LIFESTYLE DISEASES AND OBESITY: AN OVERVIEW...

Chapter Chapter Chapter Chapter VVVV

LIFESTYLE DISEASES AND OBESITY:

AN OVERVIEW OF KERALA

Contents

5.1 Lifestyle Diseases in Kerala

5.2 Obesity and its Consequences

5.3 Childhood and Adolescent Obesity

5.4 Obesity in Kerala

5.5 Causes of Childhood and Adolescent Obesity

The changing environments and lifestyles have tremendous impact

on the new restless world of human life. WHO (2010) reports that as

world’s population ages, gets richer, smokes more, eats more and drives

more, non- communicable diseases will become bigger killers than the

infectious ones over the next 20 years. World Health Statistics (2008)

shows that AIDS, tuberculosis, neonatal tetanus and malaria will become

less important causes of death. Heart diseases, cancer, stroke, diabetes and

traffic accidents claim greater percentages of victims (Mcneil, 2008).

The world today is threatened not only by the traditional diseases

but also by a host of new lifestyle related disorders like diabetes, obesity,

asthma and cardiovascular diseases.

Lifestyle diseases are diseases that appear to become ever more

widespread as countries become more and more industrialized. These

diseases are different from other diseases because they are potentially

preventable and can be lowered with a change in diet, lifestyle,

environment etc. (www.naturalhealth perceptive.com). The onset of these

Chapter VChapter VChapter VChapter V ---- Lifestyle Diseases and Obesity: An Overview of Kerala Lifestyle Diseases and Obesity: An Overview of Kerala Lifestyle Diseases and Obesity: An Overview of Kerala Lifestyle Diseases and Obesity: An Overview of Kerala

LIFESTYLE DISEASES IN KERALA: AN ANALYSIS OF SOCIO-ECONOMIC STATUS, CONSUMPTION

PATTERN AND ADOLESCENT OBESITY IN KOTTAYAM DISTRICT

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diseases is insidious; they take years to develop and once encountered do

not lead themselves easily to cure.

Lifestyle diseases are permanent and require long periods of

excessive care and hence they are termed chronic diseases by medical

practitioners, which are putting pressure on the health care system. If

uncurbed, a new generation of 'diseases of comfort' (those chronic diseases

caused by obesity and physical inactivity) will become a major public

health problem in this and the next century (Choi et al., 2005).

Drastic changes in our diet; food intake and energy expenditure

increased the level of metabolic diseases such as diabetes and obesity

leading to cardiovascular diseases (Gluckman and Hanson, 2006). Chronic

diseases such as heart diseases, stroke, cancer, diabetes, and chronic

respiratory diseases are responsible for more than 60% of death globally

and are projected to account for 47 million deaths annually in the next 25

years (Akhil TandulWadiker, 2004). India faces a double burden on the

health front. Communicable diseases (CDs) such as tuberculosis and

malaria are still rampant. Meanwhile, chronic lifestyle related or non-

communicable diseases (NCDs) have emerged as an even bigger hazard

(Mohan, 2008). Migration for business, globalization of culture and

civilization, processed food consuming habits, semi-cooked and unsuitable

food system etc. cause the occurrence of lifestyle diseases (Rajan M, 2012).

Lifestyle diseases are the outcome of an in inappropriate

relationship of people with their environment. In the second half of the 20th

century, people’s diet changed substantially with the increased

consumption of meat, dairy products, vegetable oils and alcoholic




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beverages and with the decreased consumption of starchy staple foods.

These changes along with lifestyle changes such as large reduction of

physical activities, smoking etc. have resulted in high prevalence of these

diseases. The top ten lifestyle diseases are Alzheimer’s, Arteriosclerosis,

Cancer, Cirrhosis, Chronic Obstructive Pulmonary Diseases (COPD),

Hypertension, Diabetes, Heart Diseases, Nephritis and Stroke. The

combination of four healthy lifestyle factors, mainly maintaining a healthy

weight, regular exercise, healthy diet and non-smoking seem to be

associated with as much as an 80 per cent reduction in the risk of deadly

chronic diseases (Lekshmi, 2012).

5.1 Lifestyle Diseases in Kerala

Several population based studies and medical records in Kerala

have spotted the prevalence of both non-communicable and lifestyle

diseases in the state. Both of these diseases are spreading and causing death

in Kerala (Malayala Manorama Daily, 2011b). Though Kerala succeeded

to a great extent in reducing the vagaries of major public health diseases

like small pox, filaria and malaria, the diseases like respiratory infections,

acute diarrhoeal diseases etc are pausing challenges to the society and

health sector. Among the chronic illnesses, hypertension, diabetes and

cardio vascular diseases are emerging as serious health problems.

Sedentary lifestyle, lack of physical activity and obesity increase the risk of

chronic diseases (Gangadharan, 2007).

The lifestyle of the population changed a lot mostly in the 19th and

20th century. These changes are not always for the good. The unhealthy

living condition along with a change from traditional dietary habits,




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coupled with a sedentary lifestyle has made man vulnerable to lifestyle

diseases (Padmakumar, 2007). Lifestyle diseases are increasing both in

urban and rural areas. Modern consumption pattern and reduction in

physical activities are the reasons behind these problems in Kerala

(Johnson, 2012). Lifestyle diseases and obesity are increasing among the

police (Malayala Manorama Daily 2010a). Entrance and spread of lifestyle

diseases make a major challenge in the health sector of Kerala (Malayala

Manorama Daily 2011c).

The demographic and health transition in Kerala have been

remarkable and follow a pattern similar to the advanced countries. But the

transition from traditional illness pattern to modern neo-plastic diseases has

substantially increased the public health care burden (Asokan, 2009).

The prevalence of lifestyle diseases among children is increasing at

an alarming rate and the physical fitness of these children deteriorated in

Kerala (Joseph et al. 2011).

Report of the Indian Council for Medical Science and Technology

(2010) revealed that the percentage of diabetes, hypertension, overweight

and cholesterol among the population of Kerala are 16.2%, 32.7%, 30.8%

and 56.8% respectively. High prevalence of lifestyle diseases forced the

government of Kerala to implement some measures to control these

diseases. Adoor Prakash, Minister for Health, declared that lifestyle

diseases clinics would be held every week at the primary health centres and

services of specialists would be made available once in a month. Medicines

would be supplied free of charge to those with high blood pressure and

diabetes (The Hindu Daily, 2012).




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In spite of significant achievements in the health sector, the

prevalence of acute diseases and the emergence of the diseases of affluence

even in rural areas create doubts whether changes in the health sector of

Kerala have been quantitative rather than qualitative (Joseph and Padmaja,

2008).

The health situation in Kerala has improved quite a lot. Contagious

infectious diseases have gone down with a few exceptions of epidemics

which could be corrected by better surveillance strategies. Lifestyle

diseases that are coming in a big way should be handled with diligence and

tolerance without negating individual rights (Soman, 2007).

The prevalence of diabetes in urban regions of Kerala such as

Thiruvanathapuram is as high as 16% almost twice the rate of that in

European countries or the United States where body mass index is several

fold higher than in Kerala (Soman et al., 2000).

The increased consumption of high calorie foods and lack of

physical activity among Keralites has taken its toll on public health,

especially among the elderly, in the form of many chronic diseases,

including diabetes mellitus and related metabolic and cardiovascular

disorders (Sreekumaran, 2007). The state of Kerala has the highest

prevalence of coronary artery disease (CAD) among all Indian States with a

rural prevalence of 7.5% and urban prevalence of 12%. In a single medical

college hospital in Kerala there was more than 20-fold increase in

admissions for acute myocardial infarction during the period 1966 to 1988.

This is mainly because of the large number of patients with diabetes,

hypertension and hyper lipidemia in Kerala (Venugopal, 2007).




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Many cancers are related to the diet. Predominant among them are

cancers of the upper aero-digestive tract, oesophagus stomach, large

intestine and breast cancer in women. The role of diet takes special

importance in a state like Kerala which is fast moving towards urbanization

and westernization. We had a predominantly plant based diet and with the

advent of western lifestyle, are moving towards a diet rich in animal

proteins. This coupled with other habits like smoking and alcohol will lead

to an increase in chronic disease burden especially cancer and

cardiovascular diseases (Varghese et al., 2007).

Community based studies have indicated that there is an increasing

trend in the prevalence of hypertension and type -2 diabetes in Kerala. The

prevalence of hypertension ranges from 36.7% to 54.5% and there is no

gender disparity in prevalence, awareness, treatment and control of

hypertension (Zachariah et al., 2003).

The key health achievements in Kerala can be summarized as the

shift in the demographic profile, good life expectancy, low infant mortality

and low fertility rates. Social equity and minimal urban rural difference is

prevailing in the state.

At the same time, the transition in positive energy balance has

simultaneously reflected on the increasing prevalence of all the

cardiovascular diseases and risk factors like hypertension, diabetes,

dislipidemia and metabolic syndrome in Kerala (Thankappan et al., 2006).

Most of the modern fast food items contain dangerous trans fats. By

including fast foods and junk foods in the diet, Keralites invite lifestyle




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diseases like obesity, high blood pressure and diabetes (Deepika Daily,

2012).

5.2 Obesity and its Consequences

Overweight and obese individuals are at an increased risk of

hypertension, hypercholesterolemia, type 2 diabetes, coronary artery

diseases, congestive heart failure, stroke, gallstones, gout, osteoarthristis,

obstructive sleep apnea and other respiratory problems, pregnancy

complications, poor reproductive health and psychological disorders

(Morrill and Chinn, 2004). In developed countries more people become ill

from being overweight and eating rich diet (Ash, 2008). Obesity is the

most common nutritional disorder in the western world. There is no magic

cure for obesity but you can achieve a lower healthier weight by increasing

your level of physical activity and reducing your intake of calories

(Mcwhirter and Clasen, 1996). The only region of the world where obesity

is not common is sub Saharan Africa (Haslam and James 2005). WHO

reports that obesity is increasing world-wide. There are around 50 crores

people who are overweight world-wide. This problem is spreading from

developed nations to developing nations like tsunami. 10% of total medical

expenditure is spent for treating obesity related problems world wide

(Malayala Manorama Daily, 2011). U.S health secretary declares that the

country is spending $15000 crores per year to solve the problem of

overweight and obesity and that one third of adults are overweight there

(Malayala Manorama Daily, 2009).

Obesity increases the diseases burden. The morbidity associated

with obesity is given in the following table.




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Table 5.1

Morbidity Related to Obesity

Disease Proportion (%)

Hypertension 24

Myocardial Infraction 14

Angina Pectoris 21

Stroke 26

Venous Thrombosis 8

Type II Diabetes 24

Hyperlipidemia 08

Gout 20

Osteoarthritis 12

Gall bladder disease 14

Colorectal cancer 05

Breast cancer 03

Hip fracture 04

Source: Elizabeth, KE, (2007). “From the marasmic to obese”, in CC. Kartha (ed.),

Kerala fifty years and beyond, Gautha Books, Thiruvananthapuram, p.381.

Obesity results from the interaction of economic and non-economic

factors. The following chart highlights the theoretical factors that affect the

incidence of obesity and its potential impact on chronic diseases.




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Obesity: Incidence and Impact

Source: Asfaw, Abay (2006), “The effects of obesity on Doctor-Diagnosed Chronic

Diseases in Africa: Empirical results from Senegal and South Africa”, Journal of Public

Health Policy, Vol.27, No.3, pp.250-264.

Technological progress, international trade agreements and

urbanization etc have altered income levels and the relative prices of

different food items. As income changes, consumers may switch from the

Obesity

Education, Risk, Test, Culture

Food Policy

Chronic diseases

Technology Globalization Trade Urbanization

Income, food processing &

Marketing, Relative prices

Consumption (Energy

intake, diet quality)

Energy Balance

Physical Activity

Opportunity

cost of time Environment Technological

progress




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consumption of cereals and staples towards energy dense food items such

as oils, fats, sugar and other salty processed food items. Globalization and

urbanization also affect the consumption style and physical activities of

households. The impact of these factors on the incidence of obesity

depends on the nature of individuals and households: education, risk taking

behaviour, cultural and religious factors etc. Obesity constitutes a major

risk factor for chronic diseases and may affect the health of individuals

with huge subsequent direct and indirect costs.

The obese people are discriminated at home, in education,

employment, social circle and are considered as lazy, gluttonous, adamant

and wicked (Sharan, 2009). Weight control is a very important aspect of

heart disease prevention as it prevents high blood pressure, elevated blood

fat levels and diabetes (Padmavati, 1990). A health survey conducted by

Indian Defence Ministry and Indian Council of Medical Research revealed

that 30 per cent of Indian soldiers are overweight. Majority of them are

suffering from obesity, high blood pressure and cholesterol (Rashtra

Deepika Daily, 2011).

5.3 Childhood and Adolescent Obesity

Traditionally, an overweight child was considered attractive and

often referred to as a healthy child. However, the adverse and serious health

consequences of childhood and adolescent obesity are now proven beyond

doubt. An epidemic of childhood obesity is sweeping both the developed

and developing countries, with US leading all nations.

According to the World Health Organization, globally, 10% of

school children between 5 and 17 year are overweight or obese




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(www.who.int/mediacenter/news/releases/2004/pr.81/en). In the USA,

25% of children aged 10 to 16 years are affected by overweight (Janssen ,

2005). In Europe, the prevalence of overweight and obesity in children

aged 7 to 11 years ranges from 10% to 35% (Lobstern and Frelult, 2003).

Childhood obesity is not an immediately lethal disease itself but has

significant risk factors associated with a range of serious non-

communicable diseases in adolescents and childhood (Chandla et al.,

2009). Childhood obesity is a significant public health problem that causes

a wide range of serious complication and increase the risk of pre-mature

illness and death later in life (Onis, 2009). Obesity in children appears to

increase the risk of subsequence morbidity, whether or not obesity persists

into adulthood (Must et al. 1992). Obesity is a major health issue in the

United States and around the world impacting both children and adults

(Odgen et al., 2008). Logically, increasing childhood obesity leads to

increasing adult obesity. Obese children are much more likely than normal

weight children to become obese adults. Obesity even in very young

children is correlated with higher rates of obesity in adulthood (Anderson

and Butcher, 2006).

Obesity in adolescents results in a reduced health-related quality of

life, similar to that of those diagnosed with cancer (Schwimmer et al.,

2003). Obesity also entails co-morbidities that were previously thought to

be reserved for adults, including sleep-associated breathing disorders,

occurring in more than 90 per cent of obese adolescents; fatty liver diseases

and non-alcoholic steatohepatitis in up to 53 per cent of obese adolescents,

potentially progressing to necrosis and cirrhosis or hepatocellular




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carcinoma: metabolic syndrome with insulin resistance, hypertension,

hyperlipidaemia (43%) and type II diabetes (29%); and many orthopedic

problems caused by the excess weight (Wess et al., 2004). The severe co-

morbidities and complications result in obese adolescents suffering

severely increased rate of premature death in early adulthood (Bjorge et al.,

2008).

Childhood and adolescent obesity is not limited to developed

countries. It is seen in developing nations too (Popkin and Doak, 1998). In

India urbanization and modernisation has been associated with adolescent

obesity (Yadav and Krishnan, 2008).

Children nowadays have no time for sports and games. All their

time is taken up by academics. They spend their free time in front of the

TV or computer. With the easy availability of calorie-rich junk foods, food

habits also have gone from bad to worse. No wonder childhood obesity is

increasing in prevalence, and along with it, childhood type 2- diabetes

(Unnikrishnan and Mohanan, 2008).

Childhood obesity is a major worldwide epidemic. The

consequences of overweight and obesity among children will be the

development of type 2 diabetes in children. Overweight in children and

adolescents are generally caused by lack of physical activity and healthy

eating patterns (Rao and Viswanathan, 2008).

5.4 Obesity in Kerala

The increased purchasing power and affluence among the people of

Kerala during the last few decades have tremendously influenced their food

habits. Rapid westernization, change in the lifestyle of people, dramatic




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change in the dietary patterns and decline in physical activities of the

Keralites have thrown Kerala into the epidemic of obesity and overweight.

From the mid thirties of age to the early fifties of age, significant

populations have their BMI rising towards 25. This clearly brings the onset

of obesity even in rural population in Kerala. This has serious bearing on

the public health sector; productivity will decrease and more and more

people are likely to develop lifestyle diseases like diabetes, hypertension

and coronary artery diseases at an early age (Varghese and Vijayakumar,

2008).

A study conducted in Thiruvananthapuram reveals that overweight

and obesity is 18.3% among children (Ramesh, 2010). The proportion of

overweight children increased considerably in Ernakulam district, Kerala

during the period from 2003 to 2005 (Manuraj et al., 2007). Indian

Academy of Pediatrics, Kottayam suggested that people should understand

the dangers of overweight and obesity and should make necessary changes

in their lifestyle to keep away the epidemic of obesity (Malayala

Manorama Daily, 2012). Childhood obesity is the gateway to many

lifestyle diseases like diabetes, heart diseases, cancer, high cholesterol etc

(Grishma, 2011). Moreover a survey conducted in 2005 revealed that

people above the age of 35 in Kerala suffer from many lifestyle diseases

and overweight. Around 34% to 54% of the people in the above age group

suffer from the problem of overweight (Johnson, 2012a). While analysing

the causes of obesity, Sivasankaran focused on the impacts of three aspects

of the dietary pattern on the health of Keralites. The traditional Kerala diet

has transformed into energy dense, refined and civilized multi-cuisine

delicacy. The nutrition of Keralites is now that of over nutrition in terms of




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significant positive energy balance. Thirdly, the response of Keralites is

one of maladaptation, many becoming obese, while others remain as

metabolically obese individuals with weight in the normal range

(Sivasankaran, 2007).

5.5 Causes of Childhood and Adolescent Obesity

The increase in childhood obesity has gained full attention of health

care professionals, health policy experts and parents. All are concerned

that today’s overweight and obese children will turn into tomorrow’s

overweight and obese adults, destined to suffer from all the health problems

and health care costs associated with obesity. There are several

contributing factors to the development of obesity in childhood and

adulthood including poor nutrition, lack of physical activity, home and peer

influences as well as socio economic factors (Raspa et al., 2010). In India,

under nutrition attracted the focus of health workers, as childhood obesity

was rarely seen. But over the past few years childhood obesity is

increasingly being observed with the changing lifestyle of families (Singh

and Sharma, 2005). Parental lifestyle including time spent with children

and work commitments have a strong influence on dietary intake and

children’s weight (Jackson et al. 2005).

The rise in overweight and obesity rates across the globe has been

so rapid that it can not be attributed to genetic factors alone (Gulati, 2003).

Diet is what we eat and nutrition is what the body absorbs but the outcome

depends on how the body reacts. The traditional eating habits with good

physical activity are ideal. But modern unhealthy eating habits and




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sedentary lifestyle provide positive energy balance which is the main

reason of obesity especially obesity among children & adolescents.

5.5.1 Positive Energy Balance

The primary cause of childhood obesity must be due to changes in

energy balance. Weight is gained when energy intake exceeds energy

expenditure (Anderson and Butcher, 2006a). Physiologically, obesity can

only develop if food consumption is high and energy expenditure is low,

resulting in positive energy balance across months or years. A positive

energy balance of 10% can lead to approximately a 13.5 kg increase in

body weight within a year (Bray, 1987). The two important components of

energy balance are energy intake (Consumption) and energy expenditure.

5.5.1.1 Energy intake or Consumption pattern

Deviations from traditional micro-nutrient rich food is one of the

reasons responsible for over nutrition leading to obesity. Traditional dietary

patterns got easily contaminated by the refined energy dense, oily products

which are poor in micro-nutrients and dietary fiber (Sivasakaran, 2007a).

Children’s dietary habits have shifted away from healthy food (such as

fruits, vegetables, whole grains etc.) to a much greater reliance on fast food,

processed food, snacks and sugary drink. Children who regularly consume

more calories than they use will gain weight. Consumption of just 100

calories above daily requirement will typically result in a 10 pound weight

gain over one year (Lakshmipathy, 2010). Most of the carbohydrate food in

modern times have been processed and refined so that we do not receive

them in their natural state (Bloom, 1982). Man is now forced to take food

not because he is hungry but because food is available or it is part of




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socialization. Now every event is centered round food. The deep frying

technique and reuse of oil and reheating of foods stored in refrigerator will

increase oxidative stress and will lead to early ageing and unmasking of

metabolic syndrome. Increased supply of cheap, palatable energy dense

foods coupled with better distribution and marketing had led to passive

over consumption (Walker, 2011). Our irrational eating habits and over

eating invites obesity on the one side and micro nutrient malnutrition on the

other.

One of the important causes of positive energy balance among

children is fast food consumption. Cross-sectional studies have established

that individuals consuming fast food meals have higher energy intake with

lower nutritional values than those not consuming fast food (Sahasporn,

2003). Today, over one billion adults world-wide and almost 18 million

children under the age of 5 are overweight indicating a trend linked to fast

food consumption (Jeffery et al., 2006). There is a possible mechanistic

link between fast foods, energy density and obesity (Jebb, 2003).

Prevalence of overweight and obesity is high among the children of

working mothers. The main reason for this problem is that children of

working mothers eat more fast food than the children of non-working

mothers (Malayala Manorama Daily, 2011a). Padmavathi suggests that the

government should regulate fast food culture, which, she says is one of the

prime reasons for many lifestyle problems (The Hindu Daily, 2009).

Another frequently studied source of energy is soft drinks. As with

fast food, studies generally establish that drinking these beverages results in

higher overall energy intake. Buying a 600 ml bottle of cola on the way




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from school has become routine for children. Research has proved that a

glass of fizzy soft drink is nothing less than a killer assault on the body

(Lall, 2009). There is a positive link between overweight and soft drink

consumption (Ludwig et al., 2001).

Another much studied source of energy intake is snacks. Snack

foods such as potato chips are available around the corner, in a variety of

flavors and sizes to suit everyone’s palate and pocket (Gulati, 2003a).

Snack foods are often densely caloric, prepared, processed and packaged

foods (Nielsen et al., 2002). A significant and positive relationship

between Energy Dense Snack (EDS) food consumption and television

viewing is found to exist among 8 to 12 year old girls (Phillips et al., 2004).

5.5.1.2 Energy Expenditure

The other equally important side of energy balance is energy

expenditure both through physical activity and through dietary

thermogenesis and the Basal Metabolic Rate (BMR). Dietary

thermogenesis refers to the energy required to digest meals, and the basal

metabolic rate refers to the energy required to maintain the resting body’s

functions. Several studies examine the link between physical activity and

BMI. Increased hours of sedentary activities such as television viewing

have been linked positively with childhood overweight (Gable and Lutz,

2000). 19% of children who spend more than two hours a day in front of a

screen are overweight, compared to 15% of those children who do so for

less than one hour per day (Fisher et al. 2006). The Report of Cardiological

Socity of India revealed that obesity, unhealthy eating habits and modern




139

lifestyle increase the risk of heart problems in India (Malayala Manorama

Daily, 2009a).

The reductions in television viewing could have a positive effect on

physical activity, which in turn could possibly increase the likelihood of

decreasing childhood obesity (You and Nayga, 2005). Watching TV is

sedentary, and reduces available playtime. Moreover, each year it exposes

child viewers to an average of 40,000 advertisements, many promoting

junk food and fast food. In short, the more watching of television by

children, more likely they are to be overweight (www.kff.org/entmedia/

7030.cfm). It is found that an additional hour to television per day

increased the prevalence of obesity by 2 per cent (Dietz and Gortmaker,

1985). They note that television viewing may affect weight in several ways.

First, it may squeeze out physical activity. Second, television

advertisements may increase children’s desire for, and ultimately their

consumption of energy dense snack foods. Third, watching television may

go hand in hand with snacking, leading to higher energy intake among

children watching television. Video games also are more likely to make one

obese (Manuraj, 2008). Unsafe neighborhoods and limited access to

recreation areas in some urban environment discourage leisure time

physical activities (Pucher and Dijkstra, 2003). Breast feeding is not only

good for children but also for mothers. It reduces 500 calories of feeding

mothers daily. It also prevents the onset of type-2 diabetes (Malayala

Manorama Daily, 2010).

Modern marketing strategies also do not adhere to the principles of

social responsibility and marketing ethics. The young and ambitious




140

advertising executives resort to striking campaigns to increase the sale of

their unhealthy products without considering their negative impact on the

consumers. Unfortunately, some school officials relay on food marketing

in schools for revenue for school programs. Concern about food marketing

tactics and pressure they exert on decision making of children about food

purchases are highlighted in many studies (Dixon et al., 2006).

Another factor responsible for obesity is the increased value of time

especially for working mothers. More women are entering the formal

labour force; they have less time to spend for preparing food and as a result

there is an increased substitution of convenience foods; also there is an

increased demand for unsupervised after school activities for adolescents.

It changed the leisure time activities of adolescents and children (often,

with an increased number of hours spent watching TV and playing video

games neither of which require much or any physical exertion).

In short, the major factors which have contributed to positive

energy balance of children and adolescents are: (a) Deviations from

traditional micro-nutrient rich and home made food. (b) Over consumption

of calorie-rich junk food, fast foods, fried items, soft drinks and snack

foods. (c) Deep frying technique, re use of oil and reheating of foods stored

in refrigerator. (d) Inadequate level of physical activity, lack of exercise

and low aerobic fitness. (e)Availability of Television from 1982 as source

of cheap indoor entertainment dramatically reduced the recreational energy

expenditure. (f) The technological revolution, urbanization, the economic

boom and liberalizations have brought down the transport energy

expenditure of children in modern times. Moreover, due to unsafe roads,




141

children are discouraged from walking or cycling to school. (g) Increased

focus on academic excellence reduced physical education hours and drill

periods at school. The intense competition for admission to schools and

colleges with flourishing tuition classes right from nursery classes force the

children to forgo their play time for additional studies. (h) Unsafe

neighborhoods and improper urban and town planning discourage leisure

time physical activities.

5.5.2 Genetics or Heredity

Heredity has recently been shown to influence fatness, regional fat

distribution and response to over feeding. Genetics also plays a big role in

developing obesity. Recent studies have concluded that about 25 to 40

percent of BMI is heritable (Anderson and Butcher, 2006b). A child with

an obese parent, brother or sister is more likely to become obese (Rao et al.,

2010). The result of several studies suggests that the very fact of a women

being obese during pregnancy may predispose her children to obesity

(Judson, 2008).

5.5.3 Medical, Social and Emotional Factors

Obesity may follow due to damage to the hypothalamus after head

injury because it is not able to regulate appetite. Endocrine factors may

also contribute to obesity. Obesity is common at puberty, pregnancy and

menopause. Several studies have shown an association between depression

in children and development of obesity (Chandla et al., 2009a).

Prevention of obesity from childhood and adolescents and

appropriate early intervention is a simple and feasible solution for obesity

that is creeping up in global pandemic proportions.




142

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