Adolescent Health Committee FOGSI
ADOLESCENCE
Adolescent Obesity Dr. Krishna Kavita Ramavath Visiting Clinician Mayoclinc Gynecology Robotic Surgery Phoenix 85021 Arizona Usa Adolescence is a time of huge physical, social and emotional changes. It is normally characterized by low levels of disease and death; it is the period of life when mortality rates are lowest. However many societies in which adolescent girls live are unable to provide optimal conditions for their healthy development. As a result, these girls may miss opportunities to progress successfully through the transition to adulthood, becoming vulnerable to behaviors that put their health at risk. One such is Obesity. Defining Obesity in Children and Adolescents : Obesity is defined as an excessive accumulation of body fat. Obesity is present when total body weight is more than 25 percent fat in boys and more than 32 percent fat in girls. Although childhood obesity is often defined as a weight-for-height in excess of 120 percent of the ideal, skin fold measures are more accurate determinants of fatness. Obesity as an Emerging concern : During the past two decades, the prevalence of obesity in children has risen greatly worldwide and this excessive fatness has arguably become a major health problem of both developed and developing countries. Overweight and obesity during childhood is a matter of growing concern in India also. Overweight is associated with the onset of major chronic diseases leading to complications and also psychosocial problems in children and adults. The greater concern is that the risks of overweight during childhood will persist into adolescence and adulthood. Tackling the problems of the growing numbers of overweight individuals is a major challenge for most countries. Childhood obesity has reached epidemic levels in developed countries. WHO Report : Obese adolescents tend to grow up to be obese adults and are thus exposed to a higher risk of diseases, such as osteoarthritis, diabetes and cardiovascular diseases, at a younger age than those who are not obese. Physical activity is not only crucial to avoiding weight gain but is also an important factor in improving adolescents' control over anxiety and depression. Physically active adolescents more readily adopt other healthy behaviours – including avoiding tobacco, alcohol and drug use – and show higher academic performance at school. Significant rise in childhood obesity in adolescent girls : According to a study by Swedish researchers on BMI figures for more than a thousand children over two decades, it is found that obesity levels had risen significantly among younger children, but that levels were much more constant among teenagers included in the research. They also found that young girls were much more likely to be overweight or obese than boys. Studies on urban Indian schoolchildren from selected regions report a high prevalence of obese and overweight children. In addition, studies on Indian school children have also demonstrated that the prevalence of hypertension in overweight children is significantly higher than that among normal children. Till date no nationally representative data have emerged from India, which makes it difficult to project the prevalence of obesity and overweight among children in India. While adolescent girls in many countries still suffer from under nutrition, data from low- and middle-income countries show that around 12% of school-going 13–15-year-old girls are overweight. However, data from 36 low- and middle-income countries indicate that 86% of girls do not meet recommended levels of physical activity, which is a far higher proportion than among boys. Health Risks of Obesity : Concern grows that the current dramatic rise of obesity among children and adolescents portends a future wave of 7
successful strategy for weight loss in children and adolescents unless coupled with another intervention, such as healthy nutrition or behavior modification. However, exercise has additional health benefits. A 50 minute of aerobic exercise three times per week, had significantly decreased blood lipid profiles and blood pressure in them.
successfully applied to children and adolescents are self-monitoring and recording food intake and physical activity, slowing the rate of eating, limiting the time and place of eating, and using rewards and incentives for desirable behaviors. Particularly effective are behaviorally based treatments that include parents in the treatment plan. Preventive Measures: Obesity is easier to prevent than to treat, and prevention focuses in large measure on parent education. In infancy, during promotion of breastfeeding mother should recognize the signals of satiety, and should delay in the introduction of solid foods. In early childhood, education should include proper nutrition, selection of low-fat snacks, good exercise/activity habits, and monitoring of television viewing.
increasing cardiovascular disease as these overweight youth reach the adult years. Childhood obesity is highly predictive of adult obesity, and among adults, excessive body fat carries multifold risk for morbidity and premature death from coronary artery disease, hypertension, stroke, and renal vascular disease, as well as other disorders. • Hypertension,
In cases where obesity is due to the influence of hereditary factors, parent education should focus on building self-esteem and address psychological issues.
• Type 2 diabetes mellitus,
Conclusion:
• Dyslipidaemia,
Unless effective interventions and preventive strategies are instituted at the local and national level, the trend of increasing cardiovascular disease in adults observed in recent decades will accelerate even further.
Outcomes related to childhood obesity include :
• Left ventricular hypertrophy, • Non-alcoholic steatohepatitis, • Obstructivesleep apnoea, • Psychosocial problems, • Asthma, • Arthritis, • Neoplasms The causes of Adolescent Obesity : The mechanism of obesity development is not fully understood. Environmental factors, lifestyle preferences, and cultural environment play pivotal roles in the rising prevalence of obesity worldwide. In general, overweight and obesity are assumed to be the results of an increase in caloric and fat intake. On the other hand, there are supporting evidence that excessive sugar intake by soft drink, increased portion size, and steady decline in physical activity have been playing major roles in the rising rates of obesity all around the world. Consequently, both over-consumption of calories and reduced physical activity are involved in childhood and adolescent obesity. The development of obesity in childhood and subsequently in adulthood involves interactions among multiple factors. These factors are personal (e.g., beliefs, attitudes, cultural experiences, taste preferences, and dietary composition), environmental (e.g., homes, schools, community, food availability and cost), societal (e.g., cultural norms, advertising and food marketing, social networks, technological developments, economics,) and healthcare-related (counseling and treatment, reimbursement), as well as physiological (e.g., intrauterine and early life “programming”, appetite and satiety mechanisms and regulation, adipose tissue metabolism, genetic predisposition) In light of the recognition of childhood obesity as a major public health problem with multiple etiological factors National Heart, Lung, and Blood Institute (NHLBI) and other NIH Institutes convened a Working Group meeting in 2007. The objective of the Working Group was to identify priorities for future research directions in childhood obesity prevention and treatment. Fig.1 gives a conceptual model of Obesity and CVD. Fig 1 : Obesity and CVD- Conceptual model( courtesy:NHLBI working group report) The goal is not a weight loss program for children and adolescents for obesity treatment . Rather, the aim is to slow or halt weight gain so the child will grow into his or her body weight over a period of months to years. Experts estimate that for every 20 percent excess of ideal body weight, the child will need one and one-half years of weight maintenance to attain ideal body weight. Three forms of intervention include :
2. Diet Management with caloric restriction : Fasting or extreme caloric restriction is not advisable for children. Balanced diets with moderate caloric restriction, especially reduced dietary fat, have been used successfully in treating obesity. Diet management coupled with exercise is an effective treatment for childhood obesity. 3. Behavior Modification : Many behavioral strategies that have been
A close monitoring of overweight prevalence in children and adolescents and taking timely preventive measures will be an effective approach in dealing with the problem of obesity. Actions are needed to ensure that societies and their health systems respond appropriately to the health and development needs of adolescent girls. Small lifestyle changes can make a big difference in the overall health of these adolescents.
Project of the Year 2011 “Challenges for the youth today & tomorrow ” FOGSI-Emcure Health Project One of our ongoing project titled “Challenges for youth project today & tomorrow” was started as a pilot project in 2009, seeing to the good result & acknowledgement received by the school & college authorities, this year under guidance of Dr. P.C. Mahapatra President FOGSI we decided to increase the area of activity aggressively expanding to 21 states in India. As suggested by Dr. P.C. Mahapatra one of our focuses this year will be more on moral values & spiritual health as major part of our talks. The idea is to empower the adolescents to be developed in to good human beings with noble attitudes & ideas which will enable them to overcome peer pressure & put them on the right path. We aim to “help young people form a strong moral identity in their early Adolescent years & empower them to contribute to the well-being of their communities....” The Challenges for youth Today & Tomorrow project has started now with five regional TOTs in West, East, South, Central & North. Under the Chairmanship of Dr. Roza Olyai as the National Coordinator for the same, the target is to cover more than 500,000 girls in 100 FOGSI societies. Special tool kit & booklets have been prepared by the committee for the same. We are thankful to all the doctors who have volunteered to be part of this project. The project is being sponsored by Emcure Pharma since 2009 as part of their social corporate responsibility for which we are thankful to them specially Mr. Arun Khanna COO Emcure Pharma for his constant encouragement & support, Mr. Anoop Sood for his excellent coordination, Ms. Charu & her team for their wonderful execution.
1. Exercise : Adopting a formal exercise program, or simply becoming more active, is valuable to burn fat, increase energy expenditure, and maintain lost weight. Studies have not shown exercise to be a 8