Original title: Fat babies = fat adults

If you are a parent of a fairly small baby, chances are your older relatives would advise or even nag at you to get your baby’s weight up.

They will tell you that chubby babies are perceived to be well-fed and, thus, strong and healthy.

Besides, it is common thinking that the child’s baby fat will melt away when he grows up.

Yet, more and more research is saying otherwise. Fat babies are, in fact, at a higher risk of becoming overweight or obese children.

These obese children are, in turn, more likely to be obese as adults, putting them in greater danger of serious health problems such as heart disease, type 2 diabetes and cancer.

This link was underscored in a US study published last year, which tracked 10,186 children from birth to seven or eight years old.

Babies with a hefty birth weight of above 4.5kg at full term were 69 per cent more likely to be obese by the time they entered kindergarten.

This was compared with babies with an average birth weight, said researchers from the University of Virginia School of Medicine.

The average birth weight of Singaporean Chinese babies at 40 weeks is about 3.2kg.

Doctors in Singapore agree the danger is real.

Dr Yang Linqi, a paediatrician at Thomson Paediatric Centre, said higher birth weight is associated with greater body mass index in childhood and later in life. But the individual could be gaining more lean mass rather than fatty tissue, she pointed out.

The problem does not just affect babies born with high birth weights.

Even smaller infants, such as those who had poor growth during pregnancy, can be at risk, studies show.

This is because they tend to pile on weight more quickly in their early months – and this leads to increased central fat deposition in their bodies, said Dr Yang.

In Singapore, there is a group of researchers studying an entire generation of babies to find out how their mothers’ pregnancies impact them as they grow up – and the researchers are also keen to uncover more about the link between fat babies and fat adults.

Associate Professor Lee Yung Seng, head of paediatrics at National University Hospital who is involved in the study, said that it is “a simple and yet interesting question which we plan to analyse when the children are older”.

The study, termed Growing Up In Singapore Towards Healthy Outcomes (Gusto), started in 2009 and tracks the health of more than 1,000 children. The oldest child in the study is now eight years old.

A better understanding of the relationship between birth and future weight could help to address the uptrend of overweight children here.

The 11- and 12-year-olds in Singapore today are more likely to be overweight or severely overweight, compared with 20 years ago. This is based on the Health Promotion Board's (HPB’s) height and weight screening data from 1990 to 2015.

In 2015, about four in five children who were overweight or severely overweight at seven years old remained overweight when they reached 11 or 12 years old.

In 1995, the figure was lower at about four in six children, according to the HPB figures.

A possible factor is the feeding of formula milk to infants. Dr Christelle Tan, a specialist in paediatric medicine at Raffles Specialists – Holland V, noted that overseas studies have found that formula-fed infants may be at greater risk of overfeeding and rapid weight gain and, hence, childhood obesity.

WHY DO FAT BABIES STAY FAT?

A theory is that accelerated growth in a child’s early years has a longterm impact on the body’s hormonal feedback systems.

These systems regulate one’s weight, food intake and metabolism and can thus affect the presence of fat deposits, said Dr Tan.

Weight gain in babies is fastest in the first three months and will gradually slow down throughout the first year of life, said Dr Han Wee Meng, head of nutrition and dietetics at KK Women’s and Children’s Hospital.

On average, babies would double their birth weight at around three to four months and triple it by one year of age.

Fat babies become fat adults through the cumulation of excess fatness in each stage of the babies’ growing up years, said Associate Professor Fabian Yap, who heads the endocrinology service at KK Women’s and Children’s Hospital’s department of paediatrics.

The fatness of a newborn baby is a direct result of nutrition from the mother during pregnancy, and it also depends mainly on maternal factors , he said.

Subsequently, for the first six months of a baby’s life, his fatness primarily stems from milk feeding practices, added Dr Yap.

Most babies would be fully weaned to a solid-based diet by the time they turn one year old. A habitual eating pattern emerges thereafter that continues throughout his childhood and beyond.

“Maternal obesity, gestational weight gain, gestational diabetes, excessive milk feeding and delayed weaning are examples of early life factors that can lead to fat babies and infants, setting the stage for higher risk of adverse health outcomes later in life,” said Dr Yap.

Beyond infancy, a child’s dietary habits and physical activity will influence weight gain, he explained. “These behaviours often reflect the culture and mindsets of a child’s parents and caregivers,” he added.

IF YOUR BABY IS TOO CHUBBY ...

Parents in Singapore can keep track of their child’s growth trajectories by looking at growth charts, rather than absolute weight gain.

These charts are in the health booklet issued by the hospital at birth, and allow the child’s growth and development to be compared against his peers.

If you find that your baby is very large for his age – for example, he is among the higher percentile of the growth curve – here are some measures you can take, said Dr Han Wee Meng, who heads nutrition and dietetics at KK Women’s and Children’s Hospital.

1 PRACTISE RESPONSIVE FEEDING
Recognise your child’s cues for hunger and fullness, and respond appropriately.

Babies are born with an ability to self-regulate their own feeding, so parents should help to maintain this self-regulation.

Often, parents and caregivers become anxious when the child eats less than expected or refuses food.

They force the child to eat, but this results in the child losing the ability to self-regulate his feeding.

Avoid doing so. Simply remove the plate of unfinished food without commenting on it.

2 HAVE REALISTIC EXPECTATIONS OF PORTION SIZES
The stomach capacity of children may be limited by their size and young age.

They may also not have the attention span to sit still and eat for long periods.

Therefore, it can be challenging for them to meet the target of three substantially-sized meals a day.

Instead, offer small and nutrient-dense snacks. Space their meals regularly throughout the day.

Avoid making comparisons between your child and other children, as every child shows his own hunger and fullness signals.

3 ENCOURAGE REGULAR EATING HABITS
Skipping breakfast has been associated with obesity and other health issues. This is possibly due to people making up for the missed meal by eating more calorie-rich foods during the rest of the day.

Parents should expose the child to a wide variety of foods. Avoid categorising foods as good or bad, referring to certain items as “special treats” or using food as reward.

It is also unwise to dangle the promise of a food that the child likes – for example, cupcakes – just to get him to eat something he does not like, such as vegetables.

Introduce healthy food choices in a neutral way, without placing emphasis that the child needs to eat. Be encouraging when he makes a positive change to his eating behaviour.

4 FOCUS ON MEALS, NOT ON SCREENS
Mealtime interactions are important to create a positive and enjoyable feeding experience.

Avoiding distractions during meal times will help to turn the focus on what and how much is eaten, which helps the child to be more responsive during meal times. Discourage snacking when the child is engaged in another activity, such as when watching television.

5 INCREASE ACTIVITY TIME, REDUCE SEDENTARY PERIODS
For young children, encourage free play and limit their screen time to less than two hours per day.

Toddlers and pre-schoolers should be motivated to walk rather than be transported in strollers.

In older children, routine exercises and organised sports may be initiated as their motor skills and coordination would have improved; and they should be able to engage in physical activity lasting 30 minutes a few times a week.