OBESITY AN EMERGING THREAT Dr Nikhil Tandon Additional

OBESITY: AN EMERGING THREAT Dr. Nikhil Tandon Additional Professor Department of Endocrinology All India Institute of Medical Sciences

PREVALENCE OF OBESITY IN DELHI SCHOOL CHILDREN FROM DIFFERENT SOCIO -ECONOMIC GROUPS 1400 1200 1000 800 600 400 24. 4 23. 9 200 0 Total Non-obese Obese /Overwt. 28. 7 1. 5 Private Boys Girls Govt. Tandon and colleagues, 2004

Obesity in Children and Young Adults Obesity Abdominal Obesity Misra and colleagues, International Journal of Obesity, 2004

Childhood Obesity is the Important Determinant for Diabetes in Children Snapshot • Youth-onset Type 2 diabetes is a real concern in many countries • Our data show that increase fat over chest and abdomen is a extremely important determinant of youth-onset diabetes

Type 2 Diabetes Mellitus in Children, Adolescents and Young Adult Asian Indians (CAYA-2 DM Trial): A Multicenter Collaborative study Objective To study the anthropometric, biochemical and immunological profiles of children, adolescents and young adults with type 2 diabetes mellitus and compare them with age-matched healthy controls

CAYA-2 DM Trial Methods Subjects: • 31 patients; 59 age-matched healthy controls Anthropometric Profile: • Body mass index, waist circumference, waist-hip ratio, skinfold thickness at 8 sites • Percentage body fat by two-point bioelectrical impedance

CAYA-2 DM Trial Comparative Clinical Profile Variable(s) Cases (n=31) Controls (n=59) Pulse rate 81. 6± 10. 3 83. 2± 10. 2 Systolic BP (mm. Hg) 121. 5± 12. 3 114. 7± 12. 2*** Diastolic BP (mm. Hg) 76. 6± 11. 1 75. 1± 11. 0 BMI (kg/m 2) 24. 7± 5. 3 20. 8± 5. 3** Waist Circumference (cm) 83. 0± 15. 4 70. 9± 15. 2*** Waist Hip Ratio 0. 89± 0. 07 0. 80± 0. 07*** *: p<0. 05; **: p<0. 01; ***: p<0. 001

CAYA-2 DM Trial Comparison of Cases and Controls Variable(s) Cases (n=31) Controls (n=59) Biceps 13. 8± 6. 3 8. 7± 6. 3** Triceps 21. 2± 8. 8 15. 6± 8. 7* Subscapular 29. 0± 10. 7 17. 5± 10. 7*** Suprailiac 29. 7± 12. 4 18. 9± 12. 3** Thigh 31. 7± 13. 2 25. 5± 13. 0 Calf 19. 5± 7. 3 17. 3± 7. 2 33. 1± 9. 7 23. 9± 9. 6*** Skinfold thickness (mm) Percent body fat *: p<0. 05; **: p<0. 01; ***: p<0. 001

CAYA-2 DM Trial Comparison of Cases and Controls Variable(s) Cases (n=31) Controls (n=59) Overweight (BMI>25 kg/m 2) 42. 9 8. 5** High %BF (>25% M, >30% F) 59. 3 19. 0** High WC (>102 cm M, > 88 F) 21. 4 5. 1* High W-HR (>0. 95 M, > 0. 80 F) 46. 4 10. 36** Hypercholesterolemia (>200 mg/d. L) 21. 4 5. 1* Hypertriglyceridemia (>150 mg/d. L) 39. 3 5. 1** Low HDL-C (< 40 M, < 50 F) 46. 4 23. 7* High LDL-C (>130 mg/d. L) 7. 1 5. 1 *: p<0. 05; **: p<0. 01; ***: p<0. 001

CAYA-2 DM Trial Conclusions Generalized (high BMI) as well as abdominal obesity (high W-HR) are the most important predictors for early onset of IGT and T 2 DM in Asian Indians.

How to Predict Diabetes in Children Parameter Risk Abdominal obesity & family history of diabetes 68 times

CAYA-2 DM Trial Weight Percentiles of Cases: Birth and Current 100 90 Percentiles 80 70 60 50 40 30 20 10 0 Birthweight Present weight

ISSUES • Increasing obesity • Contributory factors: - calorie dense food - consumption of processed foods limited physical activity sedentary interests: computers, TV, video games • THE SEED FOR ADULT OBESITY IS SOWN EARLY - CHILDHOOD -

INTERVENTIONS • Catch them young - school age children must be targeted • Increase awareness: media; school teachers; governmental and NGO effort • Minimise advertising pressure for “junk foods” • School play grounds; “Games periods” • Health food in school canteens