OBESITY

Dr Neena Mehan

Professor, Dept. of Practice of Medicine Dr. B.R.Sur.Homoeopathic Medical College

Keywords: obesity; abdominal obesity; Dyslipidemia; Asian Indians; South Asians; nutrition; physical activity; type 2 diabetes; pharmacological therapy Abstract: Obesity and Dyslipidemia are emerging as major public health challenges in South Asian countries. The prevalence of obesity is more in urban areas than in rural because of their sedentary lifestyle and bizarre eating habits. In South Asians the more characteristic features of obesity are: high prevalence of abdominal obesity, with more intra-abdominal and truncal subcutaneous adiposity than white Caucasians. There is also great accumulation of fat in sights like liver and skeletal muscles, thus leading to higher level of insulin resistance and further causing metabolic disorders. Because of the occurrence of type 2 diabetes, Dyslipidemia and other cardiovascular morbidities at a lower range of body mass index (BMI) and waist circumference (WC), it is proposed that cut-offs for measures of obesity should be lower (BMI 2324.9 kg/m2 for overweight and 25 kg/m2 for obesity, WC 80 cm for women and 90 cm for men for abdominal obesity) for South Asians. Increasing obesity and Dyslipidemia in South Asians is primarily driven by nutrition, lifestyle and demographic transitions, increasingly faulty diets and physical inactivity, in the background of genetic predisposition. Pediatric obesity is one of the most important health issues facing the world today. Changing lifestyles, affluence on the rise, introduction to the new diets, changing social order and an increasingly sedentary lifestyle of the youth have contributed to the alarming rise of child and adolescent obesity. Recent definitions of obesity by WHO and IOTF have afforded distinct cutoffs to determine prevalence of obesity at the community level in children. Newer insights into leptin, adiponectin and ghrelin and its signaling pathways have helped our understanding of the genesis of obesity, which has been further

bolstered by the numerous studies into genetics of obesity. Endocrine disorders like hypothyroidism, Cushings syndrome, and syndromic disorders need to be ruled out. In addition to the routine investigations, evaluation of markers of insulin resistance and fat percentage is of great research utility in Indian children who differ a great deal metabolically from children in west. The overall prevalence of overweight/obesity in urban children in New Delhi has shown an increase from 16% in 2002 to about 24% in 2006-2007. While India already has highest number of patients with Type 2 Diabetes Mellitus (T2DM) globally, rapid rise of obesity in children is the prime reason for increasing insulin resistance, the metabolic syndrome, dyslipidemia, polycystic ovarian syndrome and raised level of Creactive protein. As compared to the other ethnic groups, children with ancestral origin in south Asia manifest adiposity, insulin resistance and metabolic perturbations earlier in life and these derangements are of higher magnitude than white Caucasian children. Since the metabolic syndrome and obesity track into adulthood, these clinical entities need to be recognized early for effective prevention of T2DM and coronary heart disease. The cornerstones of treatment are therapeutic lifestyle changes, behavior modifications and pharmacological therapy when needed. However, primordial prevention by inculcation of a healthy lifestyle seems to be the best bet in combating pediatric obesity. Click here for PPT.