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How should Doctors deal with the Obesity Epidemic in India ?

M3 India Newsdesk Oct 27, 2017

Overweight and obesity are rapidly increasing in countries like India. We take a look at its prevalence, along with simple tips for doctors to treat obesity.



The epidemiological burden of Obesity

Obesity, characterized by excessive fat accumulation, is increasing at an alarming rate globally over the past few decades, affecting men, women and children and is currently a major threat to public health. Obesity is known to adversely affect the overall health of a population in several ways. According to the World Health Organization (WHO), obesity, earlier a disorder mainly of affluent developed nations is now also widely prevalent in developing countries, with at least 2.8 million people dying each year because of this condition. In addition, childhood obesity is a well- known track to obesity and other NCDs in adulthood. Due to the increased risk of morbidity and mortality, obesity is now being recognized as a disease. In India, obesity is increasing at an alarming rate affecting men, women and children in both urban rural areas. The most worrisome fact is that youth are becoming overweight and obese at earlier ages. This is mainly attributed to the fast-growing economy, epidemiological, nutritional and demographic transitions. Traditionally known for malnutrition, recent studies have shown that both overweight and obesity are equally rising, thus providing a classic double burden which makes public health policies that much more complicated.

A cross-sectional study conducted in 5 cities in India among 38,296 children reported the prevalence of obesity in children aged 8 to 18 years to be 2.8% using International Obesity Task Force [IOTF] classification, 4.8% using Centres for Disease Control and Prevention (CDC) criteria and 5.3% by WHO criteria. In another study conducted by us: the Obesity Reduction and Awareness and Screening of Non communicable diseases through Group Education in Children and Adolescents (ORANGE) study,18,955 children (aged 6-11 years) and adolescents (aged 12-17 years) across 51 schools (31 private and 20 government) of Chennai in South India, were surveyed . This study showed that the prevalence of obesity to be higher in girls than boys, in adolescents than children, in private schools than government schools and higher on using the Khadilkar’s criteria compared to the IOTF criteria.

Asian Indians have been known to have a greater predisposition to abdominal obesity and accumulation of visceral fat, termed as the “Asian Indian phenotype. The National Family Health Surveys [NFHS] have reported that the proportion of married women aged 15-49 years who are overweight/obese increased from 10.6% in 2002 ([NFHS-2] to 12.6% in 2007 [NFHS-3], to 20.7% in 2017 [NFHS-4]. The prevalence of overweight or obese among men increased from 9.3% in NFHS-3 to 18.6% in NFHS-4. Overweight was more prevalent among female, urban and high-socioeconomic-status [SES] groups.

Advising patients on how to prevent and manage obesity

It is being increasingly recognized, that the greatest dietary contributor to obesity is not fat, but carbohydrate. Hence any attempt to reduce obesity for people in India must include restriction of cereals whether it is rice, wheat, ragi or any other form of refined carbohydrates. This can be supplemented by adding plenty of vegetables (especially green leafy vegetables), pulses, legumes and other sources of protein. For vegetarians, dhals, sprouts, Bengal gram, green gram, black gram, soya, paneer, mushroom and milk are good sources of protein.

For non-Vegetarians fish and chicken can be included. In addition to reducing carbohydrates and calories, physical activity must be increased. This can include any form of exercise. It is now realized that even daily chores like doing house work, gardening, taking the dog for a walk, playing with children or using the staircase instead of the elevator all help. One simple tip can be to walk when you talk on your mobile phone. Of course, the place must be safe to walk. One should avoid talking while walking, while using the stairs or on the road.

Simple measures such as healthy eating and increased physical activity can help to both prevent obesity, as well as in reducing weight in those who are already obese. It is a good investment to buy a weighing machine and to regularly check one’s weight. Being aware of one’s weight itself is a motivation to lose weight. Finally, most mobile phones (smart phones) have apps which help you to count your steps. If you set your target at 10,000 steps per day and see that you achieve this regularly, one can prevent obesity.

In severe cases of obesity, one might have to use pharmacological therapy i.e. drug treatment for obesity. In cases of morbid obesity, one even consider bariatric surgery. However, this should be the last resort.

Disclaimer-This article is contributed by Dr V Mohan and Dr Dr. Rajendra  Pradeepa.The information and views set out in this article are those of the author(s) and do not necessarily reflect the official opinion of M3 India. Neither M3 India nor any person acting on their behalf may be held responsible for the use which may be made of the information contained therein.

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