Written by Dr Vivek Jain

A 10-year-old boy, standing 4 feet 6 inches (137 cm), came to the clinic complaining of extreme fatigue, knee pain and reluctance to participate in physical activity. He wanted to run like his peers but couldn’t keep up with them. Hence he withdrew into a shell.

He weighed 47 kg, with a Body Mass Index (BMI) of approximately 25. For his age, this placed him above the 95th percentile, categorising him as obese. In simple terms, his BMI was nearly 20–25% higher than the upper limit of a healthy range for his age and height.

The answer lay in his diet. His daily routine comprised breads, sandwiches, noodles, chips, sodas, burgers and processed snacks. In fact, these had become his staples rather than being the occasional treat.

A typical diet among urban Indian children today often begins with a breakfast of white bread sandwiches, packaged cereals or biscuits, accompanied by sweetened milk or flavoured drinks. Mid-morning snacks may include chips, namkeen, or cream-filled biscuits. Lunch, instead of a balanced home-cooked meal, is frequently replaced with instant noodles, pizza made on refined flour bases or burgers. By evening, hunger is again met with packaged snacks, sugary beverages, or bakery items like puffs and pastries. Dinner, ideally the most balanced meal of the day, often mirrors the same pattern—refined flour rotis, takeaway food, or ready-to-eat processed meals.

Across the day, this pattern results in excessive intake of refined carbohydrates, unhealthy fats, salt and added sugars, while remaining critically deficient in fibre, protein and essential micronutrients. The result: The child becomes overweight.

Childhood obesity is not just about appearance. This is the beginning of chronic illnesses later in life. First, the child develops belly fat. Unlike fat under the skin, abdominal fat surrounds vital organs such as the liver and pancreas. It releases inflammatory chemicals and hormones that interfere with the body’s normal functioning. One of the earliest effects is on insulin, the hormone that regulates blood sugar. These inflammatory signals make the body less responsive to insulin, a condition known as insulin resistance.

Over time, this persistent state disrupts multiple systems. Excess fat around the liver increases fat deposition within the liver itself, contributing to fatty liver disease. Blood fat levels become abnormal, with higher triglycerides and lower “good” HDL cholesterol. Blood pressure may also begin to rise due to changes in vascular function and hormone signalling.

All of this clusters together, forming what is known as metabolic syndrome — a combination of high blood sugar, increased waist circumference, abnormal cholesterol levels and elevated blood pressure. This syndrome significantly raises the risk of developing Type 2 diabetes and cardiovascular disease, even at a young age.

The joint stress led to knee discomfort even while walking, so the child felt discouraged about exercises, something absolutely crucial for foundational health. His low stamina affected play and school participation. Meanwhile, frequent blood sugar spikes from high-sugar foods disrupted energy levels. At this age, excess weight interferes with normal growth patterns, hormonal balance and even emotional wellbeing.

Recognising the risks, the family made a decisive change not through extreme dieting, but by restoring balance. They gradually removed junk food, once a daily habit, and ensured 90% of his meals are home-cooked — dal, roti, and sabzi. Pizza spices were used to spice up salads while fruits in bowls of curd or with small cheese slices became an in-between snack instead of ice-cream. Infused water replaced his soda cravings.

Flavour-seeking is natural human behaviour once you have been exposed to delicious food, so we have to reconfigure healthy meals smartly so that children easily move away from foods high in fat, sugar and salt.

In fact, I recommend that the way we introduce food to children should change when they get off their milk years.  There should be no exposure to sugar for two years. Offering sweet items can lead to a preference for sugary foods, leading to the rejection of nutritious foods like vegetables and lentils. Low sugar exposure in the first 1,000 days (including in utero) significantly reduces the risk of obesity, diabetes, and cardiovascular disease. Babies have small stomachs and need nutrient-dense food. Added sugar offers no vitamins, minerals, or proteins.

The parents made an hour outdoor play mandatory in his daily routine and did not negotiate it even during his exam or project days. And they set a discipline of meal times, sleep and study hours. Six months later, the child’s weight reduced to 40 kg (a loss of 7 kg). His height increased to 4 feet 8 inches (142 cm), his waist shrunk and his BMI dropped to approximately 19.8, now within the healthy range. More importantly, the child regained energy, confidence, and the ability to play freely.

This is not an isolated case. In India, 20–25% of school-going children are overweight or obese. Nearly 15% show early signs of fatty liver disease. And it begins with what the child puts into their mouth.

(Dr Jain is Senior Director & Unit Head, Paediatrics, Fortis Hospital, Shalimar Bagh, Delhi)