1. 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

2. 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

3. Author Year of Study Country/ State Criteria used Prevalence of over- weight (M/F) Prevalence of obesity (M/F) Gopinath et.al1994DelhiBMI>2521.3% (M) 33.4% (F) INA Singhal et al1998JaipurBMI>2514.6% (M) 6.6% (F) INA Asthana et al1997VaranasiBMI>2530.2% (F)INA Chadha et al1997DelhiBMI>2520.7 (M) 32.6% (F) INA Obesity Trends in India : Recent studies: Adults

4. Author Year of Study Country/ State Criteria used Prevalence of over- weight (M/F) Prevalence of obesity (M/F) Singh et.al19995 Cities BMI>23 BMI>25 BMI>27 50.9% (F) Vasanthanani2000 Coimbatore BMI>3036.0% (M) Mohan et al2000ChennaiBMI>25 38.0% (M) 33.1% (F) Easwaran et al2001 Coimbatore BMI>25 BMI>24 65.0% (M) 65.0% (F) Gupta et al2002JaipurBMI>27 24.5% (M) 30.2% (F) NFHS-II1998- 99 IndiaBMI>258.6% MIG 27.2 HIG Obesity Trends in India : Recent studies

5. SurveyNormal (%) BMI 18.5-25 Obese (%) BMI>25 NNMB (75-79)48.83.4 NNMB (88-90)46.64.1 NNMB (94)46.36.6 NNMB Slum (93-94)51.711.6 Trends in Body Mass Index of Adult Women Body Mass Indix (BMI) is defined as weight (kg)/height² (m)

6. Obesity Trends in India : Recent studies Children S.NoAuthor NameState/ 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.

7. Obesity Trends in India : Recent studies Children S.NoAuthor NameState/ country Prevalence of obesity 3.*A.K.Gupta etal, 1985-86 India7.94% boys 6.90% girls 4.**Ramachandran A etal, 2000 India3.6% boys 2.7% girls 3.* Indian Pediatrics, 1990, Apr, 27 333-337 4.** Diabetes research and Clinical Practice 2002; 57 185-190.

10. 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 ã Bone: Joint and skin diseases  Oesteoprosis  Mental Health  Psychological well being  Accidents  Muscloskeletal injuries Obesity

13. High Prevalence of Metabolic Syndrome (Syndrome X) Hypertension Increased Insulin Resistance Central Obesity Dyslipidemia

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

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

16. Obesity and Diabetes As many as 80% of patients with type-2 diabetes mellitus are obese

18. 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

19. 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

20. Obesity and Diabetes Mild obesity Two fold risk of Diabetes Moderate obesity Five fold risk of Diabetes Severe obesity Ten fold risk of Diabetes

21. 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 of 13% in adults

22. Possible Reasons: Average per capita energy ( Kcals ) intake as per expenditure classes, India Expenditure Classes Urban (1972-73) Urban (1993-94) Lower 30%15791682 Middle 40%21542111 Top 30%25722405 Source: NSSO, 1997

23. Average daily per capita dietary intake of Fats in India YearFat (g) Rural Fat(g) Urban 1972-732436 19832737 1993-9431.442 1999-200036.149.6 Source: NSSO 2001

24. 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

25. Studies on prevalence of hypertension on obese children S.NoAuthor NameState/ 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 IndiaObese children: 34% Non-obese children: 0.16% 1* Indian Pediatrics1994Sept; 31: 1065-1069 2** Indian Pediatrics 1990 Apr;27(4)333-7.

26. Study on prevalence of IGT(Impaired Glucose Tolerance) and diabetes mellitus in obese children S.NoAuthor NameState/ country Prevalence of IGT & DM 1.*Ranjana Sinha etal, 1999-2000 YaleIGT: 25% (4-10yrs : 21%(11- 18yrs) DM: 4%( 11-18yrs) 2.**Ripamonti G etal, 1990 ItalyIGT: 11% 1.* New England Journal of Medicine;2002 March;346(11);802-810 2.** Minerva Med; 1991 Jun; 82(6):345-8

27. Study on the prevalence of Dyslipediamas in obese children S.NoAuthor NameState/ country Prevalence of Dyslipediamas 1.*Zwiauer K etal, 1990 Australia46% girls 41% boys 2,**Valverde MA etal, 1998 Portugal67.6% elevated triglyceride levels 1.* Wien Klin Wochenschr. 1990 May 11; 102(10): 299-303 2.** Arch Latinoam Nutr. 1999 Dec; 49(4): 338-43

28. Study on the prevalence of Dyslipediamas in obese children (Cont..) S.NoAuthor NameState/ country Prevalence of Dyslipediamas 3.*Fredland O etal, 2002 Texas (USA) 52% elevated serum cholesterol levels 3.*J Pediatr Endocrinology Met’ 15’ 1011-1016 (2002)

29. 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.

32. WE MUST LEARN LESSON FROM THE DVELOPED COUNTRIES RDA for the Affluent Urban Sedentary Population life Styles Should be developed

33. All India Institute of Medical Sciences, New Delhi Thank you