By Dr.J.K. Bhutani
Obesity in children is rapidly spreading across the globe as public health problem. The prevalence of over-weight and obesity has increased steadily over the past 30 years, almost doubling in the children and more so in adolescents where it has probably trebled. Earlier the problem of developed economies like USA and Europe, the epidemic is fast increasing in developing economies like India and China. India, a developing economy is already burdened with more than 20 million obese people and the number is increasing every year.
What are the etiological risk factors?
Obesity is essentially a state of excess adipose tissue mass. Overweight and obesity are the result of “caloric imbalance” mostly which means too few calories expended for the amount of calories consumed. In addition, it is also affected by various genetic, behavioral, and environmental factors. Globally, there has been an increased intake of energy-dense foods that are high in fat, salt and sugars but low in fiber, vitamins, minerals and other micro-nutrients. With increased prosperity there has been a decrease in physical activity due to the increasingly sedentary and luxurious inactive life. The calories consumed are far more than are spent in “Computer/TV/Car and lack of physical activity routine” of most of the children. The lack of patronage to sports by elected governments in furthering careers has decreased interest of young people in physical activity. The developing urban clusters, with less open spaces and parks also have put physical activity and street-park games to almost oblivion. The most important consequence of childhood obesity is its persistence into adulthood with all its health risks. The health risks include diabetes, hypertension and cardio-vascular diseases, stroke, gall bladder disease, osteoarthritis and sleep apnea etc.
Public health intervention strategies
World Health Organization (WHO) has developed the 2008-2013 Action Plans for the global strategy for the prevention and control of non-communicable diseases including the WHO Global Strategy on diet, physical activity and health. The aim is to address the common public health problem of obesity and its consequent morbidity and mortality. India is experiencing a rapid health transition with a rising burden of non-communicable diseases for which a National Program for Prevention and Control of Cancer, Diabetes, CVD and Stroke has been launched in 2008. The emphasis of this program is to educate about overweight and obesity as well.
National Sports Development Code of India -2011, lays stress on encouraging and patronizing sports at school/college levels and suggesting legislation to include sports and physical education/activity as an essential activity at CBSE/ISC curriculum schools. The NCERT is forming the guidelines for the schools regarding compulsory physical education.
What can be done in India
We all know the cause of obesity epidemic and we all know that if appropriate actions are taken, it can be prevented. Large scale awareness about the weight and BMI targets can easily be spread taking help of media (print, TV/Satellite and web resources).
The elected governments can provide supportive environment and participation at community level regarding healthier choices of foods and regular physical activity to prevent overweight and obesity.
The provision of parks/playgrounds and open spaces in urban development should be a priority for new urban clusters. The compulsory physical education and sports periods in school/college curriculum can be combined with no entry to fast-food joints and cola rich snacks in the schools premises. The food industry can play a significant role in promoting healthy diets by reducing the fat, sugar and salt content of processed foods. The glamour of advertising by industry should be in the message of healthy foods and not in selling the unhealthy calorie-dense foods.
At the individual level, people can be educated by print and television media regarding limiting energy intake, avoiding saturated fats and fast foods, increasing consumption of fruit and vegetables. Engaging in regular physical activities, at work place or home, should be encouraged.
The ultimate goal is to have a healthy weight and a physically fit body and mind. It only requires acting at all the levels simultaneously and in unison. The concept of ‘deep practice’ postulated by Daniel Coyle if practiced in changing our food habits and physical activity levels at individual, community and national levels can surely make healthy citizens in India and globally too.