Childhood Obesity in Developing Countries: Facets of Abnormal Growth

Abstract

Increased availability of indigenous and “westernized” energy-dense fast foods, aggressive advertising practices, relatively low cost, and improved purchasing power have led children and adolescents in developing countries to increasingly consume saturated-fat snacks, refined carbohydrates, and sweetened carbonated beverages. Such rapidly changing dietary practices accompanied by an increasingly sedentary lifestyle predispose to nutrition-related non-communicable diseases, including childhood obesity. Over the last 5 years, reports from several developing countries indicate prevalence rates of obesity (inclusive of overweight) > 15% in children and adolescents aged 5–19 years: Mexico 41.8%, Brazil 22.1%, India 22.0%, and Argentina 19.3%. Moreover, secular trends also indicate an alarming increase in obesity in developing countries: in Brazil from 4.1 to 13.9% between 1974 and 1997; in Thailand from 12.2 to 15.6% between 1991 and 1993; in China from 6.4 to 7.7% between 1991 and 1997; and in India from 4.9 to 6.6% between 2003–2004 and 2005–2006. Other contributory factors to childhood obesity include high socio-economic status, residence in metropolitan cities, and female gender. Over-protection and forced feeding by parents may also account for the growing prevalence rates. Mothers in developing countries often have false traditional beliefs such as “feeding oils, ghee (clarified butter), and butter to children would benefit their growth” and “a chubby child is healthy child.” Childhood obesity tracks into adulthood, thus increasing the risk for conditions and diseases linked to obesity in childhood and later in life too (the metabolic syndrome, type 2 diabetes mellitus (T2DM), sub-clinical inflammation, polycystic ovarian syndrome, hypertension, dyslipidemia, and coronary artery disease). Interestingly, prevalence of the metabolic syndrome was 35.2% among overweight Chinese adolescents. Presence of central obesity (high waist-to-hip circumference ratio) along with hypertriglyceridemia and family history of T2DM increases the odds of T2DM by 112.1 in young Asian Indians (< 40 years). Further, overweight children tend to have a poor body image and low self-esteem, which could interfere with their learning and may result in depression. Therapeutic lifestyle changes and maintenance of high levels of physical activity are most important strategies for preventing childhood obesity. Parental initiative and social support are necessary to bring about changes. Governmental control of “calorie-dense junk foods” and audiovisual advertisements of such junk foods through legal and policy initiatives are urgently required in many developing countries. Effective health awareness educational programs for children should be immediately initiated in developing countries following the successful model program in India (project “MARG”).