Childhood Obesity in Developing Countries: Facets of Abnormal Growth

  • Nidhi Gupta
  • Kashish Goel
  • Anoop Misra


Increased availability of indigenous and “westernized” energy-dense fast foods, aggressive advertising practices, relatively low cost, and improved purchasing power have led children and adolescents in developing countries to increasingly consume saturated-fat snacks, refined carbohydrates, and sweetened carbonated beverages. Such rapidly changing dietary practices accompanied by an increasingly sedentary lifestyle predispose to nutrition-related non-communicable diseases, including childhood obesity. Over the last 5 years, reports from several developing countries indicate prevalence rates of obesity (inclusive of overweight) > 15% in children and adolescents aged 5–19 years: Mexico 41.8%, Brazil 22.1%, India 22.0%, and Argentina 19.3%. Moreover, secular trends also indicate an alarming increase in obesity in developing countries: in Brazil from 4.1 to 13.9% between 1974 and 1997; in Thailand from 12.2 to 15.6% between 1991 and 1993; in China from 6.4 to 7.7% between 1991 and 1997; and in India from 4.9 to 6.6% between 2003–2004 and 2005–2006. Other contributory factors to childhood obesity include high socio-economic status, residence in metropolitan cities, and female gender. Over-protection and forced feeding by parents may also account for the growing prevalence rates. Mothers in developing countries often have false traditional beliefs such as “feeding oils, ghee (clarified butter), and butter to children would benefit their growth” and “a chubby child is healthy child.” Childhood obesity tracks into adulthood, thus increasing the risk for conditions and diseases linked to obesity in childhood and later in life too (the metabolic syndrome, type 2 diabetes mellitus (T2DM), sub-clinical inflammation, polycystic ovarian syndrome, hypertension, dyslipidemia, and coronary artery disease). Interestingly, prevalence of the metabolic syndrome was 35.2% among overweight Chinese adolescents. Presence of central obesity (high waist-to-hip circumference ratio) along with hypertriglyceridemia and family history of T2DM increases the odds of T2DM by 112.1 in young Asian Indians (< 40 years). Further, overweight children tend to have a poor body image and low self-esteem, which could interfere with their learning and may result in depression. Therapeutic lifestyle changes and maintenance of high levels of physical activity are most important strategies for preventing childhood obesity. Parental initiative and social support are necessary to bring about changes. Governmental control of “calorie-dense junk foods” and audiovisual advertisements of such junk foods through legal and policy initiatives are urgently required in many developing countries. Effective health awareness educational programs for children should be immediately initiated in developing countries following the successful model program in India (project “MARG”).


Metabolic Syndrome Preschool Child Childhood Obesity Junk Food National Family Health Survey 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



Body mass index


Coronary artery diseases


Centers for Disease Control and Prevention


High-density lipoprotein cholesterol


high-sensitivity C-reactive protein


International Diabetes Federation


International Obesity Task Force


Non-alcoholic fatty liver disease


National Cholesterol Education Program, Adult Treatment Panel III


National Family Health Surveys


Non-metropolitan cities


National Nutrition Monitoring Bureau


Nutrition-related non-communicable diseases






Polycystic ovarian syndrome


Polyunsaturated fatty acids


Recommended dietary allowance


Rheumatic heart disease


Subcutaneous adipose tissue


Socio-economic status


Type 2 diabetes mellitus


Waist circumference


World Health Organization


Waist-to-hip circumference ratio





We acknowledge the support and cooperation of National Diabetes, Obesity, and Cholesterol Disorders Foundation (N-DOC), New Delhi, Diabetes Foundation (India), and World Diabetes Foundation, Denmark, in various research initiatives in childhood obesity undertaken by our group. We thank Dr Priyali Shah, Ph.D. (Public Health Nutrition) for her helpful comments and reviewing the manuscript.


  1. Agirbasli M, Cakir S, Ozme S, Ciliv G. Metabolic syndrome in Turkish children and adolescents. Metabolism. 2006;55:1002–6.PubMedCrossRefGoogle Scholar
  2. Al-Hazzaa HM, Al-Rasheedi AA. Adiposity and physical activity levels among preschool children in Jeddah, Saudi Arabia. Saudi Med J. 2007;28:766–73.PubMedGoogle Scholar
  3. Allensworth D, Lawson E, Nicholson L, Wyche J. Schools and health: our nation’s investment. Committee on Comprehensive School Health Programs in Grades K-12, Division of Health Sciences Policy, Institute of Medicine. Washington, DC: National Academy Press; 1997.Google Scholar
  4. Armstrong N, Balding J, Gentle P, Kirby B. Patterns of physical activity among 11 to 16 year old British children. BMJ. 1990;301:203–5.PubMedCrossRefGoogle Scholar
  5. Armstrong ME, Lambert MI, Sharwood KA, Lambert EV. Obesity and overweight in South African primary school children – the Health of the Nation Study. S Afr Med J. 2006;96:439–44.PubMedGoogle Scholar
  6. Arya S, Isharwal S, Misra A, Pandey RM, Rastogi K, Vikram NK, Dhingra V, Chatterjee A, Sharma R, Luthra K. C-reactive protein and dietary nutrients in urban Asian Indian adolescents and young adults. Nutrition. 2006;22:865–71.PubMedCrossRefGoogle Scholar
  7. Ayatollahi SM, Mostajabi F. Prevalence of obesity among schoolchildren in Iran. Obes Rev. 2007;8:289–91.PubMedCrossRefGoogle Scholar
  8. Banerjee D, Misra A. Does using ethnic specific criteria improve the usefulness of the term metabolic syndrome? Controversies and suggestions. Int J Obes (Lond). 2007;31:1340–9.CrossRefGoogle Scholar
  9. Bavdekar A, Yajnik CS, Fall CH, Bapat S, Pandit AN, Deshpande V, Bhave S, Kellingray SD, Joglekar C. Insulin resistance syndrome in 8-year-old Indian children: small at birth, big at 8 years, or both? Diabetes. 1999;48:2422–9.PubMedCrossRefGoogle Scholar
  10. Bhardwaj S, Misra A, Khurana L, Gulati S, Shah P, Vikram NK. Childhood obesity in Asian Indians: a burgeoning cause of insulin resistance, diabetes and sub-clinical inflammation. Asia Pac J Clin Nutr. 2008;17(Suppl 1):172–5.PubMedGoogle Scholar
  11. Bhargava SK, Sachdev HS, Fall CH, Osmond C, Lakshmy R, Barker DJ, Biswas SK, Ramji S, Prabhakaran D, Reddy KS. Relation of serial changes in childhood body-mass index to impaired glucose tolerance in young adulthood. N Engl J Med. 2004;350:865–75.PubMedCrossRefGoogle Scholar
  12. Biasillo G, De Maria GL, Leo M, Stefanelli A, Biasucci LM. Relation of C-reactive protein and coronary heart disease. Current knowledges. Recenti Prog Med. 2009;100:279–85.PubMedGoogle Scholar
  13. Biro L, Regoly-Merei A, Nagy K, Peter S, Arato G, Szabo C, Martos E, Antal M. Dietary habits of school children: representative survey in metropolitan elementary schools. Ann Nutr Metab. 2007;51:454–60.PubMedCrossRefGoogle Scholar
  14. Butte NF, Garza C, de Onis M. Evaluation of the feasibility of international growth standards for school-aged children and adolescents. J Nutr. 2007;137:153–7.PubMedGoogle Scholar
  15. Caceres M, Teran CG, Rodriguez S, Medina M. Prevalence of insulin resistance and its association with metabolic syndrome criteria among Bolivian children and adolescents with obesity. BMC Pediatr. 2008;8:31.PubMedCrossRefGoogle Scholar
  16. CAMBIO. Canada–Mexico Battling Childhood Obesity. 2009. Accessed 7 October 2009.
  17. CDC. Centers for Disease Control and Prevention. Overweight and obesity: health consequences. 2009. Accessed 13 October 2009.
  18. Chhatwal J, Verma M, Riar SK. Obesity among pre-adolescent and adolescents of a developing country (India). Asia Pac J Clin Nutr. 2004;13:231–5.PubMedGoogle Scholar
  19. Cole TJ, Bellizzi MC, Flegal KM, Dietz WH. Establishing a standard definition for child overweight and obesity worldwide: international survey. BMJ. 2000;320:1240–3.PubMedCrossRefGoogle Scholar
  20. Cook S, Weitzman M, Auinger P, Nguyen M, Dietz WH. Prevalence of a metabolic syndrome phenotype in adolescents: findings from the third National Health and Nutrition Examination Survey, 1988–1994. Arch Pediatr Adolesc Med. 2003;157:821–7.PubMedCrossRefGoogle Scholar
  21. Coviello AD, Legro RS, Dunaif A. Adolescent girls with polycystic ovary syndrome have an increased risk of the metabolic syndrome associated with increasing androgen levels independent of obesity and insulin resistance. J Clin Endocrinol Metab. 2006;91:492–7.PubMedCrossRefGoogle Scholar
  22. de Assis MA, Rolland-Cachera MF, Grosseman S, de Vasconcelos FA, Luna ME, Calvo MC, Barros MV, Pires MM, Bellisle F. Obesity, overweight and thinness in schoolchildren of the city of Florianopolis, Southern Brazil. Eur J Clin Nutr. 2005;59:1015–21.PubMedCrossRefGoogle Scholar
  23. de Onis M, Blossner M. Prevalence and trends of overweight among preschool children in developing countries. Am J Clin Nutr. 2000;72:1032–9.PubMedGoogle Scholar
  24. de Vasconcelos VL, da Silva GA. Overweight and obesity prevalences in male adolescents in Northeast Brazil, 1980–2000. Cad Saude Publica. 2003;19:1445–51.PubMedCrossRefGoogle Scholar
  25. DFI. Primary prevention in Indian schools, World Diabetes Foundation. 2006. Accessed 13 October 2009.
  26. Duncan GE, Li SM, Zhou XH. Prevalence and trends of a metabolic syndrome phenotype among U.S. Adolescents, 1999–2000. Diabetes Care. 2004;27:2438–43.PubMedCrossRefGoogle Scholar
  27. Dunn W, Schwimmer JB. The obesity epidemic and nonalcoholic fatty liver disease in children. Curr Gastroenterol Rep. 2008;10:67–72.PubMedCrossRefGoogle Scholar
  28. El-Hazmi MA, Warsy AS. The prevalence of obesity and overweight in 1-18-year-old Saudi children. Ann Saudi Med. 2002;22:303–7.PubMedGoogle Scholar
  29. Esmaillzadeh A, Mirmiran P, Azadbakht L, Etemadi A, Azizi F. High prevalence of the metabolic syndrome in Iranian adolescents. Obesity (Silver Spring). 2006;14:377–82.CrossRefGoogle Scholar
  30. Fall CH, Sachdev HS, Osmond C, Lakshmy R, Biswas SD, Prabhakaran D, Tandon N, Ramji S, Reddy KS, Barker DJ, Bhargava SK. Adult metabolic syndrome and impaired glucose tolerance are associated with different patterns of BMI gain during infancy: data from the New Delhi Birth Cohort. Diabetes Care. 2008;31:2349–56.PubMedCrossRefGoogle Scholar
  31. Gortmaker SL, Must A, Perrin JM, Sobol AM, Dietz WH. Social and economic consequences of overweight in adolescence and young adulthood. N Engl J Med. 1993;329:1008–12.PubMedCrossRefGoogle Scholar
  32. Gupta N, Shah P, Goel K, Misra A, Rastogi K, Vikram NK, Kumari V, Pandey RM, Kondal D, Wasir JS, Bhardwaj S, Gulati S. Imbalanced dietary profile, anthropometry, and lipids in urban asian Indian adolescents and young adults. J Am Coll Nutr. 2010;29:81–91.PubMedGoogle Scholar
  33. Hassapidou M, Papadopoulou SK, Frossinis A, Kaklamanos I, Tzotzas T. Sociodemographic, ethnic and dietary factors associated with childhood obesity in Thessaloniki, Northern Greece. Hormones (Athens). 2009;8:53–9.Google Scholar
  34. Holst-Schumacher I, Nunez-Rivas H, Monge-Rojas R, Barrantes-Santamaria M. Components of the metabolic syndrome among a sample of overweight and obese Costa Rican schoolchildren. Food Nutr Bull. 2009;30:161–70.PubMedGoogle Scholar
  35. ICMR EGo. Nutrient requirements and recommended dietary allowances for Indians. New Delhi: Research, ICoM; 1990.Google Scholar
  36. IHHP. Isfahan Healthy Heart Program – Heart Health Promotion from Childhood. 1999. Accessed 5 October 2009.
  37. Jabre P, Sikias P, Khater-Menassa B, Baddoura R, Awada H. Overweight children in Beirut: prevalence estimates and characteristics. Child Care Health Dev. 2005;31:159–65.PubMedCrossRefGoogle Scholar
  38. Jafar TH, Qadri Z, Islam M, Hatcher J, Bhutta ZA, Chaturvedi N. Rise in childhood obesity with persistently high rates of undernutrition among urban school-aged Indo-Asian children. Arch Dis Child. 2008;93:373–8.PubMedCrossRefGoogle Scholar
  39. Jayatissa R, Ranbanda RM. Prevalence of challenging nutritional problems among adolescents in Sri Lanka. Food Nutr Bull. 2006;27:153–60.PubMedGoogle Scholar
  40. Julia M, van Weissenbruch MM, Prawirohartono EP, Surjono A, Delemarre-van de Waal HA. Tracking for underweight, overweight and obesity from childhood to adolescence: a 5-year follow-up study in urban Indonesian children. Horm Res. 2008;69:301–6.PubMedCrossRefGoogle Scholar
  41. Kapil U, Singh P, Pathak P, Dwivedi SN, Bhasin S. Prevalence of obesity amongst affluent adolescent school children in Delhi. Indian Pediatr. 2002;39:449–52.PubMedGoogle Scholar
  42. Kaur S, Sachdev HP, Dwivedi SN, Lakshmy R, Kapil U. Prevalence of overweight and obesity amongst school children in Delhi, India. Asia Pac J Clin Nutr. 2008;17:592–6.PubMedGoogle Scholar
  43. Kelishadi R, Sadri G, Tavasoli AA, Kahbazi M, Roohafza HR, Sadeghi M, Khosravi A, Sabet B, Amani A, Ansari R, Alikhassy H. Cumulative prevalence of risk factors for atherosclerotic cardiovascular diseases in Iranian adolescents: IHHP-HHPC. J Pediatr (Rio J). 2005;81:447–53.Google Scholar
  44. Keller KL, Kirzner J, Pietrobelli A, St-Onge MP, Faith MS. Increased sweetened beverage intake is associated with reduced milk and calcium intake in 3- to 7-year-old children at multi-item laboratory lunches. J Am Diet Assoc. 2009;109:497–501.PubMedCrossRefGoogle Scholar
  45. Kennedy G, Nantel G, Shetty P. Globalization of food systems in developing countries: impact on food security and nutrition. FAO Food Nutr Pap. 2004;83:1–300.PubMedGoogle Scholar
  46. Khadilkar VV, Khadilkar AV. Prevalence of obesity in affluent school boys in Pune. Indian Pediatr. 2004;41:857–8.PubMedGoogle Scholar
  47. Kim HM, Park J, Kim HS, Kim DH. Prevalence of the metabolic syndrome in Korean adolescents aged 12–19 years from the Korean National Health and Nutrition Examination Survey 1998 and 2001. Diabetes Res Clin Pract. 2007;75:111–4.PubMedCrossRefGoogle Scholar
  48. Kitagawa T, Owada M, Urakami T, Yamauchi K. Increased incidence of non-insulin dependent diabetes mellitus among Japanese schoolchildren correlates with an increased intake of animal protein and fat. Clin Pediatr (Phila). 1998;37:111–5.CrossRefGoogle Scholar
  49. Kosti RI, Panagiotakos DB. The epidemic of obesity in children and adolescents in the world. Cent Eur J Public Health. 2006;14:151–9.PubMedGoogle Scholar
  50. Kuczmarski RJ, Ogden CL, Grummer-Strawn LM, Flegal KM, Guo SS, Wei R, Mei Z, Curtin LR, Roche AF, Johnson CL CDC growth charts: United States. Adv Data. 2000;314:1–27.PubMedGoogle Scholar
  51. Kumar HN, Mohanan P, Kotian S, Sajjan BS, Kumar SG. Prevalence of overweight and obesity among preschool children in semi urban South India. Indian Pediatr. 2008;45:497–9.PubMedGoogle Scholar
  52. Kuriyan R, Bhat S, Thomas T, Vaz M, Kurpad AV. Television viewing and sleep are associated with overweight among urban and semi-urban South Indian children. Nutr J. 2007;6:25.PubMedCrossRefGoogle Scholar
  53. Lafta RK, Kadhim MJ. Childhood obesity in Iraq: prevalence and possible risk factors. Ann Saudi Med. 2005;25:389–93.PubMedGoogle Scholar
  54. Laxmaiah A, Nagalla B, Vijayaraghavan K, Nair M. Factors affecting prevalence of overweight among 12- to 17-year-old urban adolescents in Hyderabad, India. Obesity (Silver Spring). 2007;15:1384–90.CrossRefGoogle Scholar
  55. Lee YS. Consequences of childhood obesity. Ann Acad Med Singapore. 2009;38:75–7.PubMedGoogle Scholar
  56. Lee MS, Wahlqvist ML, Yu HL, Pan WH. Hyperuricemia and metabolic syndrome in Taiwanese children. Asia Pac J Clin Nutr. 2007;16(Suppl 2):594–600.PubMedGoogle Scholar
  57. Li Y, Yang X, Zhai F, Kok FJ, Zhao W, Piao J, Zhang J, Cui Z, Ma G. Prevalence of the metabolic syndrome in Chinese adolescents. Br J Nutr. 2008a;99:565–70.PubMedCrossRefGoogle Scholar
  58. Li Y, Yang X, Zhai F, Piao J, Zhao W, Zhang J, Ma G. Childhood obesity and its health consequence in China. Obes Rev. 2008b;9(Suppl 1):82–6.PubMedCrossRefGoogle Scholar
  59. Likitmaskul S, Kiattisathavee P, Chaichanwatanakul K, Punnakanta L, Angsusingha K, Tuchinda C. Increasing prevalence of type 2 diabetes mellitus in Thai children and adolescents associated with increasing prevalence of obesity. J Pediatr Endocrinol Metab. 2003;16:71–7.PubMedCrossRefGoogle Scholar
  60. Littlejohn EE, Weiss RE, Deplewski D, Edidin DV, Rosenfield R. Intractable early childhood obesity as the initial sign of insulin resistant hyperinsulinism and precursor of polycystic ovary syndrome. J Pediatr Endocrinol Metab. 2007;20:41–51.PubMedCrossRefGoogle Scholar
  61. Misra A, Khurana L. Obesity and the metabolic syndrome in developing countries. J Clin Endocrinol Metab. 2008;93:S9–30.PubMedCrossRefGoogle Scholar
  62. Misra A, Shah P, Goel K, Hazra DK, Gupta R, Seth P, Tallikoti P, Mohan I, Bhargava R, Bajaj S, Madan J, Gulati S, Bhardwaj S, Sharma R, Gupta N, Pandey RM. The high burden of obesity and abdominal obesity in Urban Indian school children: a multicentric study of 38,296 children. Ann Nutr Metab. 2011;in press.Google Scholar
  63. Misra A, Sharma R, Pandey RM, Khanna N. Adverse profile of dietary nutrients, anthropometry and lipids in urban slum dwellers of northern India. Eur J Clin Nutr. 2001;55:727–34.PubMedCrossRefGoogle Scholar
  64. Misra A, Vikram NK, Arya S, Pandey RM, Dhingra V, Chatterjee A, Dwivedi M, Sharma R, Luthra K, Guleria R, Talwar KK. High prevalence of insulin resistance in postpubertal Asian Indian children is associated with adverse truncal body fat patterning, abdominal adiposity and excess body fat. Int J Obes Relat Metab Disord. 2004;28:1217–26.PubMedCrossRefGoogle Scholar
  65. Moayeri H, Bidad K, Aghamohammadi A, Rabbani A, Anari S, Nazemi L, Gholami N, Zadhoush S, Hatmi ZN. Overweight and obesity and their associated factors in adolescents in Tehran, Iran, 2004–2005. Eur J Pediatr. 2006;165:489–93.PubMedCrossRefGoogle Scholar
  66. Mohan B, Kumar N, Aslam N, Rangbulla A, Kumbkarni S, Sood NK, Wander GS. Prevalence of sustained hypertension and obesity in urban and rural school going children in Ludhiana. Indian Heart J. 2004;56:310–4.PubMedGoogle Scholar
  67. Monteiro CA, D’A Benicio MH, Conde WL, Popkin BM. Shifting obesity trends in Brazil. Eur J Clin Nutr. 2000;54:342–6.PubMedCrossRefGoogle Scholar
  68. Moodie M, Haby M, Galvin L, Swinburn B, Carter R. Cost-effectiveness of active transport for primary school children – Walking School Bus program. Int J Behav Nutr Phys Act. 2009;6:63.PubMedCrossRefGoogle Scholar
  69. Moraes SA, Beltran Rosas J, Mondini L, Freitas IC. Prevalence of overweight and obesity, and associated factors in school children from urban area in Chilpancingo, Guerrero, Mexico, 2004. Cad Saude Publica. 2006;22:1289–301.PubMedCrossRefGoogle Scholar
  70. Mo-suwan L, Junjana C, Puetpaiboon A. Increasing obesity in school children in a transitional society and the effect of the weight control program. Southeast Asian J Trop Med Public Health. 1993;24:590–4.PubMedGoogle Scholar
  71. Mozaffari H, Nabaei B. Obesity and related risk factors. Indian J Pediatr. 2007;74:265–7.PubMedCrossRefGoogle Scholar
  72. Nelson MC, Lytle LA, Pasch KE. Improving literacy about energy-related issues: the need for a better understanding of the concepts behind energy intake and expenditure among adolescents and their parents. J Am Diet Assoc. 2009;109:281–7.PubMedCrossRefGoogle Scholar
  73. Nemours. Kids Health from Nemours. Healthy Eating. 2009. Accessed 14 October 2009.
  74. Neutzling MB, Taddei JA, Rodrigues EM, Sigulem DM. Overweight and obesity in Brazilian adolescents. Int J Obes Relat Metab Disord. 2000;24:869–74.PubMedCrossRefGoogle Scholar
  75. NFHS. National Family Health Survey, India. Accessed 13 October 2009.
  76. NNMB. Diet and nutritional status of rural population. National Nutrition Monitoring Bureau Technical Report No. 21; 2002.Google Scholar
  77. NNMB. Diet and nutritional status of population and prevalence of hypertension amongst adults in rural areas. National Nutrition Monitoring Bureau Technical Report No. 24; 2007.Google Scholar
  78. Nunez-Rivas HP, Monge-Rojas R, Leon H, Rosello M. Prevalence of overweight and obesity among Costa Rican elementary school children. Rev Panam Salud Publica. 2003;13:24–32.PubMedCrossRefGoogle Scholar
  79. Pedrozo W, Rascon MC, Bonneau G, de Pianesi MI, Olivera CC, de Aragon SJ, Ceballos B, Gauvry G. Metabolic syndrome and risk factors associated with life style among adolescents in a city in Argentina, 2005. Rev Panam Salud Publica. 2008;24:149–60.PubMedCrossRefGoogle Scholar
  80. Pinhas-Hamiel O, Dolan LM, Daniels SR, Standiford D, Khoury PR, Zeitler P. Increased incidence of non-insulin-dependent diabetes mellitus among adolescents. J Pediatr. 1996;128:608–15.PubMedCrossRefGoogle Scholar
  81. Pituelli SN, Corbera PM, Lioi LS, Turco PM, D’Arrigo DM, Rosillo PI. Prevalence of risk factors: obesity and lipid profile. An Pediatr (Barc). 2008;68:257–63.CrossRefGoogle Scholar
  82. Premanath M, Basavanagowdappa H, Shekar MA, Vikram SB, Narayanappa D. Mysore childhood obesity study. Indian Pediatr. 2010;47:171–3. Epub 2009 Apr 15.PubMedCrossRefGoogle Scholar
  83. Raj M, Sundaram KR, Paul M, Deepa AS, Kumar RK. Obesity in Indian children: time trends and relationship with hypertension. Natl Med J India. 2007;20:288–93.PubMedGoogle Scholar
  84. Ramachandran A, Snehalatha C, Vinitha R, Thayyil M, Kumar CK, Sheeba L, Joseph S, Vijay V. Prevalence of overweight in urban Indian adolescent school children. Diabetes Res Clin Pract. 2002;57:185–90.PubMedCrossRefGoogle Scholar
  85. Rao S, Kanade A, Kelkar R. Blood pressure among overweight adolescents from urban school children in Pune, India. Eur J Clin Nutr. 2007;61:633–41.PubMedGoogle Scholar
  86. Rosenbloom AL. Increasing incidence of type 2 diabetes in children and adolescents: treatment considerations. Paediatr Drugs. 2002;4:209–21.PubMedGoogle Scholar
  87. Sachdev HS, Fall CH, Osmond C, Lakshmy R, Dey Biswas SK, Leary SD, Reddy KS, Barker DJ, Bhargava SK. Anthropometric indicators of body composition in young adults: relation to size at birth and serial measurements of body mass index in childhood in the New Delhi birth cohort. Am J Clin Nutr. 2005;82:456–66.PubMedGoogle Scholar
  88. Sacheck J. Pediatric obesity: an inflammatory condition? JPEN J Parenter Enteral Nutr. 2008;32:633–7.PubMedCrossRefGoogle Scholar
  89. Salazar-Martinez E, Allen B, Fernandez-Ortega C, Torres-Mejia G, Galal O, Lazcano-Ponce E. Overweight and obesity status among adolescents from Mexico and Egypt. Arch Med Res. 2006;37:535–42.PubMedCrossRefGoogle Scholar
  90. Sawaya AL, Dallal G, Solymos G, de Sousa MH, Ventura ML, Roberts SB, Sigulem DM. Obesity and malnutrition in a Shantytown population in the city of Sao Paulo, Brazil. Obes Res. 1995;3(Suppl 2):107s–115s.PubMedGoogle Scholar
  91. Shah P, Misra A, Gupta N, Hazra DK, Gupta R, Seth P, Agarwal A, Gupta AK, Jain A, Kulshreshta A, Hazra N, Khanna P, Gangwar PK, Bansal S, Tallikoti P, Mohan I, Bhargava R, Sharma R, Gulati S, Bharadwaj S, Pandey RM, Goel K. Improvement in nutrition-related knowledge and behaviour of urban Asian Indian school children: findings from the ‘Medical education for children/Adolescents for Realistic prevention of obesity and diabetes and for healthy aGeing’ (MARG) intervention study. Br J Nutr. 2010;104:427–36.PubMedCrossRefGoogle Scholar
  92. Sharma A, Sharma K, Mathur KP. Growth pattern and prevalence of obesity in affluent schoolchildren of Delhi. Public Health Nutr. 2007;10:485–91.PubMedGoogle Scholar
  93. Story M, Hayes M, Kalina B. Availability of foods in high schools: is there cause for concern? J Am Diet Assoc. 1996;96:123–6.PubMedCrossRefGoogle Scholar
  94. Sullivan A. Cultural capital, cultural knowledge and ability. Sociological Research Online 12; 2007.Google Scholar
  95. Sumarni MG, Muhammad AK, Ibrahim MS, Mohd RI, Izzuna MMG, Nurziyana I. Obesity among schoolchildren in Kuala Selangor: a cross-sectional study. Trop Biomed. 2006;23:148–54.Google Scholar
  96. Tee ES. Nutrition in Malaysia: where are we heading? Malay J Nutr. 1999;5:87–109.Google Scholar
  97. Tee ES, Khor SC, Ooi HE, Young SI, Zakiyah O, Zulkafli H. Regional study of nutritional status of urban primary schoolchildren. 3. Kuala Lumpur, Malaysia. Food Nutr Bull. 2002;23:41–7.PubMedGoogle Scholar
  98. UNICEF. The Fat Truth. Fighting Childhood Obesity in the UAE. 2009. Accessed 5 October 2009.
  99. US Department of Agriculture ARS. Nutrient intakes from food: Mean amounts consumed per individual, one day, 2003–04; 2007.Google Scholar
  100. Vikram NK, Misra A, Dwivedi M, Sharma R, Pandey RM, Luthra K, Chatterjee A, Dhingra V, Jailkhani BL, Talwar KK, Guleria R. Correlations of C-reactive protein levels with anthropometric profile, percentage of body fat and lipids in healthy adolescents and young adults in urban North India. Atherosclerosis. 2003;168:305–13.PubMedCrossRefGoogle Scholar
  101. Vikram NK, Misra A, Pandey RM, Luthra K, Wasir JS, Dhingra V. Heterogeneous phenotypes of insulin resistance and its implications for defining metabolic syndrome in Asian Indian adolescents. Atherosclerosis. 2006a;186:193–9.PubMedCrossRefGoogle Scholar
  102. Vikram NK, Tandon N, Misra A, Srivastava MC, Pandey RM, Mithal A, Sharma S, Ajmani A, Madhu SV, Batra CM, Gupta N. Correlates of Type 2 diabetes mellitus in children, adolescents and young adults in north India: a multisite collaborative case-control study. Diabet Med. 2006b;23:293–8.PubMedCrossRefGoogle Scholar
  103. Vikram NK, Pandey RM, Misra A, Goel K, Gupta N. Factor analysis of the metabolic syndrome components in urban Asian Indian adolescents. Asia Pac J Clin Nutr. 2009;18:293–300.PubMedGoogle Scholar
  104. Wang Y, Monteiro C, Popkin BM. Trends of obesity and underweight in older children and adolescents in the United States, Brazil, China, and Russia. Am J Clin Nutr. 2002;75:971–7.PubMedGoogle Scholar
  105. Wang Y, Chen HJ, Shaikh S, Mathur P. Is obesity becoming a public health problem in India? Examine the shift from under- to overnutrition problems over time. Obes Rev. 2009;10:456–74.PubMedCrossRefGoogle Scholar
  106. Wardle J, Brodersen NH, Cole TJ, Jarvis MJ, Boniface DR. Development of adiposity in adolescence: five year longitudinal study of an ethnically and socioeconomically diverse sample of young people in Britain. BMJ. 2006;332:1130–5.PubMedCrossRefGoogle Scholar
  107. Wasir JS, Misra A. The metabolic syndrome in Asian Indians: impact of nutritional and socio-economic transition in India. Metab Syndr Relat Disord. 2004;2:14–23.PubMedCrossRefGoogle Scholar
  108. WHO. Physical status: The use and interpretation of anthropometry. Report of a WHO Expert Committee. WHO technical report series. Geneva: World Health Organization; 1995.Google Scholar
  109. WHO. WHO child growth standard. 2006. Accessed 1 October 2009.
  110. WMGRS Group. WHO child growth standards: length/height-for-age, weight-for-age, weight-for-length, weight-for-height and body mass index-for-age: Methods and development. Geneva: World Health Organization; 2006.Google Scholar
  111. Yajnik CS, Lubree HG, Rege SS, Naik SS, Deshpande JA, Deshpande SS, Joglekar CV, Yudkin JS. Adiposity and hyperinsulinemia in Indians are present at birth. J Clin Endocrinol Metab. 2002;87:5575–80.PubMedCrossRefGoogle Scholar
  112. Yannakoulia M, Karayiannis D, Terzidou M, Kokkevi A, Sidossis LS. Nutrition-related habits of Greek adolescents. Eur J Clin Nutr. 2004;58:580–6.PubMedCrossRefGoogle Scholar
  113. Zimmet P, Alberti KG, Kaufman F, Tajima N, Silink M, Arslanian S, Wong G, Bennett P, Shaw J, Caprio S. The metabolic syndrome in children and adolescents – an IDF consensus report. Pediatr Diabetes. 2007;8:299–306.PubMedCrossRefGoogle Scholar

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© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  1. 1.Department of PediatricsChildren’s Hospital of Michigan, DetroitDetroitUSA
  2. 2.Endocrine Research UnitMayo Clinic College of Medicine, RochesterDetroitUSA
  3. 3.Department of Internal MedicineWayne State University, DetroitDetroitUSA
  4. 4.Division of Cardiovascular DiseasesMayo Clinic College of Medicine, RochesterDetroitUSA
  5. 5.Fortis-C-DOC (Centre of Excellence for Diabetes, Obesity, Metabolic Diseases and Endocrinology)Fortis Flt. Lt. Rajan Dhall HospitalNew DelhiIndia
  6. 6.Centre of Internal Medicine (CIM), Fortis HospitalNew DelhiIndia
  7. 7.National Diabetes, Obesity and Cholesterol Foundation (N-DOC)New DelhiIndia
  8. 8.Diabetes and Metabolic Diseases, Diabetes FoundationNew DelhiIndia

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