SINGAPORE - Many adults in Singapore have gained pandemic pounds.
Kids have too.
Some public hospitals are reporting a rise in pandemic weight gain for children, with medical professionals warning it could be the tip of the iceberg.
The increasing number of overweight and obese children reflects similar stressors that led some adults to gain weight under Covid-19 restrictions.
Doctors say, however, that the methods of dealing with excessive weight - even for kids who put on up to 10kg during the lockdown months - may differ from adults.
The Weight Management Clinic at KK Women's and Children's Hospital (KKH), which serves children who are overweight and obese, has seen a 12 per cent uptick in the number of cases.
Before the pandemic erupted, the clinic saw 481 children in 2019. Comparing a similar length of time of 12 months from July last year to last month, there were 539 new cases.
The clinic typically sees children and teenagers aged between six and 16.
The Division of Paediatric Endocrinology at National University Hospital (NUH) has seen a more than 15 per cent increase in referrals of children and adolescents who are obese or overweight, and this figure is likely to be under- reported.
Last year, the NUH division saw more than 140 patients, up from about 120 in 2019.
The first half of this year has already seen some 100 such patients, a number that is expected to exceed last year's, says Dr Nicholas Ng Beng Hui, an associate consultant at NUH's department of paediatrics.
"These numbers may be an underestimate of the actual cases of childhood obesity seen at NUH, as some cases are seen in the general paediatric clinic as well," adds Dr Ng, who also works at the Khoo Teck Puat-National University Children's Medical Institute at NUH.
Multiple factors have contributed to this spike in obesity rates since the pandemic started, he says.
Stay-home conditions meant an increase in home-based learning, the cessation of outdoor co- curricular activities, reduced outdoor gatherings and "a significant reduction in time spent on physical activity", he says.
When schools are open, there are additional opportunities for light exercise, such as walking to access public transport, moving between classes and climbing the stairs.
For many households, a more sedentary, pandemic-restricted lifestyle was accompanied by excessive, hours-long screen time; ordering more food deliveries; snacking out of boredom; and increased consumption of sugary drinks, says Dr Ng.
In a local survey reported in January, almost one-third of Singaporean adults said they had gained weight during the pandemic.
The study by marketing research company Ipsos showed that 30 per cent of 500 respondents experienced an average increase of around 5kg, driven by factors such as working from home.
Excessive weight gain for children should not be brushed off as baby fat, a childhood chubbiness that will give way naturally to slim adulthood, experts say.
An obese child may grow to become an obese adult, they add.
Dr Elaine Chew, senior consultant in KKH's Adolescent Medicine Service in the hospital's department of paediatrics, says: "The outgrowing of 'baby fat' does not happen for most children who are overweight.
"Early management and intervention of childhood obesity is important to reduce the risk of obesity and its complications."
Based on a study of children attending KKH's Weight Management Clinic, about 70 per cent of overweight children had already developed at least one health problem related to being overweight, says Dr Chew.
Having high cholesterol levels was the most common condition, followed by high blood pressure.
Other possible health challenges include an increased risk of type 2 diabetes, as well as fatty liver, sleep apnoea and joint problems.
These children are also at risk of having low self-esteem and a poor quality of life, as well as a greater likelihood of being bullied, Dr Chew says.
Ms Aileen Goh, a 39-year-old teacher, noticed that her son Amos looked "rounder" during the shut-in circuit breaker last year, which lasted nearly two months.
Besides becoming more inactive, seven-year-old Amos, who has an elder brother, had been snacking on crisps and biscuits, and drinking sweetened drinks like Coke and chocolate milk.
After weighing him, she realised that he had put on about 10kg and sought the help of KKH's Weight Management Clinic.
Through his mother's efforts and the clinic's online intervention scheme, the Kick Start Move Smart Programme, which has parent-and-child exercise and nutrition sessions, Amos has slimmed down over the past three months.
"He didn't lose weight, but he grew taller," says Ms Goh.
Amos still weighs 39kg but is now 1.26m tall, compared with being 1.2m tall last year, making him less obese than before.
Charts plotting a child's BMI-for-age score and gender are available in the health booklets typically issued to Singapore children by the Health Promotion Board at birth.
These charts are used to determine whether a child is of a healthy weight. BMI stands for body mass index, which is calculated by one's weight divided by one's height squared.
When a child's BMI is above the 90th percentile based on his or her age and gender, he or she is considered overweight.
Dr Chew says: "Weight loss goals for children will depend on their age and development.
"Children who are undergoing growth and puberty are not encouraged to lose weight as their bodies require proper nutrition for healthy growth."
Professor Lee Yung Seng, group chief of paediatrics at National University Health System and head and senior consultant at NUH's department of paediatrics, adds: "As children are growing, it may not be feasible to aim for weight loss. For young children, we will advise slower weight gain, or no further weight gain, through healthy eating and more physical activities."
Exercising three times a week with Amos, and learning to cook cauliflower fried rice with him, has been rewarding for Ms Goh as her son has embraced these lifestyle changes.
She says: "The important thing is that you as a parent must be involved. Only then will the child want to take part."
How parents help their children stay active
Compelled to stay home more during the pandemic, many households have experienced plummeting levels of physical activity.
But some families have been fighting back.
During the circuit breaker last year, 16-year-old Jeff Chea could not play tennis competitively like he used to.
A member of his school team, he no longer trained on the courts up to five times a week.
With many facilities closed and home-based learning in full swing, the temptation to reach for nibbles was hard to resist. Jeff sometimes whipped out the air-fryer to fry chicken.
He gained about 5kg.
His parents swung into action to help Jeff and their three younger children - aged 15, 12 and eight - get healthier after seeing the dip in their physical activity under Covid-19 restrictions.
His father Kenny Chea, a tennis coach at ActiveSG Tennis Academy, created a "support system" to help the entire family get into a healthier routine.
Mr Chea, 48, says: "It is important to ensure we model good habits like exercising regularly, even if we're at home, and keeping our home stocked with healthier foods. We are able to control these factors and create an 'unconscious' support system for our children."
He and his wife, spa manager Candy Guo, 47, placed flasks of water and a bowl containing apples and oranges on the table.
He bought resistance bands and other sports equipment, placing them in different parts of their flat.
Besides these visual cues to drink more water, eat fruit and exercise, the family started playing tennis and doing online Tabata workouts together.
Ms Guo has been cooking more meals at home, which have greater amounts of vegetables.
While Jeff has not lost weight, he looks slimmer, having grown taller by about 7cm over the past year, his father says.
The lure of digital devices is another way to motivate kids to get active.
Last year, communications consultant Danny Tan bought his two daughters Fitbit fitness trackers, the first gadget they owned, to monitor the number of steps they take daily.
The digital display that flickers onscreen when they hit 10,000 steps on their regular walks is attractive to Cadence, nine, and Caitlyn, seven.
Cadence likes the disco ball graphic that pops up, while Caitlyn opts for the rocket blasting into space to mark the daily milestone.
"It's a sense of accomplishment for them. Inactivity is one aspect of the challenges of parenting under Covid-19. You also worry about their ability to socialise and be resilient and you take steps to try and address it," says Mr Tan, who is married to housewife Shermin Pang.
The couple, both 38, also have a one-year-old son, Callum.
To bond with family members who do not live with them, the couple and their daughters arrange "family challenges" with Mr Tan's dad, vying to see who can clock the most steps in three days.
Granddad, who is 72, usually wins.
Ms Angelina Ong, 45, noticed that her children were listless yet restless when they had to stay in more.
The stay-at-home mother says: "Since we couldn't go to the playground, we brought the playground to us."
She installed a small slide, a trampoline and a rocking horse in her condominium unit last year, which helped her four-year-old son and two-year-old daughter expend some of their pent-up energy.
Deprived of some of his favourite sports, Mr Bradley Joe, a manager in the IT industry, has converted the hallway of his apartment into a mini chipping green for his sons, aged five and three, to play golf.
Mr Joe, 39, and his wife have had to keep their young children entertained while working from home. He fixed up a basketball hoop and has been teaching the boys how to cycle.
He says: "The kids like to see what daddy does and follow suit. We've been doing more exercise than we did before the pandemic."
5 tips to keep kids moving
Keep kids active and healthy during the pandemic, even when the entire family is working and learning indoors.
1 Start small
Mr Chua Wee Lee, managing director of RSGK Singapore, which runs the Ready Steady Go Kids franchise, a multi-sports and exercise programme for pre-schoolers, says: "Set a routine such as by engaging the child in being active at the end of the day. You may wish to consider starting with a simple toss-and-catch or turn the task of picking up toys into a game."
2 Do not force the issue
Find out what works for the little ones, advises Mr Chua, who acknowledges that getting the kids moving can be challenging.
He says: "It's important to accept that you cannot force your children to do certain activities. If they choose not to play along, you may have to pivot and play what they want, how they want to."
3 View exercise as play
Mr Chua says: "Whether it's playing sports or games, creating physical 'challenges', following yoga online or even dancing freestyle, there are many ways to get kids moving. Don't view it as exercise as an adult might, but view it as play."
4 Go old school
Mr Chua suggests introducing traditional games to children.
Hopscotch and chapteh will get them moving and parents can glean other examples from YouTube.
5 Eat healthier as a family
Dr Nicholas Ng Beng Hui, associate consultant at the department of paediatrics at National University Hospital, advises a diet higher in vegetables, legumes, fruit and whole grains, and lower in sugar and refined carbohydrates, which helps control overall calorie consumption.
Reduce the intake of fast food and avoid stocking up on unhealthy snacks at home.
Try a piece of fruit instead.
He says healthier dietary changes are more likely to stick if parents are the role models.
"It is important for these habits to be a family commitment - not just for the child," he adds.