OBESITY-CSE-IHC-AUGUST-04-umesh kapil

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Obesity Trends in India and Consequences Dr. Umesh Kapil MD, DNB, FAMS , Professor Public Health Nutrition Department of Human Nutrition All India Institute of Medical Sciences, New Delhi 110 029, INDIA Tel No: (Off) 91-11- 26593383 ; (R) 91-11-26195105 Mobile:. 9810609340 Fax : 91-11-26588641 , 91-11-26588663 kapilumesh@hotmail.com

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India : Double Burden of Disease Under nutrition due to Poverty 30 % below BPL Over nutrition and Obesity 5-7% MIG and HIG Urban area This is most productive workforce of the country Academics/Planners/ Administrators/ Professionals SHOULD BE GIVEN PRIORITY

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Author Year of Study Country/ State Criteria used Prevalence of over-weight (M/F) Prevalence of obesity (M/F) Gopinath et.al 1994 Delhi BMI>25 21.3% (M) 33.4% (F) INA Singhal et al 1998 Jaipur BMI>25 14.6% (M) 6.6% (F) INA Asthana et al 1997 Varanasi BMI>25 30.2% (F) INA Chadha et al 1997 Delhi BMI>25 20.7 (M) 32.6% (F) INA Obesity Trends in India : Recent studies: Adults

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Author Year of Study Country/ State Criteria used Prevalence of over-weight (M/F) Prevalence of obesity (M/F) Singh et.al 1999 5 Cities BMI>23BMI>25BMI>27 50.9% (F) Vasanthanani 2000 Coimbatore BMI>30 36.0% (M) Mohan et al 2000 Chennai BMI>25 38.0% (M) 33.1% (F) Easwaran et al 2001 Coimbatore BMI>25 BMI>24 65.0% (M) 65.0% (F) Gupta et al 2002 Jaipur BMI>27 24.5% (M) 30.2% (F) NFHS-II 1998-99 India BMI>25 8.6% MIG 27.2 HIG Obesity Trends in India : Recent studies

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Survey Normal (%) BMI 18.5-25 Obese (%) BMI>25 NNMB (75-79) 48.8 3.4 NNMB (88-90) 46.6 4.1 NNMB (94) 46.3 6.6 NNMB Slum (93-94) 51.7 11.6 Trends in Body Mass Index of Adult Women Body Mass Indix (BMI) is defined as weight (kg)/height ² (m)

Obesity Trends in India : Recent studies Children: 

Obesity Trends in India : Recent studies Children S.No Author Name State/ country Prevalence of obesity 1.* Umesh Kapil etal, 2001 Delhi (India) 8% boys 6% girls 2.** Vedavati S etal, 1998 Chennai, India 6% obese 1.* Indian Pediatrics, 2002 May, 17: 449-452 2.** Indian Pediatrics, 2003 Aug, 40: 775-779.

Obesity Trends in India : Recent studies Children: 

Obesity Trends in India : Recent studies Children S.No Author Name State/ country Prevalence of obesity 3.* A.K.Gupta etal, 1985-86 India 7.94% boys 6.90% girls 4.** Ramachandran A etal, 2000 India 3.6% boys 2.7% girls 3.* Indian Pediatrics, 1990, Apr, 27 333-337 4.** Diabetes research and Clinical Practice 2002; 57 185-190.

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Risk factor for Non Communicable Diseases  Cardiovascular diseases CAD, CHF, Stroke  Insulin Resistance and  Type-2 Diabetes Mellitus  Reproductive disorders  Pulmonary diseases  Gall stone disease  Cancer- Colon, Rectum, Prostate-Male  Gall stone–bile duct, breast, endometrium cervix, ovary- Female Bone: Joint and skin diseases  Oesteoprosis  Mental Health  Psychological well being  Accidents  Muscloskeletal injuries Obesity

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High Prevalence of Metabolic Syndrome (Syndrome X) Hypertension Increased Insulin Resistance Central Obesity Dyslipidemia

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Obesity and Mortality Morbidly obese individuals (more than 200% ideal body weight) have as much as a twelve fold increase in mortality

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Source : Bray GA. 1992. AJCN; 55; 488S-94S

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Obesity and Diabetes As many as 80% of patients with type-2 diabetes mellitus are obese

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4% 4-6% 6% n/a Source: Mokdad et al., Diabetes Care 2000;23:1278-83 Prevalence of Diabetes among U.S. Adults, BRFSS, 1993-94

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Prevalence of Diabetes among U.S. Adults, BRFSS, 1997-98 4% 4-6% 6% n/a Source: Mokdad et al., Diabetes Care 2000;23:1278-83

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Obesity and Diabetes Mild obesity Two fold risk of Diabetes Moderate obesity Five fold risk of Diabetes Severe obesity Ten fold risk of Diabetes

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Indian Scenario : Diabetes Between 1988 and 2000, there was a 70% increase in the prevalence of Diabetes in the city of Chennai The recent study document a prevalence of 13% in adults

Possible Reasons: Average per capita energy ( Kcals ) intake as per expenditure classes , India: 

Possible Reasons: Average per capita energy ( Kcals ) intake as per expenditure classes , India Expenditure Classes Urban (1972-73) Urban (1993-94) Lower 30% 1579 1682 Middle 40% 2154 2111 Top 30% 2572 2405 Source: NSSO, 1997

Average daily per capita dietary intake of Fats in India: 

Average daily per capita dietary intake of Fats in India Year Fat (g) Rural Fat(g) Urban 1972-73 24 36 1983 27 37 1993-94 31.4 42 1999-2000 36.1 49.6 Source: NSSO 2001

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Life style changes between 1972-2000 Increase in Sedentary Life style Decrease Physical activities Intake of calories remaining same Increase in Fat intake Most manual jobs have been replaced by mechanized jobs Transportation to school /work place universally by use of motor car/Bus/Bicycles Increase in hours for activities :TV viewing/ Computer

Studies on prevalence of hypertension on obese children: 

Studies on prevalence of hypertension on obese children S.No Author Name State/ country Prevalence of hypertension 1*. M.Verma etal 1994 Punjab (India) Obese children : 13.7% Non-obese: children: 0.4% 2**. A.K. Gupta etal 1993 India Obese children: 34% Non-obese children: 0.16% 1* Indian Pediatrics1994Sept; 31: 1065-1069 2** Indian Pediatrics 1990 Apr;27(4)333-7.

Study on prevalence of IGT(Impaired Glucose Tolerance) and diabetes mellitus in obese children: 

Study on prevalence of IGT(Impaired Glucose Tolerance) and diabetes mellitus in obese children S.No Author Name State/ country Prevalence of IGT & DM 1.* Ranjana Sinha etal, 1999-2000 Yale IGT : 25% (4-10yrs : 21%(11- 18yrs) DM : 4%( 11-18yrs) 2.** Ripamonti G etal, 1990 Italy IGT: 11% 1.* New England Journal of Medicine;2002 March;346(11);802-810 2.** Minerva Med; 1991 Jun; 82(6):345-8

Study on the prevalence of Dyslipediamas in obese children: 

Study on the prevalence of Dyslipediamas in obese children S.No Author Name State/ country Prevalence of Dyslipediamas 1.* Zwiauer K etal, 1990 Australia 46% girls 41% boys 2,** Valverde MA etal, 1998 Portugal 67.6% elevated triglyceride levels 1.* Wien Klin Wochenschr. 1990 May 11; 102(10): 299-303 2.** Arch Latinoam Nutr. 1999 Dec; 49(4): 338-43

Study on the prevalence of Dyslipediamas in obese children (Cont..): 

Study on the prevalence of Dyslipediamas in obese children (Cont..) S.No Author Name State/ country Prevalence of Dyslipediamas 3.* Fredland O etal, 2002 Texas (USA) 52% elevated serum cholesterol levels 3.*J Pediatr Endocrinology Met’ 15’ 1011-1016 (2002)

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Role of Physical Activity According to WHO at least 30 minutes of cumulative moderate exercise (equivalent to walking briskly) for all ages plus for children , an additional 20 minutes of vigorous exercise ( equivalent to running) three times a week . (These recommendations are basically for prevention of CHD). The prevention of obesity may require combination of both : more Physical Activity and Dietary interventions.

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WE MUST LEARN LESSON FROM THE DVELOPED COUNTRIES RDA for the Affluent Urban Sedentary Population life Styles Should be developed

All India Institute of Medical Sciences , New Delhi : 

All India Institute of Medical Sciences , New Delhi Thank you