eat healthy nutritious balanced meals accessible to all considering the abundance of local fruits and vegetables and grains that abound in different seasons.”


Q: Childhood obesity has tripled in recent years according to new studies. Do you agree?

A. Definitely. Obesity prevalence among children and adolescents is way too high and could result in early development of serious chronic and non communicable diseases such as high blood pressure, high cholesterol, Type 2 diabetes, breathing problems such as asthma and sleep apnea, and joint problems.

Q: When does childhood obesity begin?

A. Obesity most commonly begins between the ages of 5 and 6, or during adolescence. Studies have shown that a child who is obese between the ages of 10 and 13 has an 80 percent chance of becoming an obese adult.

Q: What drives this unhealthy trend among young people?

A. Causes range from unhealthy food choices, lack of physical activity and family eating habits. Some behavioral factors include eating high-calorie, low-nutrient foods and beverages like fast-food, snack foods, candy, and soda, Eating too much food, Spending too much time sitting down watching TV or using a computer, tablet, or phone. At the most basic level, children like adults develop obesity when they eat more calories than their bodies use, called an “energy imbalance.” This can be caused by a variety of factors, including genetics, hormones, metabolic makeup, and medical factors. When a child develops obesity, it’s often through a complex interaction of these and other factors .

Q: You referred to the genetic factor. If a child has a family history of diabetes what are the chances of him getting diabetes at an early stage?

A. A. If you have a family health history of diabetes, you are more likely to have prediabetes and develop diabetes. You are also more likely to get type 2 diabetes if you have had gestational diabetes, are overweight or obese. More than 75 percent of children with type 2 diabetes have a close relative that has it, too. But it’s not always because family members are related; it can also be because they share certain habits that can increase their risk.

Q: How do you diagnose childhood obesity? Is it the same as for adults?

A. Obesity in children is determined by comparing their Body Mass Index (BMI) to that of other children of their age and sex. This is different from how obesity is determined in adults, which relies solely on the person’s BMI measurement. BMI is a measure of weight in relation to height, and is calculated by dividing a person’s weight in kilograms by the square of height in meters. Childhood obesity can be diagnosed when a child’s BMI is at or above the 95th percentile of the sex-specific BMI-for-age growth charts. Being in the 95th percentile means that compared with other children the same age and sex, your child has a higher BMI than 95 percnt of them.

Q: What are the signs and symptoms?

A. In addition to excessive body weight, typical signs and symptoms of childhood obesity include shortness of breath, fatigue, increased sweating, sleep apnea and snoring, joint pain, dislocated hips, flat feet and knock knees, skin rashes and irritation.

Q: How important is Exercise?

A. Not getting enough exercise is a key factor. The WHO recommends children between the ages of 6 and 17 years get at least an hour of moderate to vigorous exercise every day. Children ages 5 and younger should be physically active throughout most of the day.

Q: Can a child have diabetes without knowing?

A. Yes, undiagnosed diabetes is very common as sometimes there are no symptoms. Some common symptoms include Increased thirst, Frequent urination, possibly bed-wetting in a toilet-trained child, Extreme hunger, Unintentional weight loss, Fatigue, Irritability or behavior changes and Fruity-smelling breath.

Q: How can a parent check?

A. To test, a blood sample is taken at a random time. A blood sugar level of 200 milligrams per deciliter (mg/dL), or 11.1 millimoles per liter (mmol/L), or higher, along with symptoms, suggests diabetes. Glycated haemoglobin (A1C) test is another test that can be carried out. This test indicates your child’s average blood sugar level for the past 3 months.

Q: Can the symptoms of childhood diabetes be confused for another disease like urinary tract infection etc.?

A. Yes, Type 2 diabetes has a number of symptoms that may be mistaken for other disorders. A wide range of diseases and non-diabetic factors can cause symptoms that mimic Type 2 diabetes. The most common signs of diabetes in toddlers include an increase in thirst and more frequent or increased urination. This can easily be misdiagnosed as a Urinary tract infection so it is very important to check for high sugars whenever these symptoms are present in a child.

Q: What do you consider as the most significant health outcomes of childhood obesity?

A. Overweight and obesity in childhood are known to have significant impact on both physical and psychological health. Overweight and obese children are likely to stay obese into adulthood and more likely to develop non-communicable diseases like diabetes and cardiovascular diseases at a younger age.. Many co-morbid conditions like metabolic, cardiovascular, orthopaedic, neurological, hepatic, pulmonary, and renal disorders are also seen in association with childhood obesity.

Q: Any psychological problems that obese children can suffer from?

A. Obesity’s mental health impact is critical. Childhood obesity can lead to sleeping disorders, anxiety, depression, and low self-esteem. Childhood obesity can profoundly affect children’s physical health, social, and emotional well being, and self esteem. It is also associated with poor academic performance and a lower quality of life experienced by the child.

Q: Studies have shown that only 30 percent of Sri Lankan households use adequate vegetables and fruits in their meals. These have been replaced by starch, sugar and fat- This change in children’s dietary habits from healthy foods has been cited as the most important contributory factor. Do you agree?

A. Yes. A diet high in fat, calories, and cholesterol increases your risk of diabetes. A poor diet can lead to obesity, which is another risk factor for diabetes and other health problems. A healthy diet is high in fibre and low in fat, cholesterol, salt, and sugar. Also, remember to watch your portion size.

Q: Give us some guidelines on foods to avoid and what to take to prevent obesity.

A. Choosing healthier foods - whole grains, fruits and vegetables, healthy fats and protein sources and beverages is a very healthy habit. Limiting unhealthy foods such as refined grains and sweets, potatoes, red meat, processed meat and beverages (sugary drinks). To prevent obesity you can increase physical activity. Limiting television time, screen time, and other “sit time.”

Q: Can you recommend some Sri Lankan foods that any mother can have access to?

A. A reduction in dietary variety of highly palatable and the energy rich foods may be an appropriate strategy to prevent and treat obesity in Sri Lankans. At the same time, to prevent deficiencies, foods with high nutrient but low calories (e.g. green vegetables, low fat milk) should be encouraged.

Q: Exercise?

A. Yes. High levels of sedentary time, particularly screen time, at a young age (0-5 years) have been associated with higher body fat, poor diet and lower self-regulation, lower levels of cognitive development, slower motor development and reduced cardiovascular health.

Regular Physical Activity is essential for promoting healthy growth and development of children. The increase in obesity among youth suggests that, as a whole, children are not obtaining sufficient levels of physical activity to match their caloric intake and thus excess energy is stored. I want to emphasise the importance of a physically active lifestyle to increase cardiorespiratory fitness levels, support weight management, and improve cardiovascular health. At least 60 minutes of moderate to vigorous physical exercise daily should be a component of a comprehensive program of diabetes management in children.

Q: What are the exercises that children can do to reduce obesity?

A. Physical activity is an important part of a healthy lifestyle and all children and young people should do at least an hour of moderate to vigorous physical activity each day. This includes things like brisk walking, very active play, and most sports and games (e.g. skipping, dancing and swimming). The plus point is that many of these exercises can be done at home

Q: What is the role of the parents in helping an obese child to reduce weight?

A. You can be a great role model for children by being as active as possible yourself.

Q: How do you treat obese and pre diabetic children?

A. Treatment is based on your child’s age and whether he or she has other medical conditions. Treatment usually includes changes in your child’s eating habits and physical activity level. In certain circumstances, treatment might include medications or weight-loss surgery. The most important factor is to be more physically active.

Q: What happens if a child with diabetes is not treated early?

A. If diabetes isn’t treated, it can lead to a number of different health problems. High glucose levels can damage blood vessels, nerves and organs. A consistently raised glucose level that doesn’t cause any symptoms can have damaging effects in the long term.

Q: With breastfeeding week coming up in July , how can breastfeeding help prevent childhood obesity?

A. Breastfed babies seem to be better able to regulate their food intake and thus are at lower risk for obesity. Breastfeeding provides food for your baby that is easy to digest and nutritious so that you do not need to feed your baby solid foods until he or she is 6 months old.

Q: Correct weaning foods have also been cited as playing an important role in children’s well being. Your comments?

A. There are two main types of feeding that healthy children will experience during infancy; the first is milk feeding and the second is the feeding of solid foods. Once children have been weaned onto solid foods, parents are still integral to the child’s feeding environment. They are responsible for what their children eat and failure to provide a healthy diet or offering children inappropriately large portions are associated with greater child weight.

Q: Advice to young people vulnerable to pre-diabetes?

A. Be aware of the signs and symptoms. If you show any sign or symptom of diabetes then it is important that you inform a parent or a teacher to receive the necessary treatment at the earliest possible time.

And get yourself periodic screening if you have any risk factors for early intervention.