Health

Transition from Underweight to Obesity in India

Dr.Gursharan Singh Kainth | March 04, 2019 02:30 PM

Overweight or Obesity is an abnormal or excessive fat accumulation that may impair health. It is measured using the simple screening tool, Body Mass Index (BMI) defined as weight in kilogram divided by square of height in meters of person.

As per WHO classification, if BMI is 25.0 and above, the person is considered to be Overweight/ Obesity. Childhood obesity is a serious medical condition that affects children and adolescents. High BMI accounted for 4 million deaths globally, nearly 40 per cent of which occurred in persons who were not obese. Obese Children have above the normal weight for their age and height. Childhood obesity is particularly troubling because the extra pounds often start from children on the path to health problems that were once considered adult problems — diabetes, high blood pressure and high cholesterol. Many obese children become obese adults, especially if one or both parents are obese. Childhood obesity can also lead to poor self-esteem and depression. One of the best strategies to reduce childhood obesity is to improve the eating and exercise habits of your entire family. Treating and preventing childhood obesity helps protect child's health now and in the future.
STATUS:
In 1975, only one per cent of the world’s children – 5 million girls and 6 million boys – were obese. By 2016, this number rose to over 50 million girls and 74 million boys, that is, an increase of 6 per cent of girls and 8 per cent of boys in the age group of 5-19 yrs. This means that the number of obese children increased from 11 million in 1975 to 124 million in 2016. Besides, there were also 213 million overweight children in the world who fall below the obese category. India next only to China has the largest number of obese children at 14.4 million kids against 15.3 million in China according to a  study published in The New England Journal of Medicine. On the other hand, US with 79.4 million and China with 57.3 million had the highest number of obese adults in 2015. Globally, over two billion children and adults suffer from health problems related to being overweight or obese – nearly 30 per cent of all people and an increasing percentage of people die from these health conditions. This includes nearly 108 million children and more than 600 million adults with BMI exceeding 30 which is threshold limit for obesity.
Obesity among children is increasing in India too fast. The prevalence of obesity in India was less than 2 per cent in the age group of 5-19 yrs in 2016. However, Indian children gain weight as they grow and 8-14 per cent Indian adolescents are obese. Among Indian adults, obesity is a clearly rising trend. In 2005, 12.6 per cent of women and 9.3 per cent of men in the 15-49 year age-group were overweight. By 2015, this grew to 20.7 per cent and 18.6 per cent respectively–an increase of 8.1 percentage points for women and 9.3 percentage points for men.
Adult obesity was higher in women than men of all age brackets, however no such distinction was observed among children and individuals under the age of 20.  The prevalence of obesity has doubled since 1980 in more than 70 countries and has continuously increased in most other countries. Although the prevalence of obesity among children has been lower than among adults, but the rate of increase in childhood obesity was greater than that of adults. They are dying even though they are not technically considered obese. Of the four million deaths attributed to excess Body weight in 2015, nearly 40 per cent occurred among people whose body mass index fell below the threshold considered obese. Among the 20 most populous countries, highest level of obesity among children and adults was in US at nearly 13 per cent; Egypt topped the list for adult at about 35 per cent. Lowest rates were in Bangladesh and Vietnam respectively at 1 per cent.
People who shrug off weight gain do so at their own risk – risk of cardiovascular disease; diabetes; cancer and other life threatening conditions.  Many studies have shown a potential links between high BMI and cancers of oesophagus; colon and rectum; liver; gallbladder and biliary tract; pancreas; breast; uterus; kidney and thyroid as well as leukaemia.
During the past decade a range of interventions was proposed to reduce obesity. Among them is restricting advertising of unhealthy foods to children and improving school meals. In 2015, Ministry of Women and Child Development proposed a ban on junk food in schools, however it was not implemented. Recently, the Maharashtra government issued a notification instructing schools to stop serving junk food in their canteens, as it is low in nutrition content and high in salt, sugar and fat.
SYMPTOMS
Not all children carrying extra pounds are overweight or obese. Some children have larger than average body frames. And children normally carry different amounts of body fat at the various stages of development. So you might not know by how your child looks if weight is a health concern.
The body mass index (BMI), which provides a guideline of weight in relation to height, is the accepted measure of overweight and obesity. Your child's doctor can use growth charts, the BMI and, if necessary, other tests to help you figure out if your child's weight could pose health problems.
CAUSES:
Lifestyle issues — too little activity and too many calories from food and drinks — are the main contributors to childhood obesity. But genetic and hormonal factors might play a role as well. For example, recent research has found that changes in digestive hormones can affect the signals that let you know you're full.
Risk factors - Many factors — usually working in combination — increase your child's risk of becoming overweight:
    Diet - Regularly eating high-calorie foods, such as fast foods, baked goods and vending machine snacks, can cause your child to gain weight. Candy and desserts also can cause weight gain, and more and more evidence points to sugary drinks, including fruit juices, as culprits in obesity in some people.
    Lack of exercise - Children who don't exercise much are more likely to gain weight because they don't burn as many calories. Too much time spent in sedentary activities, such as watching television or playing video games, also contributes to the problem.
    Family factors - If your child comes from a family of overweight people, he or she may be more likely to put on weight. This is especially true in an environment where high-calorie foods are always available and physical activity isn't encouraged.
    Psychological factors - Personal, parental and family stress can increase a child's risk of obesity. Some children overeat to cope with problems or to deal with emotions, such as stress, or to fight boredom. Their parents might have similar tendencies.
    Socioeconomic factors - People in some communities have limited resources and limited access to supermarkets. As a result, they might buy convenience foods that don't spoil quickly, such as frozen meals, crackers and cookies. Also, people who live in lower income neighborhoods might not have access to a safe place to exercise.

The combination of undernutrition in early life with obesity later is particularly pernicious so far as the risk of developing non-communicable diseases during adulthood is concerned. “Interventions should focus on improving maternal and early childhood nutrition and focusing on risk factors that might cause overweight or obesity in the teens.”


COMPLICATIONS
Childhood obesity can have complications for child's physical, social and emotional well-being as discussed below.
Physical Complications:
    Type 2 diabetes. This chronic condition affects the way your child's body uses sugar (glucose). Obesity and a sedentary lifestyle increase the risk of type 2 diabetes.
    Metabolic syndrome. This cluster of conditions can put your child at risk of heart disease, diabetes or other health problems. Conditions include high blood pressure, high blood sugar, high triglycerides, low HDL ("good") cholesterol and excess abdominal fat.
    High cholesterol and high blood pressure. A poor diet can cause your child to develop one or both of these conditions. These factors can contribute to the buildup of plaques in the arteries, which can cause arteries to narrow and harden, possibly leading to a heart attack or stroke later in life.
    Asthma. Children who are overweight or obese might be more likely to have asthma.
    Sleep disorders. Obstructive sleep apnea is a potentially serious disorder in which a child's breathing repeatedly stops and starts during sleep.
    Nonalcoholic fatty liver disease (NAFLD). This disorder, which usually causes no symptoms, causes fatty deposits to build up in the liver. NAFLD can lead to scarring and liver damage.
    Bone fractures. Obese children are more likely to break bones than are children of normal weight.
Social and Emotional Complications
    Low self-esteem and being bullied. Children often tease or bully their overweight peers, who suffer a loss of self-esteem and an increased risk of depression as a result.
    Behavior and learning problems. Overweight children tend to have more anxiety and poorer social skills than normal-weight children do. These problems might lead children who are overweight either to act out and disrupt their classrooms or to withdraw socially.
    Depression. Low self-esteem can create overwhelming feelings of hopelessness, which can lead to depression in some children who are overweight.
PREVENTION
The combination of undernutrition in early life with obesity later is particularly pernicious so far as the risk of developing non-communicable diseases during adulthood is concerned. “Interventions should focus on improving maternal and early childhood nutrition and focusing on risk factors that might cause overweight or obesity in the teens.”
Whether your child is at risk of becoming overweight or is currently at a healthy weight, you can take measures to get or keep things on the right track.
    Limit your child's consumption of sugar-sweetened beverages or avoid them
    Provide plenty of fruits and vegetables
    Eat meals as a family as often as possible
    Limit eating out, especially at fast-food restaurants, and when you do eat out, teach your child how to make healthier choices
    Adjust portion sizes appropriately for age
    Limit TV and other "screen time" to less than 2 hours a day for children older than 2, and don't allow television for children younger than 2
    Be sure your child gets enough sleep
 The transition from underweight to overweight and then obesity can be rapid, an unhealthy transition that could strain the country’s health system and its ability to deal with the situation. More broadly, in an unhealthy nutritional transition, an increase in nutrient-poor, energy-dense foods can lead to stunted growth along with weight gain in children, adolescents, and adults, resulting in higher BMI and worse health outcomes throughout the life course. Undernutrition and obesity must be looked at comprehensively in an integrated fashion to counter both of them.


Dr Gursharan Singh Kainth is Director Guru Arjan Dev Institute of Development Studies, Amritsar

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