Being overweight and obese in early childhood increases the risk of adult obesity, along with conditions like high cholesterol, diabetes and high blood pressure, which are becoming more prevalent in South Africa.
The main cause of childhood obesity is high-calorie diets, often high in salt, sugar and fats. Factors such as household poverty, the cost of healthy foods and a sedentary lifestyle also contribute to the problem.
Maternal feeding practices and cultural beliefs about ideal child weight play roles, as does the consumption of infant formula milk, which can lead to higher protein and energy intake in formula-fed infants.
About 13% of South African children under five are overweight, with higher rates among boys than girls (15% vs. 11%).
This issue affects both urban and rural areas equally, and overweight rates have remained relatively stable since 2008, according to estimates from the 2008 National Income Dynamics Study.
Independent Media Lifestyle spoke with Dr Suveena Bisetty, a paediatric gastroenterologist at Netcare St Augustine’s Hospital, about when it might be appropriate to change a child's eating habits, avoiding the term "diet", which can carry negative connotations.
She explained that children may need dietary changes for medical reasons like diabetes, high BMI, food allergies or conditions affecting digestion like irritable bowel syndrome and inflammatory bowel disease.
Bisetty warned that putting children on strict diets can sometimes harm their health. Potential risks include body image issues, eating disorders, picky eating habits in early childhood, malnutrition and developing an unhealthy relationship with food.
“Psychologically, it’s important for children to understand any necessary dietary restrictions and to have balanced goals, such as having a designated ‘treat’ day, which should be discussed with a healthcare provider or dietitian.”
When it comes to guiding children towards healthy eating, the way we communicate is crucial.
“We want children to adopt healthy eating habits rather than saying ‘We want you to diet’,” explained Bisetty. She emphasised the importance of using terms like “healthy eating habits”, “reduction” and “smaller portions” instead of “diet”.
Bisetty highlighted that being mindful of children’s emotional well-being is essential. Using negative terminology can put children, especially pre-teen and teenage girls, at risk of developing body dysmorphia or eating disorders.
These issues can negatively impact their self-esteem, making them feel inadequate, which is not the intention.
“It’s important for parents and caregivers to cultivate a healthy attitude towards food, she added. Food provides essential sustenance for our bodies and brains to grow and develop appropriately.
“Living a healthy life means adopting a healthy diet. When this balance is disrupted, unhealthy relationships with food may develop.”
Bisetty listed several signs that parents should watch out for, which may indicate an unhealthy relationship with food:
- Emotional eating, such as overeating when happy or sad.
- Emotional “blackmail”, like refusing to eat unless certain conditions are met.
- Hiding food, which might include stashing unhealthy food in their room.
- Throwing food away or “starving” themselves.
- Inducing vomiting, often indicated by frequent bathroom trips after meals.
- Counting calories obsessively.
- Skipping meals regularly.
- Displaying anxiety or unhappiness around mealtimes.
If parents notice any of these behaviours, it’s important to have an open and transparent conversation with their child. Approaching the child from a place of love, care, and concern, rather than with accusations, can help address potential long-term problems.
“Being a parent is one of the most challenging roles,” Bisetty acknowledged. “Parents need to set aside their own prejudices and preferences and work through their childhood traumas to raise an emotionally and physically healthy individual.
“Children tend to emulate what they see rather than what they are told. So, saying 'these are the right foods to eat’ but then doing the opposite will lead a child to mirror the behaviour they see.”
Bisetty also pointed out the influence of social media on children’s body image.
“Social media bombards our spaces with staged, unrealistic, and unattainable body image depictions. Parents need to be mindful of the potential harm this exposure may have on their children’s well-being and sense of self,” she said.
“We should no longer equate Body Mass Index (BMI) to health. Instead, we need to promote overall health improvement. Being healthy involves caring for oneself holistically — mind, body, and soul.
“This includes healthy eating, being more active, reducing screen time, engaging in social interactions, and connecting as a family.”
She suggested making mealtimes more social and enjoyable. This practice should start from the baby weaning stage, where solid meals should include the entire family.
"The baby watches and emulates what they see in the physical action of chewing and eating and in the social aspect of happy mealtimes,“ Bisetty noted.
She also recommended introducing new types of textured food early to foster a healthy and varied diet.