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India’s Quiet Tide Of Childhood Obesity

“If your child is obese, then you can be certain that it’s not his/her fault"

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Childhood Obesity. Wikimedia
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Madurai: When 12-year-old Madhu (not his real name) was diagnosed as obese—he weighed 98 kg when his ideal weight was 55 kg—there were no obvious medical issues, except a faulty diet and lack of exercise.

After counselling and improving his diet, the Madurai preteen, 160 cm or 5.2 ft tall, lost 8 kg in four months. At the age of 15, stressed from board exams, Madhu’s weight ballooned again—this time to 108 kg.

  • Overweight is defined as having excess body weight for a particular height from fat, muscle, bone, water, or a combination of these factors.
  • Obesity is defined as having excess body fat.

Definitions: Centers for Disease Control and Prevention, USA

Guided by his doctor, he exercised more, learnt how to deal with exam pressure better, got more sleep and cut out junk food. A year later, he weighs 79 kg, feels more confident and is doing better at school.

Obesity plagues India’s affluent, as IndiaSpend has reported, and it transcends socio-economic differences when it originates in childhood. Social and environmental factors are the driving forces behind childhood obesity in India, explained this 2015 study. Childhood obesity affects both developed and developing countries and there are “serious” implications for future Indian generations without corrective action, said this 2010 Indian Council of Medical Research paper.

Childhood obesity underestimated, afflicts urban, upper classes most

Stress does have an adverse influence on childhood obesity, but it can be reversed in a clinical setting with treatment. The key is to realise that children need help.

“If your child is obese, then you can be certain that it’s not his/her fault,” said V Kumaravel, Consultant Endocrinologist and director, Alpha Hospital & Research Centre, Madurai.

Some indications of childhood obesity in India come from Kumaravel’s childhood obesity prevention programme, which traces factors influencing childhood obesity in the neighbourhood around his hospital. The study, conducted in 2012 over a period of six months on 18,001 students aged five to 18 from 27 schools, found 9.5% overweight and 3% obese.

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When compared to boys, the proportion of obese girls was lower in younger age groups (below 12 years), but when they grew older (above 12 years), more girls were obese than boys their age, a global pattern.

Related: Obesity in Children – Global Public Health Problem (Challenges in India)

Another finding is childhood obesity in India is underestimated, regardless of local or global growth charts, according to this 2014 paper based on Kumaravel’s research. Childhood obesity is higher among urban, upper classes than rural or middle and lower socio-economic classes, said another 2014 paper by Kumaravel and his colleagues.

Other findings:

  • Environment, not socio-economic conditions, fuel childhood obesity.
  • Schools that served unhealthy snacks had more obese students.
  • There is a correlation between lack of playgrounds and obese students.
  • Obesity peaked in children with fewer friends, greater anxiety.
  • Teachers need to be made aware of childhood obesity.

The small, flabby Indian, and the thrifty phenotype hypothesis

You can blame the Indian predisposition to be smaller and flabbier than many other races on a history of poverty and deprivation, experiences now possibly coded into our genes, which make the body prone to horde fat.

“Indians in general are predisposed to obesity, cardiovascular disease and diabetes because of the genetically smaller builds, a condition called the thrifty phenotype,” said Sriram Mahadevan, endocrinologist and researcher, Sundaram Medical Foundation and Sri Ramachandra Medical College, Chennai.

So, it’s best to monitor diet and exercise early. Monitoring should begin in early adolescence, preferably in between 12 and 15, said Mahadevan. “Factors such as puberty should be considered,” he said. “Children have a rapid height spurt in this age. This natural growth can correct many issues related to childhood obesity without medical intervention.”

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Awareness is important because India has sparse data on the prevalence and implications of childhood obesity, save for select regional studies such as Kumaravel’s.

In Chennai, private schools tended to have more obese children than government-run schools, according to this 2014 study by the Madras Diabetes Research Foundation and Dr Mohan’s Diabetes Specialities Centre.

Yet, “there’s an increasing incidence in both rural and urban areas,” said Mahadevan.

Indeed, there is a correlation between a higher body mass index (BMI)—a marker for obesity—and hypertension in children, and this 2010 paper by the Amrita Institute of Medical Sciences, Kerala, found government schools, girls and rural areas as vulnerable.

The spread of obesity also indicates that genetics is only one determinant.

How stress from poor parenting or broken homes can affect growth

In addition to burgeoning costs of treatment for medical issues that may last a lifetime, moderately and severely obese children have a host of psychological and emotional issues to deal with.

These data were confirmed by Kumaravel’s private studies, which found a correlation not just between obesity and psychological issues but growth.

“Poor parenting, a broken home, increased stress during those critical growing years pre-puberty, all these factors affected a child’s potential to attain his/her natural height,” said Kumaravel.

While recording the height and weight of students they surveyed, Kumaravel and his colleagues noticed that stunted growth in childhood often goes unnoticed. They found children who battled anxiety at a young age didn’t always grow to their full potential. This was often overlooked because impaired growth isn’t a life-threatening issue that required immediate intervention.

In separate research—yet unpublished—Kumaravel and his colleagues measured 22,580 children from 48 schools in and around Madurai (including Dindugal and Vadamadurai) in 2015 and found that 5% (448) were stunted, short for their age.

While only 118 followed up for treatment in a clinical setting, it was found that 58 of them had family problems,” said Kumaravel. “They either hailed from broken homes or were dealing with step mothers, drunken fathers and other grievances.

Of these, eight children had growth-hormone deficiencies, a condition that could be corrected with medication, which can cost a family up to Rs 200,000 per month—87 of 118 children treated free as part of this pilot project regained some growth. India’s burden of thyroid disease is another reason for stunted growth.

India is now on the brink of a public-health crisis that involves its children, said medical professionals. Never before has screening and early intervention been such a necessity.In 2013, the government announced a nationwide health program to screen children up to 18 years of age, including for growth and obesity.

“We also need a regional reference growth chart (specific to regions),” said Mahadevan. “In addition to height and weight, waist circumference should be considered, as we are prone to abdominal obesity. This way we can prevent younger diabetics, a disturbing trend we’re beginning to see.” (IANS)

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World’s Anti-Corruption Day

The U.S. Statement Department said in its Friday statement that it pledges "to continue working with our partners to prevent and combat corruption worldwide."

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Anti-Corruption
Bulgarian anti-corruption protesters march during a demonstration in downtown Sofia, VOA

Corruption costs the world economy $2.6 trillion each year, according to the United Nations, which is marking International Anti-Corruption Day on Sunday.

“Corruption is a serious crime that can undermine social and economic development in all societies. No country, region or community is immune,” the United Nations said.

The cost of $2.6 trillion represents more than 5 percent of global GDP.

The world body said that $1 trillion of the money stolen annually through corruption is in the form of bribes.

Patricia Moreira, the managing director of Transparency International, told VOA that about a quarter of the world’s population has paid a bribe when trying to access a public service over the past year, according to data from the Global Corruption Barometer.

Moreira said it is important to have such a day as International Anti-Corruption Day because it provides “a really tremendous opportunity to focus attention precisely on the challenge that is posed by corruption around the world.”

Journalist, Anti-Corruption
An activist places candles and flowers on the Great Siege monument, after rebuilding a makeshift memorial to assassinated anti-corruption journalist Daphne Caruana Galizia, in Valletta, Malta. VOA

Anti-corruption commitments

To mark the day, the United States called on all countries to implement their international anti-corruption commitments including through the U.N. Convention against Corruption.

In a statement Friday, the U.S. State Department said that corruption facilitates crime and terrorism, as well as undermines economic growth, the rule of law and democracy.

“Ultimately, it endangers our national security. That is why, as we look ahead to International Anticorruption Day on Dec. 9, we pledge to continue working with our partners to prevent and combat corruption worldwide,” the statement said.

Moreira said that data about worldwide corruption can make the phenomena understandable but still not necessarily “close to our lives.” For that, we need to hear everyday stories about people impacted by corruption and understand that it “is about our daily lives,” she added.

She said those most impacted by corruption are “the most vulnerable people — so it’s usually women, it’s usually poor people, the most marginalized people in the world.”

Anti-Corruption
Anna Hazare raised his voice against corruption and went ahead with his hunger strike at the Jantar Mantar in New Delhi. Wikimedia Commons

The United Nations Development Program notes that in developing countries, funds lost to corruption are estimated at 10 times the amount of official development assistance.

What can be done to fight corruption?

The United Nations designated Dec. 9 as International Anti-Corruption Day in 2003, coinciding with the adoption of the United Nations Convention against Corruption by the U.N. General Assembly.

The purpose of the day is to raise awareness about corruption and put pressure on governments to take action against it.

Tackling the issue

Moreira said to fight corruption effectively it must be tackled from different angles. For example, she said that while it is important to have the right legislation in place to curb corruption, governments must also have mechanisms to enforce that legislation. She said those who engage in corruption must be held accountable.

“Fighting corruption is about providing people with a more sustainable world, with a world where social justice is something more of our reality than what it has been until today,” she said.

Anti-Corruption
It is important to have the right legislation in place to curb corruption

Moreira said change must come from a joint effort from governments, public institutions, the private sector and civil society.

The U.S. Statement Department said in its Friday statement that it pledges “to continue working with our partners to prevent and combat corruption worldwide.”

It noted that the United States, through the U.S. Department of State and U.S. Agency for International Development, helps partner nations “build transparent, accountable institutions and strengthen criminal justice systems that hold the corrupt accountable.”

Also Read: British Parliament Access Internal Facebook Data Scandal Papers: Report

Moreira said that it is important for the world to see that there are results to the fight against corruption.

“Then we are showing the world with specific examples that we can fight against corruption, [that] yes there are results. And if we work together, then it is something not just that we would wish for, but actually something that can be translated into specific results and changes to the world,” she said. (VOA)