Childhood Obesity in Developing Countries: Facets of Abnormal Growth

Chapter

Abstract

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”).

Keywords

Cholesterol Obesity Depression Manifold Carbohydrate 

Abbreviations

BMI

Body mass index

CAD

Coronary artery diseases

CDC

Centers for Disease Control and Prevention

HDL-c

High-density lipoprotein cholesterol

hs-CRP

high-sensitivity C-reactive protein

IDF

International Diabetes Federation

IOTF

International Obesity Task Force

NAFLD

Non-alcoholic fatty liver disease

NCEP, ATP III

National Cholesterol Education Program, Adult Treatment Panel III

NFHS

National Family Health Surveys

NMC

Non-metropolitan cities

NNMB

National Nutrition Monitoring Bureau

NR-NCDs

Nutrition-related non-communicable diseases

Ob

Obesity

OW

Overweight

PCOS

Polycystic ovarian syndrome

PUFAs

Polyunsaturated fatty acids

RDA

Recommended dietary allowance

RHD

Rheumatic heart disease

SCAT

Subcutaneous adipose tissue

SES

Socio-economic status

T2DM

Type 2 diabetes mellitus

WC

Waist circumference

WHO

World Health Organization

W–HR

Waist-to-hip circumference ratio

Yr

Years

Notes

Acknowledgments

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.

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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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