Why are so many overweight children?

India has long topped the list of countries with the highest number of malnourished children in the world.

Now it is also increasingly reporting alarming rates of childhood obesity which, experts say, could become an epidemic if the issue is not addressed quickly.

When 14-year-old Mihir Jain first walked into Delhi's Max Hospital in 2017 in his wheelchair to consult Dr Pradeep Chowbey, the surgeon said "I couldn't believe my eyes".

  "Mihir was morbidly obese, he could not stand properly and could not open his eyes as his face was very fat. He weighed 237kg.

After weeks of treatment and gastric bypass surgery in the summer of 2018, Mihir's weight dropped to 165 kg.

At the time, Mihir was described as the "heaviest teenager in the world", where India has an estimated 18 million obese children and the number is increasing every day.

The most recent National Family Health Survey (NFHS-5, conducted in 2019-21), conducting an in-depth survey of various households on health and social indicators conducted by the government, found that 3.4% of children under the age of five now they have a greater weight compared to 2.1% in 2015-16.

From his point of view, the number seems small, but Dr Arjan de Wagt, head of nutrition at Unicef in India, says that "even a very small percentage can mean a very large number" because of India's large population.

According to Unicef's World Obesity Atlas 2022 statistics, India is predicted to have more than 27 million obese children, representing one in 10 children in the world, by 2030. It ranks 99th in the list of 183 countries in terms of readiness to deal with obesity. The economic impact of overweight and obesity is expected to increase from $23bn in 2019 to $479bn by 2060.

"We are looking at a huge problem of childhood obesity in India," says Dr de Wagt. "And because the behaviors that lead to obesity generally start in childhood, obese children grow up to become obese adults."

Children under five who are overweight

And that is the biggest concern for health experts. According to the World Health Organization (WHO), excess fat in the body increases the risk of non-communicable diseases, including 13 types of cancer, type 2 diabetes, heart and lung problems, leading to premature death.

Last year, obesity caused 2.8 million deaths worldwide.

India has already entered the top five countries in terms of adult obesity in the last few years.

The 2016 statistics put 135 million Indians in the obese category and their number is increasing.

Dr. de Wagt says that in India - where 36% of children under five are still stunted - the gains we've been making in fighting malnutrition are being countered by overnutrition.

"People are undernourished and over nourished at the same time. Overweight and obesity are the result of overnutrition, but that doesn't mean a person is getting all the nutrition they need."

The biggest problem, he says, "is not knowing enough about nutrition".

"If children are given balanced meals that include carbohydrates, proteins, vitamins, fruits and vegetables, then it will prevent malnutrition and obesity.

But people don't know what good food is, they eat to fill their bellies with more carbs, more convenience food."

Dr de Wagt says statistics show that although childhood obesity is a problem among all social classes, it occurs more in wealthy urban families where children are fed a diet of foods and drinks high in fat, sugar and salt.

A 2019 survey by Max Healthcare in Delhi and its suburbs revealed that approximately 40% of children (5-9 years), adolescents (10-14 years) and young adults (15-17 years) had overweight.

"Young people sleep late and often rush to eat in the middle of the night, especially for unhealthy snacks," says Dr Chowbey.

"They don't burn any calories after eating late at night because they sleep afterwards and during the day, they are tired, which means they burn very few calories.

In addition, children spend more time on computers and phones instead of running or playing." "Obesity," he also warns, "the effects are not only medical, but every aspect of life, including psychological and social.

Obese children often face prejudice and social exclusion.

Dr Ravindran Kumeran, a surgeon in the southern city of Chennai (Madras) and founder of the Obesity Institute of India, says that if we do not intervene in children now, we will not be able to tackle the obesity problem in the country.

"If you watch TV now for half an hour, you will see a lot of commercials about junk food and those glorifying soft drinks. This constant false message about the benefits of junk food must stop, and it can only be done by the government."

Also, he says, we need to get more children playing outside. "As a country we are not investing in physical fitness. Our cities have no footpaths, no safe cycle paths, and few playgrounds where children can play."

That's what Sportz Village, a youth sports organization, is trying to change, co-founder and CEO Saumil Majumdar told the BBC.

"In our country, schools are the only place that provides a safe place for children to play, so schools must contribute to fighting obesity," he says.

Their study of more than 254,000 children showed that one in two children was not in satisfactory health; A large number of children lacked flexibility, had poor strength.

It's not a policy problem. All schools have physical education classes, but generally only the fittest children get enough attention.

So it's not fun for kids who don't enjoy playing," Mr Majumdar says. "We believe that in schools just as kids should learn the basic level of any subject, in the same way they should be taught the basic levels of fitness."

Over the years, he says, the schools they have worked with have shown several improvements.

"In some cases we have seen equality levels while some parameters have been improved from 5% to 17% and we have also been able to get more girls to dance. I think dancing can solve all the problems of the world," he adds.