“OBESITY”

How common is obesity?

Obesity is common in adults and children. About half the adults are overweight. About
one-quarter are obese. Obesity is more common in certain groups of people. Obesity is slightly
more common in women than in men. It's especially common in South Asian and Afro-
Caribbean people. People from all backgrounds can get obese. But obesity is more common in
people with lower incomes. Many children also have serious weight problems. Compared to
1990, more children now fall into the category of being overweight or obese. About 19 in 100
boys and 18 in 100 girls aged between 2 and 15 are obese.
Obesity most commonly begins in childhood between the ages of 5 and 6, and during
adolescence.  Studies have shown that a child who is obese between the ages of 10 and 13 has
an 80 percent chance of becoming an obese adult. 

What is obesity?
Obesity is a medical condition in which excess body fat has accumulated to the extent
that it may have an adverse effect on health, leading to reduced life expectancy.[1][2] Body
mass index (BMI), which compares weight and height, is used to define a person as overweight
(pre-obese) when their BMI is between 25 kg/m2 and 30 kg/m2 and obese when it is greater
than 30 kg/m2.[3]
A few extra pounds do not suggest obesity.   However they may indicate a tendency to
gain weight easily and a need for changes in diet and/or exercise.  Generally, a child is not
considered obese until the weight is at least 10 percent higher than what is recommended for
the height and body type.

What causes obesity?

The causes of obesity are complex and include genetic, biological, behavioral and cultural
factors.  Basically, obesity occurs when a person eats more calories than the body burns up.   If
one parent is obese, there is a 50 percent chance that the children will also be obese.  However,
when both parents are obese, the children have an 80 percent chance of being obese. 
Although certain medical disorders can cause obesity, less than 1 percent of all obesity is
caused by physical problems.  Obesity in childhood and adolescence can be related to:
 poor eating habits
 overeating or binging
 lack of exercise (i.e., couch potato kids)
 family history of obesity
 medical illnesses (endocrine, neurological problems)
 medications (steroids, some psychiatric medications)
 stressful life events or changes (separations, divorce, moves, deaths, abuse)
 family and peer problems
  low self-esteem
 depression or other emotional problems

Separating Genetic Causes From Environmental Causes

Obesity tends to run in families, suggesting a genetic link. Yet families also share
common dietary, physical exercise, attitude and lifestyle habits that may also contribute to
obesity. Separating these from purely genetic factors is not an easy statistical or diagnostic task.

Environmental Causes of Obesit

In view of the sudden rise in weight levels - which is a worldwide trend as reflected in
the new word "globesity" - environmental factors must be the prime cause of modern obesity.

Overconsumption - A Possible Root Cause

Eating too many calories for our energy needs must be a major candidate for the main
cause of the modern obesity epidemic. According to Dr. Marion Nestle, Professor and Chair of
the Department of Nutrition and Food Studies at New York University, US agribusiness now
produces 3,800 calories of food a day for every American, 500 calories more than 30 years ago
but at much lower per-calorie costs. Increases in consumption of calorie-dense foods, as
evidenced by the growth of fast-food chains and higher soft drink consumption, also point to a
higher energy-intake.

Reduced Energy Expenditure - A Possible Root Cause

People who eat more calories need to burn more calories, otherwise their calorie
surplus is stored as fat. For example, if we eat 100 more food calories a day than we burn, we
gain about 1 pound in a month. That’s about 10 pounds in a year. Over two decades this energy
surplus causes a weight gain of 200 pounds!
Assessing the contribution of lack of exercise to obesity is hampered by lack of research.
According to existing surveys, only 20 percent of the population are frequent exercisers. In
addition, only a small minority of children (1 in 5) regularly participate in after-school sports or
extra-curricular physical activity. Since 1990, among adults there has been a per capita decline
of 15 percent in frequent exercise activity (100+ days per year in any one activity). Among
teenagers and adolescents aged 12-17, the plunge is 41 percent.
However, data on correlation between BMI and exercise frequency is almost non-
existent, so we are unable to say exactly what effect lack of exercise has on obesity. What we
do know is that severe clinical obesity leads to serious mobility problems caused by respiratory
and musculoskeletal disorders. Thus the fitness capacity of obese individuals, especially those
suffering from morbid obesity, is typically diminished.

Family Influence - A Major Contributory Cause to Obesity

Parental behavioral patterns concerning shopping, cooking, eating and exercise, have an
important influence on a child's energy balance and ultimately their weight. Thus family diet
and lifestyle are important contributory causes to modern child obesity, especially at a time of
rising affluence. Since obese children and adolescents frequently grow up to become obese
adults, it's clear that family influence also extends to adult obesity.
Genetic Causes of Modern Obesity
Genes affect a number of weight-related processes in the body, such as metabolic rate,
blood glucose metabolism, fat-storage, hormones, to name but a few. Also, some studies of
adopted children indicate that adopted children tend to develop weight problems similar to
their biological, rather than adoptive, parents. In addition, infants born to overweight mothers
have been found to be less active and to gain more weight by the age of three months when
compared with infants of normal weight mothers, suggesting a possible inborn drive to
conserve energy. Research has also shown that normal-weight children of obese parents may
have a lower metabolic rate than normal-weight children of non-obese parents, which can lead
to weight problems in adulthood. All of this suggests that a predisposition to obesity can be
inherited.

Risk factor for obesity

There are many risks and complications with obesity.  Physical consequences include:
 increased risk of heart disease
 high blood pressure
 diabetes
 breathing problems
 trouble sleeping
Child and adolescent obesity is also associated with increased risk of emotional
problems.  Teens with weight problems tend to have much lower self-esteem and be less
popular with their peers.  Depression, anxiety, and obsessive compulsive disorder can also
occur.

Obesity complications
Obesity increases the risk of developing several health problems like high blood
pressure, insulin resistance, type 2 diabetes, coronary artery disease (heart attacks),
cerebrovascular disease (stroke), gout, gallstones, colon cancer, sleep apnea and non alcoholic
fatty liver disease.

Obesity & High blood pressure:

Multiple factors are responsible for increase in blood pressure in obesity.
- Weight gain is associated with decrease in elasticity of blood vessels & increase heart rate.
- Excess calories are deposited in body as fat in fatty tissue. This fatty tissue increases demand
for oxygen & nutrients, which in turn increases amount of blood circulating in the body. More
blood traveling through arteries adds pressure on walls of arteries leading to increase in blood
pressure.
- Obesity increases level of insulin in body. Insulin causes sodium & water retention in body,
which results in increase in blood volume & extra pressure on arteries.
All of these factors can increase blood pressure.
Obesity & Diabetes: – Increased blood sugar level:
Type2 diabetes is a common health problem in diabetes.
- Insulin controls blood sugar.
- Insulin is required for the entry of sugar (glucose) into body cells from blood.
- Excess body fat in obesity makes body resistant to insulin. Because of this insulin resistance,
sugar will remain in blood, which will lead to increase in blood sugar or diabetes.
- High amount of sugar in blood leads to complications in kidney, eyes, blood vessel, and heart.

Atherosclerosis or fatty deposits in blood vessels:

Cholesterol is carried in the blood as two compounds: Low-density lipoproteins (LDL)
and High-density lipoproteins (HDL). HDL is also called the 'good' cholesterol and LDL is also
called the 'bad' cholesterol.
- Obesity is associated with low levels of good (high-density lipoprotein) cholesterol and high
levels of bad (LDL) cholesterol.
- When cholesterol levels are high, some of the cholesterol is deposited on the walls of the
blood vessels. Cholesterol deposits reduces the elasticity of blood vessels, narrows blood
vessels & decreases blood flow. All these changes lead to atherosclerosis and an increased risk
of heart disease & stroke.

Coronary artery disease – angina & heart attack:

Atherosclerosis (fatty deposits in arteries) in coronary arteries (arteries that supply
heart) reduces blood supply to heart. Decreased blood flow to heart can cause angina (chest
pain) and complete blockage of blood flow to heart can cause heart attack.

Stroke or paralysis:
Atherosclerosis (fatty deposits in arteries) in arteries of brain can reduce blood supply to
that part of brain. This decrease in blood flow can result in stroke or paralysis.

Osteoarthritis:
Obesity & overweight increases the load on the joints such as the knee, hip & lower
back. This extra pressure on these joints speeds up the breakdown of cartilage, resulting in joint
pain & stiffness.
(Cartilage is a flexible tissue that covers bone ends in a joint to cushion the bone and allow the
joint to move easily without pain).

Gout:
Gout is type of arthritis caused by the accumulation of uric acid crystals in joints.
- Obesity is associated with increased production of uric acid, which can form solid crystal-like
masses. Uric acid crystals are deposited in the joints & provoke an inflammatory reaction in
joints leading to arthritis.

Sleep apnea:
Overweight & excess fat around neck causes narrowing of airways & leads to sleep
apnea. Sleep apnea is a condition in which person stop breathing for short periods during sleep
& snore heavily. It results in frequent awakening at night and subsequent drowsiness &
tiredness during the day.

Fatty liver disease (Non alcoholic fatty liver):

Obesity increases the risk of developing fatty liver disease due to accumulation of fat in
liver. These fatty deposits in liver can lead to inflammation & scarring of the liver called non-
alcoholic fatty liver disease. Serious complication of this scarring is cirrhosis of liver.

Gallbladder disease and gallstones:

The gallbladder is a small pear-shaped organ situated beneath the liver on the right side
of the abdomen. In obesity, excessive cholesterol gets deposited in gall bladder, which can lead
to formation of gallstones. Rapid weight loss or loss of a large amount of weight can also
increases the chances of developing gallstones.
Treatment
Obese children need a thorough medical evaluation by a pediatrician or family
physician  to consider the possibility of a physical cause.  In the absence of a physical disorder,
the only way to lose weight is to reduce the number of calories being eaten and to increase the
child's or adolescent's level of physical activity.  Lasting weight loss can only occur when there is
self-motivation.  Since obesity often affects more than one family member, making healthy
eating and regular exercise a family activity can improve the chances of successful weight
control for the child or adolescent.

Ways to manage obesity

 start a weight-management program
 change eating habits (eat slowly, develop a routine)
 plan meals and make better food selections (eat less fatty foods, avoid junk and fast
foods)
 control portions and consume less calories
 increase physical activity (especially walking) and have a more active lifestyle
 know what your child eats at school
 eat meals as a family instead of while watching television or at the computer
 do not use food as a reward
  limit snacking
 attend a support group (e.g., Overeaters Anonymous)

Obesity frequently becomes a lifelong issue.  The reason most obese adolescents gain back
their lost pounds is that after they have reached their goal, they go back to their old habits of
eating and exercising.  An obese adolescent must therefore learn to eat and enjoy healthy
foods in moderate amounts and to exercise regularly to maintain the desired weight.   Parents
of an obese child can improve their child's self esteem by emphasizing the child's strengths and
positive qualities rather than just focusing on their weight problem.
When a child or adolescent with obesity also has emotional problems, a child and
adolescent psychiatrist can work with the child's family physician to develop a comprehensive
treatment plan.  Such a plan would include reasonable weight loss goals, dietary and physical
activity management, behavior modification, and family involvement.

Conclusion
Prevention of overweight is critical, because long-term outcome data for successful
treatment approaches are limited. Genetic, environmental, or combinations of risk factors to
obesity can and should be identified. Early recognition of excessive weight gain relative to linear
growth should become routine in pediatric ambulatory care settings. BMI should be calculated
and plotted periodically. Families should be educated and empowered through anticipatory
guidance to recognize the impact they have on their children’s development of lifelong habits
of physical activity and nutritious eating. Dietary practices should encourage moderation rather
than overconsumption, emphasizing healthful choices rather than restrictive eating patterns.
Regular physical activity should be consciously promoted, prioritized, and protected within
families, schools, and communities. Optimal approaches to prevention need to combine dietary
and physical activity interventions. Advocacy is needed in the areas of physical activity and food
policy for children; research into pathophysiology, risk factors, and early recognition and
management of overweight and obesity; and improved insurance coverage and third-party
reimbursement for obesity care.

Recommendations
First identify and track patients at risk by virtue of family history, birth weight, or
socioeconomic, ethnic, cultural, or environmental factors. Then calculate and plot BMI once a
year in all children and adolescents. Use change in BMI to identify rate of excessive weight gain
relative to linear growth. Second encourage parents and caregivers to promote healthy eating
patterns by offering nutritious snacks, such as vegetables and fruits, low-fat dairy foods, and
whole grains; encouraging children’s autonomy in self-regulation of food intake and setting
appropriate limits on choices; and modeling healthy food choices. Third routinely promote
physical activity, including unstructured play at home, in school, in child care settings, and
throughout the community and recommend limitation of television and video time to a
maximum of 2 hours per day. Recognize and monitor changes in obesity-associated risk factors
for adult chronic disease, such as hypertension, dyslipidemia, impaired glucose tolerance, and
symptoms of obstructive sleep apnea syndrome.
Resources:
http://www.guardian.co.uk/lifeandstyle/besttreatments/obesity-how-common
http://en.wikipedia.org/wiki/Obesity
http://www.annecollins.com/obesity/causes-of-obesity.htm
http://www.buzzle.com/articles/complications-obesity-overweight.html
http://aappolicy.aappublications.org/cgi/content/full/pediatrics;112/2/424#SEC4