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

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

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

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>25BMI>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% MIG27.2 HIG

Obesity Trends in India : Recent studies

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)/height² (m)

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

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.

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

Diabetes

Gall bladder disease

Hypertension

Dyslipidaemia

Insulin resistance

Breathlessness

Sleep apnoea

Greatly increased(relative risk >>3)

Coronary heart disease

Osteoarthritis (knees)

Hyperuricaemia and gout

Moderately increased(relative risk

ca 2-3)

Cancer (breast cancer in postmenopausal women, endometrial cancer, colon cancer)

Reproductive hormone abnormalities

Polycystic ovary syndrome

Impaired fertility

Low back pain

Increased anaesthetic risk

Foetal defects arising from maternal obesity

Slightly increased(relative risk

ca 1-2)

Relative risk of health problems associated with

obesity in developed countries.

High Prevalence of Metabolic Syndrome

(Syndrome X)

HypertensionIncreased Insulin ResistanceCentral ObesityDyslipidemia

Obesity and Mortality

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

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

Obesity and Diabetes

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

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

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

Obesity and Diabetes

Mild obesity Two fold risk of Diabetes

Moderate obesity Five fold risk of Diabetes

Severe obesity Ten fold risk of Diabetes

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 of13% in adults

Possible Reasons:Average per capita energy ( Kcals ) intake

as per expenditure classes , IndiaExpenditure

ClassesUrban

(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

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

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

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 childrenS.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

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..)

S.No Author Name State/

countryPrevalence of Dyslipediamas

3.* Fredland O etal, 2002

Texas (USA)

52% elevated serum cholesterol levels

3.*J Pediatr Endocrinology Met’ 15’ 1011-1016 (2002)

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.

Body Mass Index

Rel

ativ

e R

isk

Women

Willett, Dietz & Colditz, N.E.J.M. 1999. 341, 426-434

BMI in relation to morbidity over 18 yearsBMI in relation to morbidity over 18 years

Aged 30-55 at start.

1

2

3

4

5

6

0<21 22 23 24 25 26 27 28 29 30

Type 2 diabetesCholelithiasisCoronary Heart DiseaseHypertension

18 20 22 24 26 28 30 32 341.0

1.2

1.4

1.6

1.8

2.0

2.2

2.4

2.6

2.8

6.6

6.2

5.8

Total cholesterol

Triglycerides

HDL cholesterol

Body Mass Index (kg/m²)

0

10

20

30

40

50

60

mm

ol/l

SBP

% w

ith h

igh

SB

P

Obesity: cardiovascular risk

Data from British Regional Heart Survey

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

Thank you