“Kids at age 14 are like old men post 40”

Even as weight-loss surgery turns fashionable, Dr Dhuper is trying to treat obesity before the need arises.

It’s not just excess kilos that can kill obese kids. It’s their vertically vrooming blood sugar, cholesterol and insulin levels that dangerously tilt them away from life and towards morbidity. In one of America’s hardest places, where obesity risk factors are thrice the national average, an Indian-born paediatric cardiologist and obesity expert Dr Sarita Dhuper launched a metabolic-weight-loss programme aimed at kids and adolescents in 2001. Live Light…Live Right is a communitarian effort in Brookdale, New York, where she leads a team of specialised medical, nutritional and behavioural counsellors and trainers. Each year they rescue 2,000 families and 350 kids from the danger zone. Dr Dhuper, who’s studied medicine in Delhi, was visiting home when she spoke to Open about the hidden facts of obesity, as India assesses the safety of anti-obesity pills.

As a cardiologist, how are you involved with obesity?

While working in Brooklyn in the 1990s, I saw children with cardiac risk factors related to obesity much before it was on the national radar. Obesity was something few of us were trained for or able to handle. Two 11-year-olds had dilated hearts, were morbidly obese and weighed over 250 pounds. They died of cardiovascular complications (obesity-related) within a year.

The kids we’re seeing at age 14 are like old men post 40. During the past three decades, childhood obesity has increased four-fold, from 5 to over 20 per cent. Today it’s prevalence in America is four times higher than in the rest of the world.

What’s making American kids balloon so dangerously?

Exposure to large portion sizes, the concept that ‘more is better’ has distorted the young developing mind about what is normal. There’s a larger social context of unsafe neighbourhoods, climate, suburban sprawl, inner city dangers, and the lack of parental involvement in children’s lives. This makes food their sole comfort.

Overweight children and adolescents are at high risk for future chronic illnesses, from type II diabetes, severe asthma, high blood pressure, high cholesterol, pulmonary diseases to certain types of cancer. By compromising a child’s health status, obesity actually causes higher rates of absenteeism and poor school performance.

Tell us a little about Live Light…Live Right.

Live Light… which serves children from Brownsville, East New York and Brooklyn, was established in 2001 when I conducted a chart review of over 1,000 children here: 66 per cent were overweight and 43 per cent were obese with risk factors like hypertension, cholesterol and insulin resistance. This was three times more than the national average. Over 95 per cent of participants are African Americans and Latinos, and over 40 per cent live below the federal poverty line. We had to start here.

You say people don’t know the real truth about obesity.

Weight and obesity is an outcome of climbing the social ladder. Scientifically, it is a mismatch of human biology and the environment. There is a thrifty gene present among immigrants from once-starving places such as Africa and Asia. Memories of scarcity make us store food, more so when there is increased access to high-calorie, cheap food and unregulated consumption.

When diabetes occurs we concentrate on glucose, not weight. Among women we’re making another mistake, over 30 per cent have polycystic ovarian disorder [PCOD] which causes irregular menstruation. We should treat insulin sensitivity but instead we use an oral contraceptive that only regularises menstruation.

Look around, India is the largest vegetarian nation in the world but our kids are eating fewer vegetables than before. In America, there’s astronomical consumption of fruit juice.

Juice is what we lavish upon kids…

Even if it is 100 per cent pure fruit, it is also 100 per cent calories. Kids are drinking a gallon a day. You don’t need to breathe pure oxygen, you need air. You don’t need juice for health, water is good.

All fructose derivatives are metabolised in the liver. The excess is converted by biochemical reactions to fat, especially triglycerides which spill into the abdominal area leading to a further inflammatory process and worsening insulin resistance (potbelly syndrome).

This morning, out of love, I was offered a glass of juice at home here. It had at least four oranges. Had I eaten it as fruit, I would have eaten one.

So how do you address these factors in Live Light…?

We start by restricting the intake of sweetened beverages which trigger off increased appetite, unaccounted calories and metabolic complications. Don’t forget that corn syrup is the metaphor for the sugars in soft drinks, juices and processed foods. Diet drinks seem to have the same metabolic effects though the biochemical reasons have not been elucidated. But it is difficult to control human desires and compete with giant marketing companies so this becomes a personal responsibility issue.

How’s the programme customised for the obese?

We have specialised personal trainers because obese children have different body mechanics. Their heart rate rises rapidly, they get short of breath, their knees buckle and they have back problems. They have to do low-intensity exercises such as dancing to soul music.

Medical doctors are poorly trained in nutrition. A dietician’s world is dominated by calorie counts which people don’t understand. We do a detailed food recall that is culturally sensitive. We allow people to eat jerk chicken, if it is their tradition, but in a healthy way.

Who are Live Light’s panoply of experts?

We’re a team of multidisciplinary medical specialists, nutritional and behavioural counsellors, we also offer tailored physical fitness programmes and organise seminars and workshops for families, physicians and community organisations.

We also have a sleep lab, because some participants wake 50 times a night, when their large tongue and poor muscle control choke their airway. Each time they wake up, their BP goes up.

Have obesity and metabolic risk factors reduced?

More than 50 per cent of our participants have decreased BMI, improved central weight and lowered blood pressure within 20 months. Metabolic data is equally positive. Almost 60 per cent had decreased overall cholesterol, triglyceride and insulin levels.

Between the time you left India in 1987 and now, what changes are you seeing among kids?

I visit India about once or twice a year. This trip I went to Akshardham Temple, there were elementary school kids from a municipal school in the queue. To my eye, every fourth child looked overweight. This is something we have never seen before.

There are similar trends in India and China among the urban rich, where lifestyle and food patterns have changed. People who have a lot of disposable income spend it on their kids and lavish them with food, which has always been a signifier of love and togetherness in our cultures.
Between America and India, how are obesity demographics different?

What’s happening to the urban poor in the US is happening to the urban middle-class in India. But the biology of the Asian Indian is programmed to work effectively at a relatively lower body weight. So that complications which are seen at a BMI of 30 in the US are seen at 25 for Indians. Any weight gain escalates the risk of diabetes and cardiovascular disorder.

Do you think the recently released film Precious, about an obese teenager, will have an impact on the American healthcare bill?

Precious is a daring presentation of inner city discrimination and portrays despair. But there is a ‘you can do it’ in the end. The healthcare bill can’t address this.

We tend to treat disease rather than provide healthcare. It’s an acute-care model where ‘defensive medicine’ is practiced. It is lucrative for hospitals to open bariatric centres for weight-loss surgery rather than offer a nutritional counselling service which could alter the way the person lives and eats for years to come. Until everyone takes responsibility for their weight, the obesity epidemic will continue to rage.

About The Author

Pramila N. Phatarphekar