Obesity Reduction and Awareness of NCD’s through Group Education in children Dr.V.Mohan, MD., FRCP (London, Edinburgh, Glasgow & Ireland), Ph.D., DSc., FNASc. Dr.Ranjani Harish, CDE, Ph.D

Childhood obesity is a forerunner of obesity in adulthood, which in turn has a strong association with NCD’s such as type 2 diabetes and cardiovascular disease In developing countries including India, overnutrition co - exists with undernutrition. Children belonging to the lower socioeconomic group are undernourished whereas the higher and middle income children are overnourished. There is an urgent need for accurate data on nutritional status of children & adolescents and also need for spreading messages about the rising obesity epidemic among them.

Most of the earlier studies in children and adolescents in India have been done either on small numbers or in selected schools in India. This study plans to undertake large scale screening of children to obtain accurate prevalence estimates of childhood obesity and glucose intolerance in children and adolescents. A massive awareness program targeting the prevention/reduction of obesity in children at the school & community level is also planned.

To estimate the prevalence of obesity, glucose intolerance, hypertension, dyslipidemia and metabolic syndrome among urban children and adolescents aged 6-19 years and to raise awareness about Non-Communicable Diseases (NCD’S) among them in Chennai city in South India.

ORANGE PROJECT SCHOOL COMPONENT COLONY COMPONENT Main difference between the components is that blood testing will be done only in the colonies

Phase I Phase II Screening Awareness about NCD’s Colony component (n= 2000) School component (n= 20,000) Step-1 Administering questionnaires to Children Parents & Teachers. Step-1 Administering questionnaires to Children & Parents. Step-2 Anthropometric Measurements a) Height b) Weight c) Waist d) Body Fat Step-2 Anthropometric Measurements a) Height b) Weight c) Waist d) Body Fat Step-3 Blood pressure and Pulse Step-3 Blood pressure and Pulse Step-4 Checking for Clinical markers Step-4 Checking for Clinical markers 1)Through visual aids booklets, handouts and posters. 2)Through skits and puppet shows 3)Through competitions like drawing, posters collage, cookery, quiz etc. 4)Through a brief, colourful slideshow accompanied with a talk/lecture 5)Through a jeopardy game 6)A short story/film on childhood obesity is being prepared Step-5 Implementing the policies of WHO’s Health Promoting School (HPS) Step-5 Biochemical tests 1) OGTT 2) Lipids profile 3) Complete Haemogram

Screening for anthropometrical and clinical parameters Demographic Information Collected in Schools and Colonies Planned Interventions In Schools & Colonies Facilitate WHO Health Promoting Schools (HPS) Screening for anthropometrical, clinical & biochemical parameters School component n = 20, 000 Colony component n = 2,000 Follow up of children from selected cooperative schools determined by consent Phase I Phase II Phase III Follow up of all colony children based on consent

Specific objectives of the School component To collect anthropometric data of school going children ranging from the age group of 6 to 19 years to develop standardised age specific cut points for height, weight, waist circumference, BMI, body fat % and blood pressure in children and adolescents as such data is not available in India. To study the prevalence of overnutrition and undernutrition in school going children from private and government schools To promote the concept of health promoting schools (HPS) in Chennai

 Corporation & Government aided schools: Group 1  Private & Management run schools: Group 2  Schools in Tamil Nadu have been divided into four major categories primary (age group 6-10 yrs), upper primary or middle (age group 6 – 13 yrs), secondary (age group 6 – 15 yrs) and upper secondary (age group 6 – 17 yrs).  10 Corporation zones in Chennai. Based on the proportion of schools in each zone, a total of 50 schools will be selected by systematic random sampling.  The number of children to be selected from each school is around 400 and number from each age group ~ 150 to achieve a proportionate sample of all age groups.

Specific objectives of the Community component To study the prevalence of obesity, glucose intolerance, metabolic syndrome in a representative sample of children and adolescents ranging from the age group of 6 – 19 years in Chennai. To develop a risk score which will help to identify diabetes/ pre-diabetes in children and adolescents. To create awareness about non-communicable diseases among the children, adolescents and their family members.

The list of zones and the areas under each corporation zone was obtained from the Corporation of Chennai website The residential colonies were randomly selected from the areas covered under each zone ensuring that the colonies selected were representative of Chennai city. Permission was obtained from the Colony Welfare Association President and Secretary of every colony before conducting the screening and awareness. Every family in the colony was approached and the children fitting the age criteria were included in the study only after obtaining the informed consent of the parent and the assent of the child.

What are NCD’s? Health implications of under nutrition, obesity and diabetes among children and adults Importance of increased physical activity and reduced TV viewing Importance of weight reduction Importance of following a traditional diet pattern and healthy eating Understanding the fast food culture and how to reduce consumption of fast foods Increasing fruits and vegetables consumption Need for cutting down on calorie, fat and sugar intake wherever appropriate Ill effects of smoking, use of smokeless tobacco, alcohol etc. Spotting the hidden messages in junk food advertisements, and The need to understand food labeling

Data on prevalence of obesity (abdominal and general), underweight, blood pressure, clinical markers of diabetes will be collected from 20,000 school children. In addition data on prevalence of glucose intolerance, dyslipidemias, metabolic syndrome will be collected from 2000 children residing in middle income colonies. By increasing awareness about various NCDs among children the health care burden due to NCDs can be reduced in the future. This project could serve as a role model to study the feasibility and viability for NCD prevention programmes for children in India and other developing countries. This project will launch the WHO - HPS initiative in atleast 50 schools in urban Chennai. This in effect can create awareness and improvement of basic health and hygiene facilities in these schools. This project is expected to positively change the health of 22, 000 children and through them atleast reach out to 1, 00,000 adults who can bring out healthy behavior changes in their own lives.

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