*3.2.3 Dietary factors*

With globalisation, the dietary mores of Indian children has also started changing rapidly. Gulati et al. found that a majority of children surveyed in four urban centres preferred to eat out; they felt that home food was 'old-fashioned'. Almost half of them also had their evening meals while watching television [31, 32]. Adolescents associate 'junk food' with independence and convenience and consider health food options odd [33].

In the Udupi study, there was no statistical correlation between frequent consumption of carbonated drinks and being overweight/obese [16]. But in Oceania, Pengpid and Peltzer found that consumption of >1 carbonated drink per day increased OR for obesity by 1.32 (95% CI 1.09–1.61, p < 0.01) [11].

A drastic behavioural change is seen in Indian children in senior secondary schools. Those interested in taking competitive examinations stop physical activity totally and adopt a sedentary lifestyle. They enjoy eating packaged food items to relieve stress. These are usually energy-dense high fat, sugar and salt (HFSS) foods. Both nocturnal snacking and consumption of HFSS foods in the breaks between study sessions can lead to significant weight gain. Snacks rich in refined sugars and fats are habit forming and children get addicted to their flavours and tastes. This perspective is supported by a growing body of neuroscience researchers who have demonstrated that the chronic consumption of energy-dense foods brings about changes in the brain's reward pathways that are central to the development and maintenance of habits. While it is difficult to precisely define 'eating behaviour', such habits are associated with pleasure centre in the brain (neural reward circuitries)—characterised by symptoms such as loss of control while eating, over consumption and/or binge eating, continued consumption of high calorie foods despite the knowledge of its negative consequences and inability to cut down despite the desire to do so [34, 35]. The vicious cycle of obesity in school children is shown in **Figure 1**.

The reinforcing value of food is higher among obese children than among children with normal weight. In general, bland foods are not eaten in excess; whereas, highly palatable foods are often consumed even after an individual's energy requirements have been covered. Some children fall prey to vicious cycle of impulsive

#### **Figure 1.**

*Vicious cycle of obesity in school children.*

eating. Highly impulsive children often do not think about the reactions or their consequences. Besides overeating, these children seem to be vulnerable to food triggers like the smell and taste of the food. It has been suggested that poor control of neural centres related to impulsivity and/or addiction could foster impaired control of food intake leading to overeating and subsequent obesity. Adaptive decisionmaking and the ability to delay gratification may positively influence eating behaviour, particularly in an energy-rich food environment, where conscious control of energy intake is essential for the maintenance of healthy body weight [36].
