Childhood Obesity in Developing Countries: Facets of Abnormal Growth
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”).
KeywordsCholesterol Obesity Depression Manifold Carbohydrate
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
- NCEP, ATP III
National Cholesterol Education Program, Adult Treatment Panel III
National Family Health Surveys
National Nutrition Monitoring Bureau
Nutrition-related non-communicable diseases
Polycystic ovarian syndrome
Polyunsaturated fatty acids
Recommended dietary allowance
Rheumatic heart disease
Subcutaneous adipose tissue
Type 2 diabetes mellitus
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.
- 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
- CAMBIO. Canada–Mexico Battling Childhood Obesity. 2009. http://cambio-red.net/. Accessed 7 October 2009.
- CDC. Centers for Disease Control and Prevention. Overweight and obesity: health consequences. 2009. http://www.cdc.gov/obesity/causes/health.html. Accessed 13 October 2009.
- DFI. Primary prevention in Indian schools, World Diabetes Foundation. 2006. http://www.worlddiabetesfoundation.org/composite-1279.htm. Accessed 13 October 2009.
- 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
- 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
- ICMR EGo. Nutrient requirements and recommended dietary allowances for Indians. New Delhi: Research, ICoM; 1990.Google Scholar
- IHHP. Isfahan Healthy Heart Program – Heart Health Promotion from Childhood. 1999. http://www.ihhp.ir/IHHP/display.aspx?id=1495. Accessed 5 October 2009.
- 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
- 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
- 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
- Nemours. Kids Health from Nemours. Healthy Eating. 2009. http://kidshealth.org/parent/nutrition_fit/nutrition/habits.html. Accessed 14 October 2009.
- NFHS. National Family Health Survey, India. http://www.nfhsindia.org/anfhs3.html. Accessed 13 October 2009.
- NNMB. Diet and nutritional status of rural population. National Nutrition Monitoring Bureau Technical Report No. 21; 2002.Google Scholar
- 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
- 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
- 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
- Sullivan A. Cultural capital, cultural knowledge and ability. Sociological Research Online 12; 2007.Google Scholar
- 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
- Tee ES. Nutrition in Malaysia: where are we heading? Malay J Nutr. 1999;5:87–109.Google Scholar
- UNICEF. The Fat Truth. Fighting Childhood Obesity in the UAE. 2009. http://www.thefattruth.org/main.html. Accessed 5 October 2009.
- US Department of Agriculture ARS. Nutrient intakes from food: Mean amounts consumed per individual, one day, 2003–04; 2007.Google Scholar
- 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
- 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
- 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
- WHO. WHO child growth standard. 2006. http://www.who.int/childgrowth. Accessed 1 October 2009.
- 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