Promoting the health of Children - Part I
Till now, we have been talking about obesity and sedentary habits leading to ill health in adults. But what’s is not well known or talked about is childhood obesity with 18 percent of children 2-19 years old (about 12.7 million) in USA fitting the criteria. It’s time to pay attention to this growing concern.
A few facts about pediatric obesity
The general tool for determining your healthy body weight is a calculated measure called Body Mass Index (BMI). Just to remind you, BMI is the ratio between an individual's weight to height relative to their gender and age and, gives you a general idea of what your ideal body weight should be in relation to your height. Using your iPhone and BMI calculator, you can easily get this number quickly, normal being <25, overweight is 25-29.9 and obesity 30 or above.
Obesity has reached epidemic proportions among the U.S. children when compared with just 20 years ago. Unfortunately, the trend is now filtering into South Asian children as well. You can see this when you go for children’s birthday parties, Indian cultural functions when children and youths are attending or participating in large numbers, etc. An obese child tends to grow into an obese adult and becomes vulnerable to the many complications of this condition such as hypertension, diabetes, heart disease and cancer. The etiology of obesity epidemic is multifactorial, among which, dietary and life style factors play a major role. The important ones are listed below:
1. The “imbalance between the calories (the food) ingested versus the calories expended (in the form of exercise)” takes the top priority. Where do most of these calories come from? Sugar rich, carb and fat overloaded goodies children eat all day long may be the main culprit. When the ice cream truck with its bells chiming passes along the streets, children come out of the front door for their cone, even though they may have just eaten their lunch or dinner. Coke and potato chips are quite the favorites of children too. They now grow up in an environment where food is the great pacifier – comfort foods like chocolates, lollipops, cookies and cakes especially. Veggies are not their favorites, unfortunately.
2. Lack of exercise: With the proliferation of digital gadgets such as iPhones, iPads, and laptops and with many entertainment channels and YouTube available, children have forgotten how to exercise. Remember when we were growing up, we didn’t have all these gadgets, including the TVs. We walked to school and back and after reaching home in the late afternoon, we were given about two hours to play outside, then wash up and be ready for evening prayers followed by dinner and home work. Now, they are watching their favorite cartoons on TV or looking at a video on the iPad before dinner. Practically, they don’t get any exercise.
3. Environmental factors: A Southern California Children’s study concluded that exposure to tobacco smoke (secondhand smoking) and air pollution may contribute to the development of childhood obesity and combined exposures to the two may have a synergistic effect.
4. Lower educational status and poor access to health care are other contributory factors —ignorance about nutritional value of the foods purchased and given to children and lack of proper and timely pediatric follow-up being the main reasons. We do see this often enough in our community free clinic, the only place to go for medical help for these uninsured and indigent children and their mothers.
5. Genetics may play a small role in the causation of childhood obesity: “Most recent studies indicate that if one parent is obese, the likelihood of having an obese child is three times higher than otherwise. If both parents are obese, the likelihood is 10 times higher.” But do keep in mind that genetics is not responsible for the current obesity epidemic.
6. Socio-cultural factors: Many parents would prefer to see their children a little plump and not so thin, even if ‘thin’ means fit. So, they tend to force feed their children. Americanization of the regular foods children eat like triple cheese pizza with all the toppings, ‘happy meals from McDonalds’ and all kinds of sweet pies and that too in large portions – have certainly contributed its share to the epidemic.
7. Hormonal imbalance: Although rare among children and young adults with obesity, growth hormone deficiency, thyroid hormone deficiency and cortisol excess can lead to central adiposity in a slowly growing child.
To be continued …
In the Eye of the Storm
“Be like the EYE of the storm, focused yet calm and aim for perfection.” A state of mind I suggest to all surgeons when I train them to handle complications of fellow eye surgeons.
With a practice that sees Lasik and cataract surgery complications from all over the world for over two decades, I became familiar with the emotions and expectations of patients and their surgeons when facing a complication they either did not anticipate or handle well in surgical ability or personal compassion.
As a surgeon who receives such patients, it is important to accept the situation but also not short-change your desire to perfect the vision of such affected patients irrespective of the damage done or lack of empathy. After all, it is only with calm and unbiased mind can your hands move like an artist to restore vision.
With the recent passage of the deadly Hurricane Irma and possibly more on their way, many Floridians and people around the world braced themselves to face what was called the Storm of a Century. The byproduct of this unearthly event was that many were educated about the very anatomy of a hurricane. It reveals high-velocity winds with high turbulence most usually in an anti-clockwise direction, along with its inner walls, which carries the maximum force, and usually is the driving factor of potential damage anywhere that a hurricane lands.
The center of this hurricane though comes to lie in the EYE of the hurricane. Paradoxical to the force, turbulence and destructive capacity of the periphery of a hurricane is the calm and serene but highly focused zone called the EYE of the hurricane. It is surrounded by the above mentioned high-impact force areas of the hurricane called the walls.
It is this anatomical analogy that I use to teach surgeons when dealing with complex and complicated eye surgeries where I stress the need to refrain from creating a storm – or turbulence – by blaming previous eye surgeons, technologies, the patient, the circumstance and destiny itself. But rather to become focused like the EYE of the hurricane, despite all the turbulence around you, until the patient has perfect vision once again.
In surgery as in life, it is our approach that decides our endpoint. And only if we are focused like the EYE of the hurricane, that very emphasis results in dramatic outcomes and yet with the calm and peace that is the prerequisite for the height of accuracy and gentle surgical maneuvers while repairing eye surgery from its “Vision storm.”
If eye surgeries, particularly those performed on normal eyes like LASIK or cataract surgeries, fail to produce 20/20 vision, they can result in emotional upheavals that if left tumultuous will spiral like a hurricane into destructive relations and final vision.
Many such cases of complications and side effects of LASIK or cataract surgery can indeed be corrected to perfect 20/20 once again (KhaasBaat) as long as the affected patient and their surgeon, or the surgeon correcting the complication, enters a state of calm to analyze the situation. Then he or she can come up with a custom-design repair plan, execute it to perfection by delivering vision with the same intense focus the patient initially desired very much like that of the Eye of an hurricane.
Extending this philosophy to life itself, let’s always find our Eye of the hurricane and seek our position in it until that very storm of life passes and we emerge not only unscathed but actually enriched.