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

PREVALENCE OF OBESITY IN DELHI SCHOOL CHILDREN FROM DIFFERENT SOCIO -ECONOMIC GROUPS PrivateBoysGirlsGovt. Total Non-obese Obese /Overwt 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-2DM 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

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-2DM Trial Methods

Variable(s)Cases (n=31)Controls (n=59) Pulse rate81.6± ±10.2 Systolic BP (mmHg) 121.5± ±12.2*** Diastolic BP (mmHg) 76.6± ±11.0 BMI (kg/m 2 )24.7± ±5.3** Waist Circumference (cm) 83.0± ±15.2*** Waist Hip Ratio0.89± ±0.07*** *:p<0.05; **: p<0.01; ***: p<0.001 CAYA-2DM Trial Comparative Clinical Profile

CAYA-2DM Trial Comparison of Cases and Controls Variable(s)Cases (n=31)Controls (n=59) Skinfold thickness (mm) Biceps13.8±6.38.7±6.3** Triceps21.2± ±8.7* Subscapular29.0± ±10.7*** Suprailiac29.7± ±12.3** Thigh31.7± ±13.0 Calf19.5± ±7.2 Percent body fat33.1± ±9.6*** *:p<0.05; **: p<0.01; ***: p<0.001

CAYA-2DM Trial Comparison of Cases and Controls Variable(s)Cases (n=31)Controls (n=59) Overweight (BMI>25 kg/m 2 ) ** High %BF (>25% M, >30% F) ** High WC (>102 cm M, > 88 F) * High W-HR (>0.95 M,> 0.80 F) ** Hypercholesterolemia (>200 mg/dL) * Hypertriglyceridemia (>150 mg/dL) ** Low HDL-C (< 40 M, < 50 F) * High LDL-C (>130 mg/dL) *:p<0.05; **: p<0.01; ***: p<0.001

Generalized (high BMI) as well as abdominal obesity (high W-HR) are the most important predictors for early onset of IGT and T2DM in Asian Indians. CAYA-2DM Trial Conclusions

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

CAYA-2DM Trial Weight Percentiles of Cases: Birth and Current

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