Being fat isn't a disease, but being too fat can kill you. In the age of scarcity, plumpness symbolized good fortune, but today it has come to be seen as a source of ill health.

Along with affluence and social change, the younger generation is getting fatter all the time, and child obesity has become a problem deserving of our attention.

In 1992 a survey of fifth graders in Taipei and Kaohsiung revealed that 20% of them were fat. Clark Hsieh, the dean of the School of Nutrition and Health Science at Taipei Medical College, notes that the survey discovered that 50% of all students were either overweight (10-20% over ideal weight) or fat (20% or more overweight), and another 25% were underweight (more than 10% under ideal weight). In other words, only one in four children was within 10% of ideal weight.

The next year a survey was carried out in Yunlin County which discovered that children in the countryside weren't necessarily growing up healthy either. The survey results showed lopsided gains in weight over height. Instead of growing up, these children were growing sideways and were aptly described by the phrase "short, fat and stubby."

Baby fat doesn't count?

There's a Chinese expression that "baby fat doesn't count as fat." But the odds are great that fat kids will end up as fat adults. According to research, children who are fat as seven-year-olds are 3.7 times more likely to be fat 26-year-olds, and children who are fat at the age of 10-13 are 6.3 times more likely to be fat 30-year-olds. Who said baby fat doesn't count?

True, fat kids probably won't immediately suffer from fat grown-up diseases like diabetes, high blood pressure, strokes and coronaries. But being overweight as a child does raise the chance of future illness: Not only will more fat children suffer from these diseases later in life, but they will suffer from them earlier.

And it's only natural for people to want to look good. Fat kids often acquire nasty nicknames and become the butt of their classmates' jokes. All this will affect their personalities and how they relate to others.

Li Yen-chin, a pediatrician at Mackay Memorial Hospital, points out that once a child's fat greatly exceeds the storage abilities of his existing fat cells, the number of those cells grows, never to decline. This is why fat kids tend to be unsuccessful dieters as adults.

Prevention is easy, dieting hard

Most parents don't think that being fat is an illness, and some people cling to the misconception that "children are best white and fat," only bringing their children in for treatment when they exceed their ideal weight by 40-50%.

But unless children are so fat that their lives are endangered, most doctors won't give them diet pills and don't recommend surgery. If children are to lose weight they must use the natural methods of exercise and dieting. Chao Ting points out that children, unlike adults on a diet, are still growing, and so they must get proper nutrition. Hence, controls over their food consumption must be carefully calculated by a dietician. She says that 1200-1500 calories of diet fare is usually ideal.

Generally speaking, the short-term results of dieting are usually good, but keeping the pounds off is difficult, especially for gluttonous kids. Ninety percent of dieters gain back all their weight within a year. Chao Ting points out that besides a few teenagers who are really concerned about their looks and willing to work at it, most children-even if they have sore knees from the strain of carrying all that weight and gasp for air when running-aren't self-motivated dieters. When other family members don't make a serious effort to help, it's only natural that the kids' efforts fail.

Balance, not quantity

The rotundas of Rome weren't built in a day, and neither are rotund bellies. Chao Ting says that most overweight kids gain only two or three kilos a year, but they add up. Li Yen-Chin notes that only a few fat kids gain more than 10 kilos a year. The earlier the problem is dealt with the better. When a child gets too fat, losing weight becomes very difficult.

The old adage that prevention is the best cure certainly applies to child obesity. To prevent it, parents need to pay attention to what their children eat.

Hung Chien-te, head of the Department of Metabolism and the Diabetes Center at Taipei Municipal Yang-Ming Hospital, argues that nutrition education hasn't kept pace with modernization, resulting in common misconceptions about nutrition. Back in the days when food was scarce, 95% of people lacked adequate protein, which led to malnutrition and greater susceptibility to disease. But now protein has been overemphasized, and diets are loaded with meat and sea food. This makes becoming fat easy, because most high protein foods are also high fat foods (typically for every 1% of protein in food, there is 3% fat).

Clark Hsieh holds that the children of Taiwan are in poor physical shape because of their poorly rounded diets. "Our children may eat a lot and may eat healthy food, but they don't get balanced nutrition." He says that there are problems with most children's diets. (See Chart I)

Children love fast food like hamburgers and fries and often don't like white rice, so some parents think that children can lose weight by cutting the rice out of their diets. But both Hung Chien-te and Clark Hsieh stress the importance of grains.

Hsieh points out that grains are the body's source of calories and energy. When a person doesn't eat grains, he becomes lethargic, making it even easier to gain weight. By using grains to provide calories, you prevent the need to burn protein as fuel. The problem with burning protein as fuel is that it hampers the process of turning protein into anti-bodies and so makes it easier to get sick.

Hung Chien-te points out that fat needs carbohydrates to be metabolized or will cause ketoacidosis. Hence, don't cut out rice when dieting. Grains should be the staples of a diet, supplemented by other foods.

Healthy, not fat

Generally speaking, a balanced diet is the only way to prevent obesity and maintain good health. Today's nutrition experts have designed a health pyramid (see Chart II), which serves as a good reference.

By providing children nutrition based on the principles outlined in the health pyramid, it's not hard to keep them fit. But can the busy parents of today take time out to prepare three meals for their children? When the streets are full of fast-food franchises and "all-you-can-eat" restaurants, the answer to that question is obvious.

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With social affluence, few children don't get enough nutrition, but overeating and unbalanced diets are causing other health problems. (photo by Diago Chiu)

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Chart I: What's wrong with children's diets

They eat too much protein and fat from animal sources.

They eat too much oily food, such as fried chicken and french fries.

They eat too many sweets and sugar-sweetened drinks and too few dairy products.

They eat too much high-cholesterol food.

Chart II: The Pyramid of Health

Oils, Salt, Sugar

(Eat little of these)

Meat, Fish, Legumes, Eggs, Milk (Get enough of them but not

too much)

Vegetables, Fruit (Eat a lot of these)

Grains (Staples of

a diet)

(Drawn by Lee Su-ling)