Prevention of Childhood Obesity Should Be an Integral Part of Prevention of Non Communicable Diseases
By Ramachandran, A Snehalatha, C
Diabetes and other major non communicable diseases (NCDs), including cardiovascular diseases (CVD) and hypertension are lifestyle disorders. Modernization and industrialization cause lifestyle changes resulting in reduced physical activity, unhealthy changes in dietary habits consisting of intake of calorie-dense, refined sugars and fats and increased stress levels. These changes produce escalating rates of obesity and worsens insulin resistance which is prevalent in the Indian race. Indians have a high genetic predisposition to diabetes, CVD and metabolic syndrome1. When the environmental factors affect adversely, the genetic tendency for these diseases gets unmasked. There is a great concern about the global increase in the prevalence of obesity especially in children and adolescents2, 3. This is closely linked to the lifestyle factors, unhealthy eating habits and decreased physical activity, both of which are occurring widely with urbanization. In this issue, Bharati and co-workers4 report on the prevalence and risk factors for overweight in children in Wardha city. Childhood obesity is a forerunner of obesity in adulthood which has a strong association with several non communicable diseases. A prospective study in American children by Sinaiko et al5, has shown that insulin resistance begins at an early age, has an independent effect on cardiovascular risk and may continue during adolescence.
Type 2 diabetes, previously considered to be a disease of the adults, developing mostly above the age of 50 years, is now being seen frequently among children and adolescents2,6-8. In India, it is reported to be common6,9. It is found to be more common in youth of Asian Indian origin than in the western counterparts7,8. Most of the studies in the youth in western countries have been in obese subjects and a strong association between insulin resistance and cardiometabolic risk factors has been shown2. A recent study by us in Chennai, showed a high prevalence of insulin resistance and cardiometabolic abnormalities among healthy adolescents10. Importantly, the abnormalities were seen even among children of normal weight. Nearly 68 per cent of the children of 12-19 yr had at least one metabolic abnormality which increased significantly in the presence of overweight (85%). These abnormalities tended to cluster. Similar reports have been presented by Misra and co-workers from northern India and also from Pakistan9,11. Presence of overweight and cardiometabolic abnormalities are more common in the higher socio-economic group, which is probably related to the differences in lifestyle. In an earlier study in school children, we noted that unhealthy lifestyle was common in the higher socio-economic stratum12. Several studies3,12,13 including the present one4 have shown that reduced physical activity and unhealthy diet habits have major roles in the causation of childhood obesity. Television viewing has been linked to childhood obesity and it also shows a causal relationship with lifestyle disorders3,13.
The present study by Bharati et al4 adds data from another area indicating that the country is facing an epidemic of obesity not only in the adults but also among the children.
Evidences have accumulated to show that the thresholds for risk factors such as age and obesity for NCDs are low in the Asians14,15. Diabetes per se is a risk factor for CVD. Moreover, a hyperglycaemic milieu is conducive for atherosclerotic changes and therefore the risk of heart diseases is enhanced by 3-4 fold in a diabetic than in a non diabetic population16.
The importance of enhancing physical activity and improving the dietary habits from childhood itself has been emphasized, as the major step towards prevention of NCDs3,11. The study reported by Bharati and coworkers4 and many other Indian studies, some of which are quoted by them, send out a warning signal that, if preventive steps are not initiated and implemented at the national level, India is likely to face a major heath hazard from the many NCDs associated with overweight and obesity, which are on the increase, among children. Education on healthy lifestyle has to begin at home, hence the parents have to be educated on these aspects for sustained effects.
References
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A. Ramachandran* & C. Snehalatha
India Diabetes Research Foundation &
Dr A. Ramachandran’s Diabetes Hospitals
Egmore, Chennai 600 008, India
*For correspondence: ramachandran @ ardiabetes.org
Copyright Indian Council of Medical Research Jun 2008
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