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 Table of Contents  
EDITORIAL
Year : 2014  |  Volume : 1  |  Issue : 1  |  Page : 4-5

The formidable challenge of underweight, overweight and obese children in India


Chief Editor, JOMR

Date of Web Publication30-Dec-2013

Correspondence Address:
Ashok D.B. Vaidya
Chief Editor, JOMR

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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2347-9906.123825

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How to cite this article:
Vaidya AD. The formidable challenge of underweight, overweight and obese children in India. J Obes Metab Res 2014;1:4-5

How to cite this URL:
Vaidya AD. The formidable challenge of underweight, overweight and obese children in India. J Obes Metab Res [serial online] 2014 [cited 2019 Jul 16];1:4-5. Available from: http://www.jomrjournal.org/text.asp?2014/1/1/4/123825

The very first issue of JOMR has, incidentally, a major focus on the prevalence of obesity in children and home makers. [1],[2],[3] Though a coincidence, it is most appropriate that at the very outset we begin with the most crucial problem in obesity and metabolic research - why and how are children getting overweight and subsequently obese? The question is not only local. There are global concerns on childhood obesity as reflected in innumerable reviews, journal and newspaper/magazine editorials. [4],[5],[6] There is already, for a decade, a journal totally dedicated to "Childhood Obesity". [7] In the often repetitive and widespread clamour on the 'Childhood obesity' (Google 21,300,000 results in 0.58 s and PubMed 20285 results), what can JOMR add that will be of value and relevance to the challenge of early obesity? There is no substitute to reading the original articles, in JOMR and drawing one's own informed conclusions. However, some data stand out to be noticed and suggest that the double whammy, in India, of underweight and overweight is real and indeed formidable.

The children, even from a school serving the higher socio-economic class, were 10% underweight. [1] The percentage of underweight children in schools serving those from the lower socio-economic strata is of course much higher. However, these schools too show a significant number of overweight and obese children. These data suggest the complexity of the challenge for planning the interventional programmes. In addition, the rural-urban divide in prevalence of obesity, shown by several studies in India, stresses that no simplistic national strategy can be envisaged. [8],[9],[10] The high prevalence of deficiency of iron, vitamin and micronutrients and of helminth infections in children provides a background noise that further confounds any easy assignment of causes of underweight. In India, health is a state subject. Hence there is a need to have a state-wise strategy for health and nutrition of children, based on the field data. The strategy should be not fragmented as per specific conditions. However, it has to be integrative of school health education, longitudinal health, growth records and regular periodic check-ups. Parent-teacher pairs have to meet often for individual children, who need more guidance and reinforcement for their physical activity, diet and life-style vis-à-vis weight management. The problem in India, particularly in the rural schools, is the low level of admissions and a high level of dropping out. So special efforts must be made at the village panchayat level to identify both the under and overweight non-school-going children and evolve goal-oriented interventions. The existing primary and district health infrastructure has to be sensitised and oriented to the emergent epidemic of obesity and diabetes. The rural health model of the Mahatma Gandhi Institute of Medical Sciences viz. medical students adopting families in 72 villages can be replicated in other medical colleges for children's health and under - or overweight. [11]

Maternal factors play a significant role in childhood obesity, particularly mother's obesity. [12] The survey of housewives published in the present issue of JOMR shows a high incidence of overweight and obesity. [3] There are hardly any school children surveys for obesity, which have also covered parental nurturing and correlated it with the child's obesity. [13] This may be worth carrying out in community surveys of families with their diets, exercise and life-styles vis-à-vis their body mass index (BMI). The emergent data may also point to epigenetic and other environmental determinants of obesity. The literature often does not have long-term longitudinal studies in children or families. The present issue of JOMR has a survey carried out in the same school after a decade. [1] It is worthwhile to note stabilization and reduction in weight gain in girls. In the US, there is also noted a 1% reduction in obesity that has even invited newspaper attention. [14] In India, there are expected differences in obesity trends region-wise, as per ethnic groups and on the urban-rural basis. So there is a need to evolve a national epidemiological network to monitor children for BMI and growth. There are sporadic efforts in this direction but there are gaps in resources, political will and academic network.

The determinants of childhood obesity, in India, have been less studied. The surveys often focus only on BMI or diet of the children. The diverse putative factors - genetic, epigenetic, environmental, proposed as playing a role need to be investigated both by epidemiology and basic research. In India, there are inadequate efforts in the field of public health for obesity. Similarly, the basic science institutes are also not taking up fundamental research in the metabolic and environmental pathogenesis of obesity. The National Institute of Nutrition has developed a rat model of obesity and some basic studies have been carried out. [15] We need to pursue basic work on the long-term consequences of antenatal and early developmental perturbations on the central control of metabolism, energy transduction, adipocytes and glucose-lipid homeostasis. The risks of childhood obesity are well-known. For example, the risk of hypertension is fourfold in obese children. The proclivity to dyslipidaemia, metabolic syndrome, diabetes and cancer is also known. [16] The total cost that has to be borne due to such diseases is mind-boggling. The investments needed for the prevention of childhood obesity have to be rationalised based on robust health econometrics. A National Mission for Healthy Children is the need of the hour. However, where are the political will and the academic unison? We hope that JOMR can provide a forum not only for academic and research pursuits but also for health activism and advocacy through collective evidence-based consensual approaches to obesity and metabolism.

 
  References Top

1.Pandey S, Anupama B, Agashe S, Rama V. A cross-sectional study of childhood and adolescent obesity in affluent school children from western suburb of Mumbai 2001-2002 and 2013-2014. J Obes Metab Res 2014;1:7-13.  Back to cited text no. 1
    
2.Madan J, Neha G, Paarmi V, Princee K. Body fat percentage and its correlation with dietary pattern, physical activity and lifestyle factors in school going children of Mumbai, India. J Obes Metab Res 2014;1:14-9.  Back to cited text no. 2
    
3.Saboo B, Talaviya P, Chandarana H, Shah S, Vyas C, Nayak H. Prevalence of obesity and overweight in housewives and its relation with household activities and socio-economical status. J Ob Met Res 2014;1:20-4.  Back to cited text no. 3
    
4.Schwartz MB, Puhl R. Childhood obesity: A societal problem to solve. Obes Rev 2003;4:57-71.  Back to cited text no. 4
[PUBMED]    
5.Karnik S, Kanekar A. Childhood obesity: A global public health crisis. Int J Prev Med 2012;3:1-7.  Back to cited text no. 5
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6.Katz DL. Our Titanic obesity problem: Why the epidemic in America is still a sinking ship. U.S. News and World Report. [Last accessed date 2013 Sep 25]. Available from: http://www.nydailynews.com/life-style/health/america-titanic-obesity-problem-article-1.1432154#ixzz2kQlQ83a3.  Back to cited text no. 6
    
7.Katz DL, editor. Childhood obesity. New York, USA: Mary Ann Liebert, Inc. Publishers; 2012.  Back to cited text no. 7
    
8.Cherian AT, Cherian SS, Subbiah S. Prevalence of obesity and overweight in urban school children in Kerala, India. Indian Pediatr 2012;49:475-7.  Back to cited text no. 8
[PUBMED]    
9.Misra A, Shah P, Goel K, Hazra DK, Gupta R, Seth P, et al. The high burden of obesity and abdominal obesity in urban Indian school children: A multicentric study of 38,296 children. Ann Nutr Metab 2011;58:203-11.  Back to cited text no. 9
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10.Mohan B, Kumar N, Aslam N, Rangbulla A, Kumbkarni S, Sood NK, et al. Prevalence of sustained hypertension and obesity in urban and rural school going children in Ludhiana. Indian Heart J 2004;56:310-4.  Back to cited text no. 10
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11.Jajoo U, editor. Towards holistic rural health: Sarvoday way. Sevagram-Wardha: Mahatma Gandhi Institute of Medical Sciences; 2012.  Back to cited text no. 11
    
12.Huffman FG, Kanikireddy S, Patel M. Parenthood - A contributing factor to childhood obesity. Int J Environ Res Public Health 2010;7:2800-10.  Back to cited text no. 12
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13.La Rocca JD. Childhood Obesity: Is parental nurturing to blame? Internet J Allied Health Sci Pract 2009;7:1-5.  Back to cited text no. 13
    
14.Holmes B. First decrease in US childhood obesity. New Scientist Connect. [2013 Aug 09]. Available from: http://www.newscientist.com/article/dn24024-first-decrease-in-us-childhood-obesity.html#.UoIdKie3VU4 [Last accessed date 2013 Sep 27].  Back to cited text no. 14
    
15.Harishankar N, Vajreswari A, Giridharan NV. WNIN/GR-Ob-An insulin-resistant obese rat model from inbred WNIN strain. Indian J Med Res 2011;134:320-9.  Back to cited text no. 15
[PUBMED]  Medknow Journal  
16.Ebbeling CB, Pawlak DB, Ludwig DS. Childhood obesity: Public-health crisis, common sense cure. Lancet 2002;360:473-82.  Back to cited text no. 16
[PUBMED]    




 

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