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Childhood Obesity:- Causes, Complications, Diagnosis, Hazards and Home Remedies of Obesity

During the past 20 years, obesity among adults has risen significantly in the United States. The latest data from the National Center for Health Statistics show that 30 percent of U.S. adults 20 years of age and older-over 60 million people-are obese. Obesity is perhaps the most prevalent form of malnutrition in developed countries, both among adults and children. It is extremely difficult to assess the size of the problem and compare the prevalence rates in different countries as no exact figures are available and also because the definitions of obesity are not standardized. Further, there has been an increased awareness of the problem in recent years. However, it has been estimated to affect 20 to 40 per cent of the adults and 10 to 20 per cent of children and adolescents In developed countries. It is a misconception that obesity is primarily a problem in the affluent countries; in fact, it is found in all countries in varying degrees.

Definition of obesity

Increase in body weight of 10-20% above the normal, caused by excess accumulation of fat is termed obesity. Healthy young men and women have a total body fat content below 20% and 25% respectively. When excess calories are supplied in any form, they are stored as fat. In addition to general appearance and weight, measurement of skin fold thickness over the biceps, triceps, sub scapular and suprailiac regions is helpful in the assessment of obesity. The skin fold thickness over the triceps for normal Indian subjects is below 20 ml. The proportion of body fat can be assessed from the skin fold thickness using nomograms. People who are obese are very overweight and at risk for serious health problems.

Difference between obesity and overweight

Obesity may be defined as an abnormal growth of the adipose tissue due to an enlargement of fat cell or an increase in fat cell numbers or a combination of both. Obesity is often expressed in term of body mass index. A body mass index of 30 or more in males and 28.6 or more in females indicates obesity.

The term "overweight" means a weight in excess of the average for a given sex, height and age. Overweight is usually due to obesity but can arise from other causes such as abnormal muscle development or fluid retention.

Epidemiological factor / Etiology/ Causes of Obesity:-

• Excessive consumption of food accounts for the vast majority. Training in early childhood and social factors influence eating habits. Both in anxiety and depression, excessive eating may be resorted to. It is not uncommon to develop obesity after recent bereavement or change of job.
• ln the Framingham, USA study, men were found to gain most weight between the ages of 29 an 35 years, while women gain most between 45 and 49 years of age.
• There is a genetic component in the aetiology of obesity. Twin studies have shown a close correlation between the weights of identical twins even when they are reared in dissimilar environments. But it has been difficult to examine the relative contribution of genetic and environmental factors.
• Physical activity which causes loss of calories closely related to obesity. Modern amenities such as automobiles and lifts which tend to minimize day-to-day physical exertion favour the development of obesity. Obesity is more evident when there is a sudden cessation of physical activity. Eating habits are also influenced by physical work. Moderate work is associated with optimal food intake whereas both physical inactivity and overexertion lead to overeating.
• Disorders such as hypothyroidism and Cushing's syndrome have obesity as part of the clinical picture. Drugs like corticosteroids, cyproheptadine and anabolic steroids may lead to weight gain, partly due to fat accumulation.
• The relationship of obesity to social class has been studied in some detail. There is a clear inverse relationship between socio-economic status and obesity. Within some affluent countries, however. obesity has been found to be more prevalent in the socio-economic groups.
• Alcohol being a good source of non-diet calories tends to aggravate obesity in the mild and moderate alcoholics.
• Psychosocial factors are deeply involved in the aetiology of obesity. Overeating may be a symptom of depression, anxiety, frustration and loneliness in childhood as it is in adult life. Excessively obese individuals are usually withdrawn, self conscious, lonely and secret eaters. An insight into the circumstances in which the obesity has developed is essential for planning the most suitable management.
• Obesity frequently runs in family, but this is not necessarily explained solely by the influence of genes.

Complications in Obesity

Middle-aged persons are more affected though no age is immune. Women outnumber men and the male to female ratio is 1 :5. Multiparity is associated with increasing . grades of obesity. The patient may not complain of her obesity on account of its gradual development and, therefore, it has to be identified during general exami­nation. Common symptoms include exertional dyspnea, sluggishness, angina, arthralgias of knees and hips, or any of the complications.

Complications: These develop invariably in all cases depending on the severity and duration of the disorder.

• III effects of increased weight: Slowness of movement, proneness to falls and accidents, osteoarthritis of weight-bearing joints like knees, hips, and spine.
• Skin: Abnormal skin folds develop and these give rise to fungal infection (moniliasis), recurrent bacterial infections, and chafing of the skin of the thighs and axillae. In extreme obesity, striae may develop.
• Cardiovascular system: Atherosclerosis, hyper­cholesterolemia, angina, ischemic heart disease, hypertension, varicose veins, venous thrombosis, and recurrent embolism.
• Respiratory system: Exertional dyspnea, reduction in vital capacity due to restriction of diaphragmatic movements and the increased mechanical effort required to move the thoracic cage, recurrent bronchitis, and in extreme cases, respiratory failure. 'Pickwickian syndrome' is the condition where obesity is associated with central depression of respiration and somnolence.
• Abdomen: The skin over the anterior abdominal wall hangs down as a fold ("abdominal apron"). Hernias develop owing to the increase in the intra-­abdominal pressure. Gall bladder lesions are more Common.
• Metabolic complications: Diabetes mellitus, hyperlipidemias, gout, and cholesterol gallstones are more common.
• Psychological abnormalities: Obese persons may develop depression because of their unattractive physical appearance and mechanical disability. They tend to avoid company and become socially isolated.
• There is a suggestion that cancer of the colon, breast, uterus, ovaries and prostate may be more common in the obese.

Diagnosis of Obesity

Diagnosis of obesity is made by comparing the patient's weight with ideal weight charts. A direct measure of body fat can also be made with an instrument known as calipers. Calipers are a scissor-shaped device used to measure the thickness of a person's flesh at the back of the upper arm. Women whose body weight consist more then 30 % of fatty tissue considered as obese. Man whose body weight consist more than 25% of fatty tissue considered as obese. Clinical diagnosis is based on weight, physical appearance and measurement of skin fold thickness. Sophisticated methods are available to establish the diagnosis in a borderline case. Increase in weight occurring during pregnancy, tluid retention, hypothyroidism, hypothalamic lesions, and other endocrine disturbances should be differentiated from obesity due to nutritional causes. So also overweight may be caused by excessive muscular development in wrestlers, weight-lifters and boxers.

Hazards of Obesity

Obesity is a health hazard and a detriment to well- being which is reflected in the increased morbidity and morality.

Increased Morbidity:-

Obesity is a positive risk factor in the development of hypertension, diabetes, gall bladder disease and coronary heart disease.

There are in addition , several associated diseases, which although not usually fatal, cause a great deal of morbidity in the community, e.g. variscose veins, abdominal hernia, osteoarthinis of the knee, hips and lumbar spine, flat and psychological stresses particularly during adolescence.

Obese person are exposed to increased risk from surgery.

Obesity may lead to lowered fertility.

Increased Morality:-

The Framingham Heart Study of United States showed a dramatic increase in sudden death among men more than 20 % overweight as compared with those with normal weight. The increased morality is brought about mainly by the increased incidence if hypertension and coronary heart disease.

There is also an excess number of deaths from renal diseases.Obesity lowers life expectancy.

Prevention and Control of Obesity

Prevention should begin in early childhood. Obesity is harder to treat adults than it is in children. The controI of obesity centres round weight reduction.This can be achieved by dietary changes, increased physical activity and a combination of both .

Dietary changes:-

The following dietary principles apply both to prevention and treatment :the proportion of energy-dense foods such as simple, carbohydrates and fats should be reduced; the fibre content in the diet should be increased through the consumption of common un-refined food; adequate.levels of essential nutrients in the low energy diets ­(most conventional diets for weight reduction are based on 1000kcal dailv model for an adult) should be ensured, and reducing diets should be as close as possible to existing nutritional patterns.

The most basic consideration is that the food energy intake should not be greater than what is necessary for energy expenditure. It requires modification of the patient's behaviour and strong motivation to lose weight and maintain ideal weight. Unfortunately, most attempts to reduce weight in obese persons by dietery advice remain unsuccessful.

lncreased physical activity :- This is an important part of reducing programme. Regular physical exercise is the key to an increased energy expenditure.

Others:- Appetite suppressing drugs have been tried in the control of obesity. They are generally inadequate to produce massive weight loss in severely obese patients. In short one should not expect quick or even tangible results in all casesfro obesity prevention programmes.

Home Remedies of Obesity

• Make a mixture of 1/4 teaspoon powdered black pepper, 3 teaspoon lime juice, and 1 teaspoon honey in 1 cup water. Drinking this mixture for 3-4 months may be helpful in weight loss for obese and overweight people.
• Drink a cup of water with 1 teaspoon fresh lime juice every morning for 3-4 months.
• The best course is to make fruits and boiled vegetables the mainstay of your diet. A diet of fruits and vegetables will give you the vitamins and the mineral salts for the sustenance of life, but would tend to reduce the amount of fat that has already been accumulating.
• Avoid refined (white flours and white rice) sugars, caffeine, and exercise. If you can't avoid sugars or refined foods, take 1-2 capsule of cinnamon, or sprinkle cinnamon on the food if possible. This helps keep the blood sugar from spiking too quickly. This especially helps insulin resistance.
• Drink 16 ounces of water 1 hour before each meal and before bedtime. Also don't eat or drink anything that contains refined sugar. Exercise is recommnended for the purpose of toning while losing the weight. Suggested minimum requirement is walking 20 to 30 minuntes(continuously) 4 times a week.
• Eating 10-12 fully grown curry leaves every morning for 3 to 4 months may be helpful in weight loss for obese and overweight people.