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สถานการณ์ของโรคอ้วนในเด็ก
ศาสตราจารย์เกียรติคุณ แพทย์หญิง ชนิกา ตู้จินดา


ปัจจุบันนี้เด็กไทยอ้วนขึ้นมากพบอุบัติการณ์เด็กอ้วน (5-15 ปี) ในเขตกรุงเทพมหานครเพิ่มจากร้อยละ 5.8 ในปี พ.ศ. 2533 เป็นร้อยละ 13.3 ในปี พ.ศ. 2539 ปัจจุบันในบางโรงเรียนพบมากขึ้นเป็นร้อยละ 20 และบางโรงเรียนมากถึง ร้อยละ 25-30 ซึ่งเป็นการเปลี่ยนแปลงที่น่าเป็นห่วงมากเพราะจะมีผลร้ายตามมาด้วยโรคเบาหวาน ความดันโลหิตสูง ไขมันสูงในเลือด โรคของหลอดเลือด โรคหัวใจ โรคกระดูก ขาโก่งผิดปกติ ปัญหาสุขภาพกาย สุขภาพจิต ซึ่งมีผกลกระทบต่อพฤติกรรม ค่านิยม ตลอดจนการเรียนและอนาคตของเด็กด้วย
โรคอ้วนระบาดทั่วโลก ในสหรัฐอเมริกาปัญหาอันดับ 1 ที่มีผลต่อเด็ก คือโรคอ้วน เขาพบว่าอัตราเด็กอ้วนเพิ่มเป็น 4 เท่า จากปี ค.ศ. 1970 สาเหตุเกิดจากพฤติกรรมการกินที่เปลี่ยนไป วิถีชีวิตและสังคม สิ่งแวดล้อม ค่านิยม การเลี้ยงดู และพันธุกรรม ผลร้ายที่ตามมาคือ การเปลี่ยนแปลงหลอดเลือดและหัวใจ ระบบการหายใจมีตั้งแต่เด็กนอนกรนจนถึงหายใจเองไม่ได้ หรือมีอาการหยุดหายใจเป็นพักๆ อุบัติการณ์ มะเร็งและอาการซึมเศร้าเพิ่มขึ้น จึงน่าเป็นห่วงมิใช่เด็กอ้วนดูน่ารักเหมือนค่านิยมเดิม แต่กลายเป็นเด็กอ้วนที่มีโรครุมเร้าและอาจมีอันตรายถึงชีวิตก่อนวัยอันควร ด้วยระบบหายใจและหัวใจล้มเหลวได้ ปัจจุบันเราพบเด็กอายุ 5 ปี น้ำหนักมากจนหายใจไม่ได้ ต้องเข้าเครื่องช่วยหายใจในโรงพยาบาลมีจำนวนมากขึ้นเรื่อยๆ โรคอ้วนส่วนใหญ่เกิดจากการกินอาหารมีพลังงานเกินกว่าร่างกายจะใช้ไป และเกินความต้องการ จึงเก็บสะสมไว้ในลักษณะไขมัน

การศึกษาเด็กอ้วนในประเทศไทย
ผลงงานของภาควิชากุมารเวชศาสตร์ คณะแพทยศาสตร์ศิริราชพยาบาล ในปี พ.ศ. 2544-2545 ได้ศึกษาเด็กอ้วน 77 ราย อายุตั้งแต่ 3.08 ถึง 19 ปี เป้ฯชาย 40 คน หญิง 37 คน พบว่ามีคอเลสเตอรอล, ไตรกลีเซอไรด์ และคอเลสเตอรอลชนิดไม่ดีสูงผิดปกติถึงร้อยละ 45.45 และ 33.77 มีร้อยละ 46.75 ที่มีระดับคอเลสเตอรอลชนิดดีต่ำมีร้อยละ 88.3 มีระดับอินซูลินสูงผิดปกติ มีการทดสอบที่แสดงแนวโน้มจะเป็นเบาหวานพบร้อยละ 33.77 และตรวจพบเด็กเป็นโรคเบาหวานชนิดที่ 2 ร้อยละ 2.6 แสดงให้เห็นว่าเด็กอ้วนมีความแปรเปลี่ยนทางเมตาบอลิค พร้อมที่จะเป็นโรคเบาหวาน จึงควรตรวจพบให้เร็วที่สุดว่าเด็กที่อ้วนมีพฤติกรรมการควบคุมอาหาร ออกกำลังกายลดน้ำหนักเพื่อป้องกันโรคต่างๆ ที่ตามมา
รศ.นพ.จิตติวัฒน์ สุประสงค์สิน ได้ศึกษาผู้ป่วยอ้วน ที่มารับการรักษาที่โรงพยาบาลรามาธิบดี ในช่วงปี พ.ศ. 2542-2543 มีประวัติบิดา มารดา หรือพี่น้องในครอบครัวเป็นเบาหวาน ร่วมกับการตรวจร่างกายพบรอยดำรอบคอ (acanthosis nigrican) จำนวน 39 ราย พบว่าร้อยละ 31 มีภาวะเริ่มเป็นเบาหวาน ในจำนวนนี้มี 29 ราย ได้ตรวจระดับคอเลสเตอรอล และพบว่าร้อยละ 79 (22 ใน 29 ราย) มีระดับคอเลสเตอรอลเกิน 200มก./ดล. โดยผู้ป่วยทุกรายยังไม่มีอาการบ่งชี้ว่าเป็นโรคเบาหวาน
นอกจากนี้ รศ.นพ.จิตติวัฒน์ สุประสงค์สิน ได้ศึกษาร่วมกับ มสช. และ สกว. สำรวจโรงเรียนเขตเมือง เฉพาะโรงเรียนขนาดใหญ่ที่มีชื่อเสียงและผู้ปกครองค่อนข้างมีฐานะในเขต กทม. พบว่าเด็กร้อยละ 25 เป็นโรคอ้วนถึง 1 ใน 4 ของนักเรียนทั้งหมด ซึ่งเป็นอัตราที่สูงมาก นักเรียนมัธยมศึกษาปีที่ 1 ของโรงเรียนแห่งหนึ่งใน กทม. มีเด็ก 600 คน เป็นเด็กอ้วนมากถึง 88 คน พบเด็กเริ่มเสี่ยงต่อโรคเบาหวานร้อยละ 14 ของนักเรียนที่อ้วน เด็กที่มีระดับคอเลสเตอรอลสูงผิดปกติกว่าร้อยละ 50 และค่าเฉลี่ยความดันโลหิตอยู่ในระดับเริ่มสูงแล้วเมื่อเทียบกับเด็กปกติในวัยเดียวกัน แสดงว่าเด็กกว่าร้อยละ 50 เริ่มมีปัญหาความดันโลหิตสูงแล้ว มีการศึกษาอีกหลายแห่งในประเทศไทย ซึ่งผลออกมาคล้ายคลึงกันและบางแห่งกำลังติดตามอยู่
จะเห็นว่าโรคเบาหวาน ความดันโลหิตสูง หัวใจ และหลอดเลือด ที่เคยพบเฉพาะในผู้ใหญ่ปัจจุบันได้เปลี่ยนแปลงไป คือ อาจเริ่มมาจากวัยเด็กมีผลต่อผู้ใหญ่หรือเริ่มแสดงอาการในวัยเด็กและวัยรุ่นได้ ทำให้น่าเป็นห่วงอนาคตของเด็กไทย และประเทศไทย ถ้าอัตราเด็กอ้วนเพิ่มจะไม่สามารถควบคุมได้

ปัญหาอื่นๆ จากโรคอ้วน
ปัญหาที่อาจตามมาไม่เฉพาะ 3-4 โรคที่กล่าวข้างต้น อาจมีภาวะความเป็นหนุ่มสาวเร็วกว่าวัยอันควร นอนกรน หรือหยุดหายใจเป็นพักๆ มีผลทำให้เกิดความดันโลหิตสูงการเต้นของหัวใจผิดปกติ และการเสียชีวิตจากโรคหัวใจ

มารณรงค์ป้องกัน-แก้ไขโรคอ้วนกันเถอะ
มีการศึกษาพบว่า เด็กอ้วนจะเติบโตเป็นผู้ใหญ่อ้วน และมีโรคภัยไข้เจ็บมากรวมทั้งอาจมีโรคร้าย เสียชีวิตก่อนเข้าวัยผู้ใหญ่ด้วย การให้ความรู้แก่ผู้ปกครอง ครู และผู้ดูแลเด็กมีความสำคัญมาก ส่วนใหญ่ความอ้วนเกิดจากการเลี้ยงดูที่ไม่ถูกต้องอาจเริ่มตั้งแต่มารดาตั้งครรภ์เลยก็ได้ ดังนั้นจึงต้องรณรงค์ดังนี้
1. ขณะตั้งครรภ์มารดากินอาหารครบ 5 หมู่ แต่ไม่ควรกินของหวานจัด เพราะน้ำตาลสามารถผ่านเข้าสู่น้ำคร่ำ ซึ่งทารกดื่มตั้งแต่อยู่ในครรภ์ กระตุ้นต่อมรับรสหวานทำให้ติดหวานตั้งแต่อยู่ในครรภ์ เมื่อคลอดมาแล้วเด็กจึงชอบรสหวาน
2. เมื่อคลอดแล้ว เริ่มนมแม่เร็วที่สุด ไม่ให้นมขวดเลย และพยายามให้นมแม่นานเท่าที่แม่จะลาพักคลอดได้ ถ้าเป็นไปได้ควรให้นาน 4-6 เดือน ระหว่างกลับไปทำงานควรปั๊มนมมารดาใส่ตู้เย็นไว้ให้ลูก จะให้นมขวดเฉพาะเมื่อจำเป็นเท่านั้น
3. เมื่อถึงวัย 4 เดือน ควรให้อาหารเสริมที่คุณแม่จัดให้ตามธรรมชาติมากกว่าอาหารสำเร็จรูป (ซีเรียล) ถ้าจะเปลี่ยนเป็นนมผงสูตรต่อเนื่อง ไม่ควรใช้นมผงที่เติมน้ำตาลทรายเพื่อเพิ่มความหวาน
4. เด็กวัย 6-8 เดือน มือเริ่มจับได้ ควรให้อาหารเสริมจากบดละเอียดเป็นบดหยาบ หรือให้เด็กหัดจับกินได้ เช่น ขนมปังเป็นแท่งเล็กๆ นุ่มๆ ไม่เคลือบน้ำตาล ส้มเป็นกลีบเล็กๆ เอาเมล็ดออก หลัง 6-8 เดือนแล้วควรฝึกให้ลูกนอนรวดเดียวไม่ดูดนมหลังเที่ยงคืน
5. เด็กมากว่า 1 ปี ให้หยิบช้อนเอง และฝึกดื่มนมจากถ้วยแก้ว ไม่เลือกนมที่เติมความหวานหรือน้ำอัดลมหรือขนมถุง
6. ไม่ให้ลูกดูดนมที่มีการเสริมรสหวาน เพราะเด็กจะติดรสหวาน และเมื่อโตพอจะกินขนมได้จะติดรสหวาน มัน เค็ม ติดขนมกรุบกรอบ กินอาหารไม่ครบ 5 หมู่ บางคนติดหวานมากจนฟันผุมาก กลายเป็นเด็กผอมได้ด้วย แต่เด็กบางคนจะกินแต่อาหารที่มีแคลอรี่สูง ไม่กินอาหารหลัก และกลายเป็นเด็กอ้วนได้
7. ฝึกให้ลูกกินอาหารเป็นมื้อ เป็นคราว เป็นเวลา ไม่พร่ำเพรื่อ อย่าตามใจลูก ให้เล่นเวลากินหรือตามป้อนลูกที่เห็นอยู่ในหมู่บ้าน หรือนั่งรถพาลูกป้อนข้าว
8. ดูรายการหารลูก ให้เคยชินกับการกินอาหารตามธรรมชาติ หลีกเลี่ยงอาหารกระป๋อง ไม่ควรมีน้ำอัดลมไว้ในตู้เย็นซึ่งหยิบฉวยง่าย ทั้งนี้เพราะน้ำอัดลมมีปริมาณน้ำตาลสูง พ่อแม่เป็นรูปแบบที่ดีในการกินอาหารสุขภาพ และมีพฤติกรรมการกินที่เหมาะสม
9. อย่าตาใจลูกเรื่องขนม และอาหารที่ไม่เหมาะสม ซึ่งโดยมากพ่อแม่ทราบดีว่าไม่ควรให้ลูกกินอะไร แต่มักตามใจมาจนชิน และไม่สามารถควบคุมได้
10. เปลี่ยนวิถีชีวิตที่ไม่เหมาะสม ให้ลูกแบ่งเวลา มีการออกกำลังกาย การพักผ่อน และการช่วยเหลืองานบ้าน ทำกิจกรรมร่วมกัน ไม่ให้ลูกจับเจ่าอยู่หน้าโทรทัศน์ และกินขนมขบเคี้ยว
11. ควรศึกษาดูจำนวนแคลอรี่ที่มีในผลิตภัณฑ์ต่างๆ หลีกเลี่ยงของที่มีรสหวาน และแคลอรี่สูง อย่าคิดว่าการกินอาหารเสริมจำนวนมากจะช่วยบำรุงร่างกาย บางคนคิดว่าลูกไม่ได้ออกกำลังกาย เกรงจะไม่แข็งแรง ให้กินอาหารเสริมมากๆ มีบางรายแม่บังคับให้กินขนมหวานถึงวันละ 7 กล่อง ซึ่งเกินความต้องการของร่างกาย โดยแม่คิดว่าจะช่วยให้สูง แต่แคลอรี่มีมากจนกลายเป็นความอ้วนและไม่สูงด้วย
12. หมั่นสังเกตดูพฤติกรรมในการกิน การนอน และการออกกำลังกายของลูก ช่วยกันทั้งครอบครัวหากเริ่มมีปัญหาคือ พ่อ แม่ ลูก ช่วยกันควบคุมน้ำหนัก และรับคำปรึกษาจากแพทย์ โดยเฉพาะครอบครัวที่มีปัจจัยเสี่ยงคือ มีปู่ ย่า ตา ยาย พ่อ แม่ ญาติ เป็นเบาหวานชนิดที่ 2 หรือมาจากครอบครัวอ้วนหรือครอบครัวที่มีวิถีชีวิต sedentary lifestyle คือ กินมาก ออกกำลังกายน้อย และใช้ชีวิตแบบชาวกรุงที่เร่งรีบ ไม่มีเวลาปรุงอาหาร กินอาหารถุงซึ่งมีไขมันมาก เวลาติดอยู่ในรถ การจราจร และการงาน และไม่สนใจดูแลสุขภาพคนในครอบครัว

สรุป
ประเทศไทยเริ่มเข้าสู่วิกฤติเด็กอ้วน ผู้ใหญ่อ้วน โรคเบาหวาน และโรคภัยต่างๆ กำลังระบาดมากในยุคนี้ และ 10 ปีข้างหน้า จะต้องสูญเสียทรัพยากรมหาศาลทั้งครอบครัวและสังคม ต้องรีบระดมสมองแก้ไขวิกฤติการณ์ โดยขอความร่วมมือจากรัฐฯ สื่อมวลชน องค์กรต่างๆ รวมทั้งผู้ผลิตภัณฑ์ต่างๆ ดังที่ทราบกันจากการศึกษาของสำนักส่งเสริมสุขภาพ พบว่าค่าขนมเด็กไทยใช้จ่ายถึง 1 แสนล้านต่อปี เท่ากับงบประมาณของ 6 กระทรวงซึ่งเป็นการสูญเสีย ทั้งนี้เพราะขนมไม่ได้ทำให้เด็กเติบโตหรือบำรุงสมองหรือร่างกาย ขนมส่วนใหญ่จะมีรสหวาน มัน เค็ม ซึ่งถ้ามากไปจะเกิดผลเสียดังกล่าวแล้ว จึงขอความร่วมมือมายังทุกท่านที่มีส่วนเกี่ยวข้อง และผู้ปกครองช่วยกันรณรงค์ป้องกันเด็กจากภัยอ้วนด้วย.


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