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A 71-year-old patient, an Ayurvedic physician, attended the Endocrine Outpatient Department of Nair Hospital,Mumbai. He was interviewed for Drug Utilisation for the project of Ayurvedic Pharmacoepidemiology of Diabetes. The patient had type 2 diabetes mellitus for 10 years and was hypertensive since 20 years. He was on a conventional treatment for diabetes, hypertension, dyslipidaemia and angina pectoris. In addition, he integrated Ayurvedic management for his Madhumeha. His self-medication was with Marketed Ayurvedic Antidiabetic Formulations classically indicated for diabetes viz Chandraprabha and Arogyavardhini. He also took once daily the juice of the following ingredients - Aloe vera, Triticum aestivum, Momordica charantia, Lagernira siceraria and Allium sativum. He underwent a weekly whole body massage (Abhyangam) and a daily foot massage with Narayan Tail. Since past 10 years he practised pranayama and suryanamaskar for an hour daily. His glycaemic control has remained very good with the glycosylated haemoglobin value of 5.9%. The serum chemistry showed normal values for creatinine, blood urea nitrogen and triglycerides. The serum cholesterol value was 233 mg/dl. The laboratory data and physical health of the patient suggested that the integrative care achieved good glycaemic control. In India, many patients resort to multi-system

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An epidemic of obesity has engulfed children and adolescents across the developed and the developing world in recent years and India is not unscathed by this crisis in public health. This article underscores some emerging trends in obesity among Indian adolescents.

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Dr. Vinod Dhurandhar, the founder President of the All India Association for Advancing Research in Obesity (AIAARO), is one of the first doctors to treat obesity in India. He has more than 50 publications to his credit. He has treated over 65,000 obese individuals and has worked wonders on many, including several celebrities. He has trained many physicians and dieticians on how to tackle obesity and has organised various camps and lectures. His contribution to the field of obesity has brought him tremendous recognition and fame. Dr. Pallavi Patankar, President AIAARO (who is also one of the founder members of the Association), took some time off one afternoon to interview Dr. Dhurandhar.

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Introduction: Nutritional status of Indian children is a double-edged sword, reflecting dual burden of malnutrition. The standard norm of body mass index (BMI) percentiles may not reflect adiposity in children at both ends of the spectrum of malnutrition. The aim of the following study was to estimate body fat percentage of school-going children of different socio-economic strata and to compare it with BMI percentiles in an effort to identify the lean obese in malnourished children. An attempt was also made to correlate body fat percentage with dietary intake pattern and life-style factors including levels of physical activity, breakfast-eating patterns, frequency of eating out and sleep patterns. Materials and Methods: The sample comprised of 764 school-going children aged 10-17 years from private and government schools of Mumbai with a majority in the age group of 10 to 15 years. Results: The results indicate a high prevalence of underweight in government and private school children (82.7% and 55% respectively) based on BMI percentiles. A high percentage of government school and private school children (69.1% and 39.4%, respectively) were also classified in the category of very less body fat. The mean BMI was 18.97±3.79 and 16.09±2.9, respectively and the mean body fat percentage was 17.43±9.79 and 11.29±7.0 respectively in private and government school children There was an increase in the percentage of children who were overweight and obese in private schools (from 4.9% to 22.9%) and in government schools (from none to 4.3%) when they were classified based on body fat percentage. A number of children in underweight and normal categories of BMI did show high body fat percentage. Body fat was positively correlated to poor quality of eating and lifestyle factors including quantum of refined flour bakery products (P=0.001), eating out frequency (P=0.001), less duration of sleep (P=0.001), increased TV-viewing (P=0.013); it was negatively correlated to frequency and quantity of salad consumption (P=0.001), regular breakfast-consumption pattern (P=0.001) and increased level of physical activity (P=0.001). Conclusion: The study gives an insight in body fat percentage of Indian children and its relationship to dietary pattern and life-style factors.

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Background: Overweight and obesity are the most prevalent nutritional disorders in developed and developing countries due to rapid urbanization. Presently, the incidence of overweight, obesity and their related co-morbidities is increasing rapidly in India. Obesity itself is not an acutely lethal disease, but is a significant risk factor associated with a range of serious non-communicable diseases. Obesity is a major player responsible for increasing prevalence of diabetes mellitus, hypertension, cancer and lipid disorders. Aim: The present study was aimed to evaluate prevalence of obesity in housewives (HWs) and its relation with household activity in Ahmedabad city, India. Participants and Methods: The house-to-house survey or interview-based study was carried out among HWs (n=200) from different areas of Ahmedabad city to evaluate the prevalence of obesity. All study participants were categorized based on their socio-economical status and divided into three groups; Group I as upper middle class (UMC), Group II as middle class (MC) and Group III as lower middle class (LMC). Further, the participants were subcategorized to evaluate age-specific prevalence of overweight and obesity. Overweight and obesity were defined using body mass index criteria recommended by the World Health Organization. Participants were inquired for their daily household activity and physical activity. Results: Prevalence of overweight and obesity in HWs were found higher in MC group compared with UMC and LMC group. Moreover, age specific evaluation of prevalence of overweight and obesity was found to be higher in age group of 30-45 years followed by other age groups (<30 years and 46-60 years). Involvements of HWs in daily household activities were observed to be higher in LMC than in MC and UMC. Conclusion: The results of the present study revealed that the prevalence of overweight and obesity is higher in HWs belonging to MC families, which may be due low household and physical activities. The prevalence of obesity and overweight in HWs is directly proportional to reduced daily household activity and physical in activities.

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Introduction: Change in lifestyle patterns associated with genetic factors is causing increasing prevalence of childhood and adolescent obesity in India. Obesity during childhood and adolescence puts these children at a high risk for adult cardio-metabolic disorders and other chronic diseases. It is important that this avalanche is prevented in time by comprehensive school health education programmes and other timely interventions. An observational cross-sectional study, as a part of the School Health Education and Enlightened Living (SHEEL) project, was conducted to assess the prevalence in childhood overweight and obesity during the academic years 2000-2001 and 2013-2014 at a private school. Materials and Methods: As a part of the SHEEL project, a total of 2421 children consists of 1346 boys and 1075 girls (age ranged, 4 -15 years) were evaluated for their height (stadiometer), weight (electronic weighing scale) and body mass index (BMI) during the academic year 2000-2001 (stage 1 study). We approached the same school again in the academic year 2013-14 (stage 2 study). In this stage, a total of 2056 children (1067 boys and 989 girls; age range 5-15 years) were measured for the same parameters to evaluate in childhood and adolescent obesity when compared with that observed in 2000-2001.The measurements were plotted on gender specific BMI charts (Center for Disease Control and Prevention [CDC] charts) for obtaining percentiles. Identification of overweight and obesity was arrived at by CDC centile charts. Results: The stage 1 study done during the academic year 2000-2001 in school children from an affluent class of society showed a prevalence of overweight, in girls as 16.7% (180/1075) and in boys, 13.7% (185/1346). The prevalence of obesity for the total number of children was 15.3% (14.2% in 1075 girls and 16.1% in 1346 boys). In stage 2 study done during the academic year 2013-2014 in the same school, prevalence of overweight in girls was 16% (158/989) and in boys, 15.3% (163/1067) and the prevalence of obesity was 11.1% (9.1% in 989 girls and 12.9% in 1067 boys). If children at risk for obesity (overweight) and obese were clubbed together, nearly 1/3 of the children, 30.4% in 2001 and 26.7% in 2013, had above-normal BMI percentiles. In this study, the percentage of children showing overweight/obesity increased from the age groups 7 to 8 years and above as compared to the younger age groups. Conclusions: The current cross-sectional study shows that the prevalence of childhood and adolescent overweight and obesity amongst children from a upper-socio-economic stratum of society has remained high at 25-30% during both the periods of the school-based study. However, the trend for the prevalence of overweight and obesity in this >10 years has shown a definite decline of 5.8% in girls, while the decline of 1.6% in boys was not as remarkable.

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Accumulation of fat at ectopic sites rather than mere increase in body fat can explain almost all metabolic consequences of obesity. Certain characteristics of adipocytes like increased size and ectopic accumulation make them metabolically sick. Hence 'adiposopathy' seems to be more important than just 'adiposity'. Genetic and epigenetic factors, along with intra-uterine factors determine ectopic fat accumulation. These three factors result in low subcutaneous adipose tissue (SAT) volume leading to 'spillover' of excess fat to ectopic sites; determining 'metabolic economy', by creating a 'thrifty phenotype' with calorie excess later in life resulting in 'maladaptation' and excess weight gain. This is particularly important for South Asians who have been found to have low SAT volume and possess a 'thrifty phenotype'. Obesogenic diet and lack of physical activity contribute to ectopic fat deposition by creating a positive energy balance. Increased fructose and trans-fat consumption are important determinants of obesity and ectopic fat deposition. The good news is that ectopic fat is very responsive to treatment, disappearing at a faster rate with minimal weight loss, resulting in improvement in metabolic and organ functions. Physical activity causes negative energy balance and improves 'metabolic flexibility'. Targeting 'ectopic fat' should be the highlight of obesity management today and its primordial prevention should aim at targeting maternal nutrition.

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Obesity is a complex disease with a multifactorial aetiology and is linked with numerous adverse health conditions. Obesity research in the past several decades has generated considerable information about various aspects of obesity, including genetics, physiology, biochemistry and socio-epidemiology. However, effective strategies for obesity prevention, or long-term weight loss and maintenance, have remained elusive, as evident from the global presence of obesity. Traditionally, obesity took a backseat in India, when debilitating infections and undernutrition dominated public health concerns. It is now evident that an urgent and effective response is needed for treating and preventing obesity in India and health care professionals and researchers are stepping up to the new challenge. It appears that obesity in the Indian context offers unique attributes that could be investigated to develop obesity-management modalities of relevance to the Indian subcontinent. Even if India was somewhat late in joining the global obesity research efforts, it may be a blessing in disguise. It is not necessary to repeat research studies or approaches that have already shown limited value in controlling obesity at the population level. Instead, it may be wise to build on what has been learned about obesity. Some clinical research possibilities are discussed.

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