CHILDHOOD OBESITY: A WEIGHTY CONCERN

In recent times, there’s been a lot of talk about childhood obesity and one often doesn’t picture developing nations (like India) having this problem. You might be surprised to know that in many low and middle income countries (LMICs), where three square meals a day is hard to come by for most. The ‘obesity epidemic’ in children is on the rise, and as a mother of two young children, this is a matter of concern to  me.


In India,  a nation struggling with undernutrition – a problem of epidemic proportions owing to poverty one might think that childhood obesity is not an issue of public health concern. However, the reality is that with the rapid and unchecked urbanization and migration from villages to cities, childhood obesity is rapidly emerging as a matter of grave concern.

The dual burden of undernutrition and obesity, much like that of infectious and communicable diseases, is  a real issue  putting  policy makers and healthcare decision makers in LMICs  in  a fix.(1) Obesity and under-nutrition – the two sides of the coin of malnutrition are both deleterious to health and their dual existence reflects a scenario of growing inequity.

Definitions of overweight & obesity

 

WHO   Body Mass Index (BMI) Classification
Normal weight	18.5-24.9
Overweight	≥ 25.0
Pre obese	25.0 -29.9
Obese	≥ 30.0
Class I	30.0 -34.9
Class II	35.0 -39.9
Class III	≥ 40.0

FEW KEY FACTS

OBESITY AND OVERWEIGHT AMONG CHILDREN IN DEVELOPING NATIONS

Changes in dietary habits and decreased physical activity in recent times has caused an increase in the prevalence of childhood obesity in several developing countries:  in Brazil 22.1%, in India 22% and 19.3% in Argentina. In addition, trends have shown an increasing prevalence in some of these countries: 4.1 to 13.9% in Brazil during 1974-1997 and 9.8 to 11.7% in India during 2006-2009.(8)

Evidence of the rise of childhood obesity in India   

Childhood obesity in Asian Indians: a burgeoning cause of insulin resistance, diabetes and sub-clinical inflammation. 
 Childhood obesity in India: a meta-analysis.  

CAUSES

The foremost cause for childhood obesity and overweight is the disproportionate consumption and expenditure of calories. (http://www.who.int/mediacentre/factsheets/fs311/en/)

The major contributing factors of obesity in childhood include high socio-economic status, urban residence, female gender, misconceptions regarding nutrition, increasing academic pressures resulting in lack of time for regular physical activity.(9)Studies have also established an association between prolonged television viewing and increase in BMI.(10)

HEALTH IMPACTS

Children who are overweight or obese are at a  greater risk for psychological and medical complications.(11) Childhood obesity can lead to serious conditions  like Type II Diabetes , hypertension, dyslipidaemia, obstructive sleep apnoea, early puberty, asthma and other respiratory disorders.(12) Researchers have also recognised a relationship between obesity and fracture of lower extremities in children.(9)

THE EVIDENCE

Metabolic Complications of Childhood Obesity

Health consequences of obesity in youth: childhood predictors of adult disease.

Health consequences of obesity

STRATEGIES IN PLACE

Childhood obesity is reversible and parents and care-givers play an important role in the reversal process by providing healthy diets and encouraging regular physical activity.(13) There is no magic wand to reverse childhood obesity; it requires perseverance and  constant support as it can be a lengthy process. Older members in the family should be role models in helping children achieve fitness.

WHO developed the  Global Strategy on Diet, Physical Activity and Health with the view to increase the overall awareness regarding the positive impact of a healthy, balanced diet and adequate physical activity on life.

Studies have shown that school-based interventions can possibly change eating habits, and level of physical activity and promote healthy body weight.(14)

 

THE EVIDENCE

Effectiveness of preventive school-based obesity interventions in low- and middle-income countries: a systematic review
Interventions for preventing obesity in children   
Interventions for treating obesity in children
School-based physical activity programs for promoting physical activity and fitness in children and adolescents aged 6 to 18   

I think the idea of offering cafeteria lunch (not the same as canteen food) to children in schools is a excellent practice as this gives children the opportunity to eat healthier foods and  it also allows healthier food choices to develop from a young age. 

If you are worried that your child may be at risk of becoming overweight or obese, a few simple measures can make a difference; limit foods with high sugar content and sweetened beverages reduce sedentary time by encouraging outdoor sports or activities, limit television watching time and practice regular bedtimes. To healthier children and a healthier tomorrow!

REFERENCES

1.         Corsi DJ, Finlay JE, Subramanian SV. Global Burden of Double Malnutrition: Has Anyone Seen It? PLoS ONE [Internet]. 2011 Sep 28 [cited 2013 Oct 5];6(9). Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3182195/

2.         WHO | Childhood overweight and obesity [Internet]. WHO. [cited 2013 Oct 5]. Available from: http://www.who.int/dietphysicalactivity/childhood/en/

3.         Muhihi AJ, Mpembeni RN, Njelekela MA, Anaeli A, Chillo O, Kubhoja S, et al. Prevalence and determinants of obesity among primary school children in Dar es Salaam, Tanzania. Arch Public Health Arch Belg Sante Publique. 2013 Oct 7;71(1):26.

4.         Ferrannini E, Natali A, Bell P, Cavallo-Perin P, Lalic N, Mingrone G. Insulin resistance and hypersecretion in obesity. European Group for the Study of Insulin Resistance (EGIR). J Clin Invest. 1997 Sep 1;100(5):1166–73.

5.         Rexrode KM, Manson JE, Hennekens CH. Obesity and cardiovascular disease. Curr Opin Cardiol. 1996 Sep;11(5):490–5.

6.         Freedman DS, Dietz WH, Srinivasan SR, Berenson GS. The relation of overweight to cardiovascular risk factors among children and adolescents: the Bogalusa Heart Study. Pediatrics. 1999 Jun;103(6 Pt 1):1175–82.

7.         Steinberger J, Daniels SR. Obesity, Insulin Resistance, Diabetes, and Cardiovascular Risk in Children An American Heart Association Scientific Statement From the Atherosclerosis, Hypertension, and Obesity in the Young Committee (Council on Cardiovascular Disease in the Young) and the Diabetes Committee (Council on Nutrition, Physical Activity, and Metabolism). Circulation. 2003 Mar 18;107(10):1448–53.

8.         Gupta N, Shah P, Nayyar S, Misra A. Childhood obesity and the metabolic syndrome in developing countries. Indian J Pediatr. 2013 Mar;80 Suppl 1:S28–37.

9.         Gupta N, Goel K, Shah P, Misra A. Childhood obesity in developing countries: epidemiology, determinants, and prevention. Endocr Rev. 2012 Feb;33(1):48–70.

10.       Braithwaite I, Stewart AW, Hancox RJ, Beasley R, Murphy R, Mitchell EA, et al. The Worldwide Association between Television Viewing and Obesity in Children and Adolescents: Cross Sectional Study. PloS One. 2013;8(9):e74263.

11.       Seth A, Sharma R. Childhood obesity. Indian J Pediatr. 2013 Apr;80(4):309–17.

12.       Midha T, Nath B, Kumari R, Rao YK, Pandey U. Childhood obesity in India: a meta-analysis. Indian J Pediatr. 2012 Jul;79(7):945–8.

13.       Golan M, Crow S. Parents are key players in the prevention and treatment of weight-related problems. Nutr Rev. 2004 Jan;62(1):39–50.

14.       Verstraeten R, Roberfroid D, Lachat C, Leroy JL, Holdsworth M, Maes L, et al. Effectiveness of preventive school-based obesity interventions in low- and middle-income countries: a systematic review. Am J Clin Nutr. 2012 Aug;96(2):415–38. 

By Rebecca Mathew

Rebecca is a Research Scientist at the South Asian Cochrane Network and Centre