Epidemiology of childhood overweight & obesity in India: A ...
Global Epidemiology Of Obesity
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Global Epidemiology Of Obesity
Dr. Sumeet ShahConsultant Laparoscopic and Bariatric Surgeon
Sir Ganga Ram HospitalNew Delhi
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The human phenotype is changing rapidly
Increased body size and fatter body composition
Response to environments that make low demands on energy expenditure, together with greater energy-density diets
This change is occurring within one to three generations, around the world
Not entirely an urban phenomenon, but more pronounced in big cities
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The Obesity Pandemic• ~1 billion malnourished worldwide• >1 billion overweight worldwide• >350 million obese worldwide• 2.5 million obesity-deaths annually• 2000: 170 million diabetics
worldwide• 2020: Doubled
Source: International obesity task force & WHO
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Obesity Trends* Among U.S. AdultsBRFSS, 1990
*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person
No Data <10% 10%–14%
http://www.cdc.gov/nccdphp/dnpa/obesity/
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Obesity Trends* Among U.S. AdultsBRFSS, 1998
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% ≥20%
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Obesity Trends* Among U.S. AdultsBRFSS, 2006
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
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Obesity rates: Current and projected
7
0
10
2020
30
40
50
19601970
19801990
20002010
20202030
USA
England
Mauritius
Australia
Brazil
Population percentage with BMI > 30kg/m2
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The Demographic Transition
The World’s Population
Was three billion in the 1960s
Now six billion
Will continue to increase for next 50 years
Will level off at 9, 10 or 11 billion by the year 2100
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South Atlantic Ocean South Pacific Ocean
North Atlantic Ocean
Indian Ocean
Arctic Ocean Arctic Ocean
Arctic Ocean
North Pacific Ocean
Brazil
South Africa
Tanzania
Kenya
Egypt
Mali
China
India
Ghana
Kyrgyzstan
Bolivia Madagascar Namibia Zimbabwe
Malawi
Cameroon C. A. R. Côte D’Ivoire
Turkey
Vietnam
Kazakhstan Uzbekistan
Uganda
Peru
Colombia
Dominican Republic
Guatemala Haiti
Niger
Nigeria
Senegal
Zambia
Benin
Chad
Guinea
Yemen
Nepal
Bang.
Togo
Patterns of Overweight and Obesity among Women of Child-bearing Age from the DHS (BMI>25, Ages 20-49 , Age-Standardized, Weighted)
10-20% 31-40%21-30% 41-50% >51%<10%
Burkina Faso
Mozambique Comoros
Eritrea
Jordan
Mexico
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Prevalence of Obese Preschool Children In Selected Countries and
Territories
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Less Active LifestylesLess Active Lifestyles
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Childhood Obesity
• 28% of Delhi’s children in the 14-18 age group are overweight or obese.
• 13% of Delhi’s school children – positive for C-reactive protein
• Women & Child Development Ministry• Diabetes Foundation of India
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Prevalence of obesity - India
• Overweight – females – 47.5% males - 32%
• Obese – females – 14% males – 3%
• Abdominal adiposity – females – 35% males – 49%
www.nutritionfoundationofindia.in
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The “Nutrition Transition”
Changes in age structure of the population, diet and physical activity patterns that result in
– Emergence of obesity as a common problem, with its predictable co-morbidities
– Change in nature and extent of cancer burden– Increases in other chronic diseases depending on the
nature of dietary and lifestyle shifts
with or without solution of existing problems of under- and mal-nutrition
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Driving Forces behind the Nutrition Transition
• Increases in life expectancy and declines in mortality: larger proportion of adults and growing number of elderly
• Urbanization• Economic and technical development
• Changes in physical activity and diet– Sedentary occupations and leisure-time activities– Urban environments that restrain physical activity– Dietary change: increases in dietary fat, sugar, animal
products, ?total dietary energy, + declines in dietary quality
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Predictable Sequence of the Developing Epidemic of Nutrition-Related Non-Communicable Diseases (NR-NCDs)
Obesity and overweight are the first manifestationWithin a generation, the prevalence of Type 2
diabetes mellitus and/or hypertension and stroke rise
Within two generations, premature CHD emerges as a major cause of premature death, disability and health care costs
Within two generations, the nature of the cancer burden shifts to domination by diet- and physical-activity related cancers
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Deaths, by broad cause group and WHO Region, 2000
24
InjuriesNoncommunicableconditions
Communicable diseases, maternal
and perinatal conditions and nutritional deficiencies
AFR EMR EURSEAR WPR AMR
25
50
75
%
So
urc
e:
WH
O,
Wo
rld H
ea
lth R
ep
ort
20
01
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Current Situation in the World’s Largest Countries
China (1.26 billion)Fast-growing economy (8.5%/year GDP growth)
% of population in poverty down from 20% in 1980s to <10% % of deaths due to NR-NCDs: 41.6% in 1995, 52.0% by 2020
India (1 billion)Real economic growth 3%/yr GDP
% of population in poverty down from 55% in 1970 to 26%% of deaths due to NR-NCDs: 31.6% in 1995; 43.3% by
2020
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Costs of Undernutrition and NR-NCDs in the World’s Largest
Countries
• China: Costs of undernutrition and NR-NCDs currently equal; NR-NCDs will dominate by 2025
• India: Costs of undernutrition still predominate, but NR-NCDs will contribute as much cost by the year 2025
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Nature of the Transition in the World’s Largest Countries
• China: dramatic rises in hypertension, stroke• India: major rise in incidence of adult-onset
diabetes
• Reasons for contrasting experience?– ?genetic backgrounds?– Nature of dietary shift (oils and meats in China,
sugars and dairy products in India)
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• Increase in prevalence in China over last 20 years was 400% compared to 20% in Australia
Asia Pacific Cohort Studies Collaboration
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Health risks overweight
33
Abdominal obesity
Dyslipidemia
Insulin resistance
Hypertension
Proinflammatory state
Prothrombotic state
Cardio-vascular disease
Diabetes Mellitus
Metabolic disorders as a common denominator for the various components
Nutrition may play an important role
in the development
Overweight subjects are at increased risk
of developingmetabolic disorders
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Why is obesity an even bigger problem for developing countries?
• More limited resources
• Late recognition of the problem
• Cultural factors favoring overweight, favoring overeating, favoring sedentary lifestyles, and/or stigmatizing thinness in some areas
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In Summary…….
• Nearly a million Overweight/ Obese population in the country
• Rising prevalence amongst children and young adults
• Much higher incidence of abdominal adiposity and metabolic syndrome
• Diabetes capital of the world
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Number of weight loss operations performed in the
United States
0
10000
20000
30000
40000
50000
60000
70000
80000
1993 1998 2002
JAMA. 2005;294:1909-1917.
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Thank You
Thank You
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