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Chapter Chapter Chapter Chapter VVVV
LIFESTYLE DISEASES AND OBESITY:
AN OVERVIEW OF KERALA
Contents
5.1 Lifestyle Diseases in Kerala
5.2 Obesity and its Consequences
5.3 Childhood and Adolescent Obesity
5.4 Obesity in Kerala
5.5 Causes of Childhood and Adolescent Obesity
The changing environments and lifestyles have tremendous impact
on the new restless world of human life. WHO (2010) reports that as
world’s population ages, gets richer, smokes more, eats more and drives
more, non- communicable diseases will become bigger killers than the
infectious ones over the next 20 years. World Health Statistics (2008)
shows that AIDS, tuberculosis, neonatal tetanus and malaria will become
less important causes of death. Heart diseases, cancer, stroke, diabetes and
traffic accidents claim greater percentages of victims (Mcneil, 2008).
The world today is threatened not only by the traditional diseases
but also by a host of new lifestyle related disorders like diabetes, obesity,
asthma and cardiovascular diseases.
Lifestyle diseases are diseases that appear to become ever more
widespread as countries become more and more industrialized. These
diseases are different from other diseases because they are potentially
preventable and can be lowered with a change in diet, lifestyle,
environment etc. (www.naturalhealth perceptive.com). The onset of these
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diseases is insidious; they take years to develop and once encountered do
not lead themselves easily to cure.
Lifestyle diseases are permanent and require long periods of
excessive care and hence they are termed chronic diseases by medical
practitioners, which are putting pressure on the health care system. If
uncurbed, a new generation of 'diseases of comfort' (those chronic diseases
caused by obesity and physical inactivity) will become a major public
health problem in this and the next century (Choi et al., 2005).
Drastic changes in our diet; food intake and energy expenditure
increased the level of metabolic diseases such as diabetes and obesity
leading to cardiovascular diseases (Gluckman and Hanson, 2006). Chronic
diseases such as heart diseases, stroke, cancer, diabetes, and chronic
respiratory diseases are responsible for more than 60% of death globally
and are projected to account for 47 million deaths annually in the next 25
years (Akhil TandulWadiker, 2004). India faces a double burden on the
health front. Communicable diseases (CDs) such as tuberculosis and
malaria are still rampant. Meanwhile, chronic lifestyle related or non-
communicable diseases (NCDs) have emerged as an even bigger hazard
(Mohan, 2008). Migration for business, globalization of culture and
civilization, processed food consuming habits, semi-cooked and unsuitable
food system etc. cause the occurrence of lifestyle diseases (Rajan M, 2012).
Lifestyle diseases are the outcome of an in inappropriate
relationship of people with their environment. In the second half of the 20th
century, people’s diet changed substantially with the increased
consumption of meat, dairy products, vegetable oils and alcoholic
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beverages and with the decreased consumption of starchy staple foods.
These changes along with lifestyle changes such as large reduction of
physical activities, smoking etc. have resulted in high prevalence of these
diseases. The top ten lifestyle diseases are Alzheimer’s, Arteriosclerosis,
Cancer, Cirrhosis, Chronic Obstructive Pulmonary Diseases (COPD),
Hypertension, Diabetes, Heart Diseases, Nephritis and Stroke. The
combination of four healthy lifestyle factors, mainly maintaining a healthy
weight, regular exercise, healthy diet and non-smoking seem to be
associated with as much as an 80 per cent reduction in the risk of deadly
chronic diseases (Lekshmi, 2012).
5.1 Lifestyle Diseases in Kerala
Several population based studies and medical records in Kerala
have spotted the prevalence of both non-communicable and lifestyle
diseases in the state. Both of these diseases are spreading and causing death
in Kerala (Malayala Manorama Daily, 2011b). Though Kerala succeeded
to a great extent in reducing the vagaries of major public health diseases
like small pox, filaria and malaria, the diseases like respiratory infections,
acute diarrhoeal diseases etc are pausing challenges to the society and
health sector. Among the chronic illnesses, hypertension, diabetes and
cardio vascular diseases are emerging as serious health problems.
Sedentary lifestyle, lack of physical activity and obesity increase the risk of
chronic diseases (Gangadharan, 2007).
The lifestyle of the population changed a lot mostly in the 19th and
20th century. These changes are not always for the good. The unhealthy
living condition along with a change from traditional dietary habits,
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coupled with a sedentary lifestyle has made man vulnerable to lifestyle
diseases (Padmakumar, 2007). Lifestyle diseases are increasing both in
urban and rural areas. Modern consumption pattern and reduction in
physical activities are the reasons behind these problems in Kerala
(Johnson, 2012). Lifestyle diseases and obesity are increasing among the
police (Malayala Manorama Daily 2010a). Entrance and spread of lifestyle
diseases make a major challenge in the health sector of Kerala (Malayala
Manorama Daily 2011c).
The demographic and health transition in Kerala have been
remarkable and follow a pattern similar to the advanced countries. But the
transition from traditional illness pattern to modern neo-plastic diseases has
substantially increased the public health care burden (Asokan, 2009).
The prevalence of lifestyle diseases among children is increasing at
an alarming rate and the physical fitness of these children deteriorated in
Kerala (Joseph et al. 2011).
Report of the Indian Council for Medical Science and Technology
(2010) revealed that the percentage of diabetes, hypertension, overweight
and cholesterol among the population of Kerala are 16.2%, 32.7%, 30.8%
and 56.8% respectively. High prevalence of lifestyle diseases forced the
government of Kerala to implement some measures to control these
diseases. Adoor Prakash, Minister for Health, declared that lifestyle
diseases clinics would be held every week at the primary health centres and
services of specialists would be made available once in a month. Medicines
would be supplied free of charge to those with high blood pressure and
diabetes (The Hindu Daily, 2012).
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In spite of significant achievements in the health sector, the
prevalence of acute diseases and the emergence of the diseases of affluence
even in rural areas create doubts whether changes in the health sector of
Kerala have been quantitative rather than qualitative (Joseph and Padmaja,
2008).
The health situation in Kerala has improved quite a lot. Contagious
infectious diseases have gone down with a few exceptions of epidemics
which could be corrected by better surveillance strategies. Lifestyle
diseases that are coming in a big way should be handled with diligence and
tolerance without negating individual rights (Soman, 2007).
The prevalence of diabetes in urban regions of Kerala such as
Thiruvanathapuram is as high as 16% almost twice the rate of that in
European countries or the United States where body mass index is several
fold higher than in Kerala (Soman et al., 2000).
The increased consumption of high calorie foods and lack of
physical activity among Keralites has taken its toll on public health,
especially among the elderly, in the form of many chronic diseases,
including diabetes mellitus and related metabolic and cardiovascular
disorders (Sreekumaran, 2007). The state of Kerala has the highest
prevalence of coronary artery disease (CAD) among all Indian States with a
rural prevalence of 7.5% and urban prevalence of 12%. In a single medical
college hospital in Kerala there was more than 20-fold increase in
admissions for acute myocardial infarction during the period 1966 to 1988.
This is mainly because of the large number of patients with diabetes,
hypertension and hyper lipidemia in Kerala (Venugopal, 2007).
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Many cancers are related to the diet. Predominant among them are
cancers of the upper aero-digestive tract, oesophagus stomach, large
intestine and breast cancer in women. The role of diet takes special
importance in a state like Kerala which is fast moving towards urbanization
and westernization. We had a predominantly plant based diet and with the
advent of western lifestyle, are moving towards a diet rich in animal
proteins. This coupled with other habits like smoking and alcohol will lead
to an increase in chronic disease burden especially cancer and
cardiovascular diseases (Varghese et al., 2007).
Community based studies have indicated that there is an increasing
trend in the prevalence of hypertension and type -2 diabetes in Kerala. The
prevalence of hypertension ranges from 36.7% to 54.5% and there is no
gender disparity in prevalence, awareness, treatment and control of
hypertension (Zachariah et al., 2003).
The key health achievements in Kerala can be summarized as the
shift in the demographic profile, good life expectancy, low infant mortality
and low fertility rates. Social equity and minimal urban rural difference is
prevailing in the state.
At the same time, the transition in positive energy balance has
simultaneously reflected on the increasing prevalence of all the
cardiovascular diseases and risk factors like hypertension, diabetes,
dislipidemia and metabolic syndrome in Kerala (Thankappan et al., 2006).
Most of the modern fast food items contain dangerous trans fats. By
including fast foods and junk foods in the diet, Keralites invite lifestyle
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diseases like obesity, high blood pressure and diabetes (Deepika Daily,
2012).
5.2 Obesity and its Consequences
Overweight and obese individuals are at an increased risk of
hypertension, hypercholesterolemia, type 2 diabetes, coronary artery
diseases, congestive heart failure, stroke, gallstones, gout, osteoarthristis,
obstructive sleep apnea and other respiratory problems, pregnancy
complications, poor reproductive health and psychological disorders
(Morrill and Chinn, 2004). In developed countries more people become ill
from being overweight and eating rich diet (Ash, 2008). Obesity is the
most common nutritional disorder in the western world. There is no magic
cure for obesity but you can achieve a lower healthier weight by increasing
your level of physical activity and reducing your intake of calories
(Mcwhirter and Clasen, 1996). The only region of the world where obesity
is not common is sub Saharan Africa (Haslam and James 2005). WHO
reports that obesity is increasing world-wide. There are around 50 crores
people who are overweight world-wide. This problem is spreading from
developed nations to developing nations like tsunami. 10% of total medical
expenditure is spent for treating obesity related problems world wide
(Malayala Manorama Daily, 2011). U.S health secretary declares that the
country is spending $15000 crores per year to solve the problem of
overweight and obesity and that one third of adults are overweight there
(Malayala Manorama Daily, 2009).
Obesity increases the diseases burden. The morbidity associated
with obesity is given in the following table.
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Table 5.1
Morbidity Related to Obesity
Disease Proportion (%)
Hypertension 24
Myocardial Infraction 14
Angina Pectoris 21
Stroke 26
Venous Thrombosis 8
Type II Diabetes 24
Hyperlipidemia 08
Gout 20
Osteoarthritis 12
Gall bladder disease 14
Colorectal cancer 05
Breast cancer 03
Hip fracture 04
Source: Elizabeth, KE, (2007). “From the marasmic to obese”, in CC. Kartha (ed.),
Kerala fifty years and beyond, Gautha Books, Thiruvananthapuram, p.381.
Obesity results from the interaction of economic and non-economic
factors. The following chart highlights the theoretical factors that affect the
incidence of obesity and its potential impact on chronic diseases.
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Obesity: Incidence and Impact
Source: Asfaw, Abay (2006), “The effects of obesity on Doctor-Diagnosed Chronic
Diseases in Africa: Empirical results from Senegal and South Africa”, Journal of Public
Health Policy, Vol.27, No.3, pp.250-264.
Technological progress, international trade agreements and
urbanization etc have altered income levels and the relative prices of
different food items. As income changes, consumers may switch from the
Obesity
Education, Risk, Test, Culture
Food Policy
Chronic diseases
Technology Globalization Trade Urbanization
Income, food processing &
Marketing, Relative prices
Consumption (Energy
intake, diet quality)
Energy Balance
Physical Activity
Opportunity
cost of time Environment Technological
progress
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consumption of cereals and staples towards energy dense food items such
as oils, fats, sugar and other salty processed food items. Globalization and
urbanization also affect the consumption style and physical activities of
households. The impact of these factors on the incidence of obesity
depends on the nature of individuals and households: education, risk taking
behaviour, cultural and religious factors etc. Obesity constitutes a major
risk factor for chronic diseases and may affect the health of individuals
with huge subsequent direct and indirect costs.
The obese people are discriminated at home, in education,
employment, social circle and are considered as lazy, gluttonous, adamant
and wicked (Sharan, 2009). Weight control is a very important aspect of
heart disease prevention as it prevents high blood pressure, elevated blood
fat levels and diabetes (Padmavati, 1990). A health survey conducted by
Indian Defence Ministry and Indian Council of Medical Research revealed
that 30 per cent of Indian soldiers are overweight. Majority of them are
suffering from obesity, high blood pressure and cholesterol (Rashtra
Deepika Daily, 2011).
5.3 Childhood and Adolescent Obesity
Traditionally, an overweight child was considered attractive and
often referred to as a healthy child. However, the adverse and serious health
consequences of childhood and adolescent obesity are now proven beyond
doubt. An epidemic of childhood obesity is sweeping both the developed
and developing countries, with US leading all nations.
According to the World Health Organization, globally, 10% of
school children between 5 and 17 year are overweight or obese
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(www.who.int/mediacenter/news/releases/2004/pr.81/en). In the USA,
25% of children aged 10 to 16 years are affected by overweight (Janssen ,
2005). In Europe, the prevalence of overweight and obesity in children
aged 7 to 11 years ranges from 10% to 35% (Lobstern and Frelult, 2003).
Childhood obesity is not an immediately lethal disease itself but has
significant risk factors associated with a range of serious non-
communicable diseases in adolescents and childhood (Chandla et al.,
2009). Childhood obesity is a significant public health problem that causes
a wide range of serious complication and increase the risk of pre-mature
illness and death later in life (Onis, 2009). Obesity in children appears to
increase the risk of subsequence morbidity, whether or not obesity persists
into adulthood (Must et al. 1992). Obesity is a major health issue in the
United States and around the world impacting both children and adults
(Odgen et al., 2008). Logically, increasing childhood obesity leads to
increasing adult obesity. Obese children are much more likely than normal
weight children to become obese adults. Obesity even in very young
children is correlated with higher rates of obesity in adulthood (Anderson
and Butcher, 2006).
Obesity in adolescents results in a reduced health-related quality of
life, similar to that of those diagnosed with cancer (Schwimmer et al.,
2003). Obesity also entails co-morbidities that were previously thought to
be reserved for adults, including sleep-associated breathing disorders,
occurring in more than 90 per cent of obese adolescents; fatty liver diseases
and non-alcoholic steatohepatitis in up to 53 per cent of obese adolescents,
potentially progressing to necrosis and cirrhosis or hepatocellular
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carcinoma: metabolic syndrome with insulin resistance, hypertension,
hyperlipidaemia (43%) and type II diabetes (29%); and many orthopedic
problems caused by the excess weight (Wess et al., 2004). The severe co-
morbidities and complications result in obese adolescents suffering
severely increased rate of premature death in early adulthood (Bjorge et al.,
2008).
Childhood and adolescent obesity is not limited to developed
countries. It is seen in developing nations too (Popkin and Doak, 1998). In
India urbanization and modernisation has been associated with adolescent
obesity (Yadav and Krishnan, 2008).
Children nowadays have no time for sports and games. All their
time is taken up by academics. They spend their free time in front of the
TV or computer. With the easy availability of calorie-rich junk foods, food
habits also have gone from bad to worse. No wonder childhood obesity is
increasing in prevalence, and along with it, childhood type 2- diabetes
(Unnikrishnan and Mohanan, 2008).
Childhood obesity is a major worldwide epidemic. The
consequences of overweight and obesity among children will be the
development of type 2 diabetes in children. Overweight in children and
adolescents are generally caused by lack of physical activity and healthy
eating patterns (Rao and Viswanathan, 2008).
5.4 Obesity in Kerala
The increased purchasing power and affluence among the people of
Kerala during the last few decades have tremendously influenced their food
habits. Rapid westernization, change in the lifestyle of people, dramatic
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change in the dietary patterns and decline in physical activities of the
Keralites have thrown Kerala into the epidemic of obesity and overweight.
From the mid thirties of age to the early fifties of age, significant
populations have their BMI rising towards 25. This clearly brings the onset
of obesity even in rural population in Kerala. This has serious bearing on
the public health sector; productivity will decrease and more and more
people are likely to develop lifestyle diseases like diabetes, hypertension
and coronary artery diseases at an early age (Varghese and Vijayakumar,
2008).
A study conducted in Thiruvananthapuram reveals that overweight
and obesity is 18.3% among children (Ramesh, 2010). The proportion of
overweight children increased considerably in Ernakulam district, Kerala
during the period from 2003 to 2005 (Manuraj et al., 2007). Indian
Academy of Pediatrics, Kottayam suggested that people should understand
the dangers of overweight and obesity and should make necessary changes
in their lifestyle to keep away the epidemic of obesity (Malayala
Manorama Daily, 2012). Childhood obesity is the gateway to many
lifestyle diseases like diabetes, heart diseases, cancer, high cholesterol etc
(Grishma, 2011). Moreover a survey conducted in 2005 revealed that
people above the age of 35 in Kerala suffer from many lifestyle diseases
and overweight. Around 34% to 54% of the people in the above age group
suffer from the problem of overweight (Johnson, 2012a). While analysing
the causes of obesity, Sivasankaran focused on the impacts of three aspects
of the dietary pattern on the health of Keralites. The traditional Kerala diet
has transformed into energy dense, refined and civilized multi-cuisine
delicacy. The nutrition of Keralites is now that of over nutrition in terms of
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significant positive energy balance. Thirdly, the response of Keralites is
one of maladaptation, many becoming obese, while others remain as
metabolically obese individuals with weight in the normal range
(Sivasankaran, 2007).
5.5 Causes of Childhood and Adolescent Obesity
The increase in childhood obesity has gained full attention of health
care professionals, health policy experts and parents. All are concerned
that today’s overweight and obese children will turn into tomorrow’s
overweight and obese adults, destined to suffer from all the health problems
and health care costs associated with obesity. There are several
contributing factors to the development of obesity in childhood and
adulthood including poor nutrition, lack of physical activity, home and peer
influences as well as socio economic factors (Raspa et al., 2010). In India,
under nutrition attracted the focus of health workers, as childhood obesity
was rarely seen. But over the past few years childhood obesity is
increasingly being observed with the changing lifestyle of families (Singh
and Sharma, 2005). Parental lifestyle including time spent with children
and work commitments have a strong influence on dietary intake and
children’s weight (Jackson et al. 2005).
The rise in overweight and obesity rates across the globe has been
so rapid that it can not be attributed to genetic factors alone (Gulati, 2003).
Diet is what we eat and nutrition is what the body absorbs but the outcome
depends on how the body reacts. The traditional eating habits with good
physical activity are ideal. But modern unhealthy eating habits and
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sedentary lifestyle provide positive energy balance which is the main
reason of obesity especially obesity among children & adolescents.
5.5.1 Positive Energy Balance
The primary cause of childhood obesity must be due to changes in
energy balance. Weight is gained when energy intake exceeds energy
expenditure (Anderson and Butcher, 2006a). Physiologically, obesity can
only develop if food consumption is high and energy expenditure is low,
resulting in positive energy balance across months or years. A positive
energy balance of 10% can lead to approximately a 13.5 kg increase in
body weight within a year (Bray, 1987). The two important components of
energy balance are energy intake (Consumption) and energy expenditure.
5.5.1.1 Energy intake or Consumption pattern
Deviations from traditional micro-nutrient rich food is one of the
reasons responsible for over nutrition leading to obesity. Traditional dietary
patterns got easily contaminated by the refined energy dense, oily products
which are poor in micro-nutrients and dietary fiber (Sivasakaran, 2007a).
Children’s dietary habits have shifted away from healthy food (such as
fruits, vegetables, whole grains etc.) to a much greater reliance on fast food,
processed food, snacks and sugary drink. Children who regularly consume
more calories than they use will gain weight. Consumption of just 100
calories above daily requirement will typically result in a 10 pound weight
gain over one year (Lakshmipathy, 2010). Most of the carbohydrate food in
modern times have been processed and refined so that we do not receive
them in their natural state (Bloom, 1982). Man is now forced to take food
not because he is hungry but because food is available or it is part of
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socialization. Now every event is centered round food. The deep frying
technique and reuse of oil and reheating of foods stored in refrigerator will
increase oxidative stress and will lead to early ageing and unmasking of
metabolic syndrome. Increased supply of cheap, palatable energy dense
foods coupled with better distribution and marketing had led to passive
over consumption (Walker, 2011). Our irrational eating habits and over
eating invites obesity on the one side and micro nutrient malnutrition on the
other.
One of the important causes of positive energy balance among
children is fast food consumption. Cross-sectional studies have established
that individuals consuming fast food meals have higher energy intake with
lower nutritional values than those not consuming fast food (Sahasporn,
2003). Today, over one billion adults world-wide and almost 18 million
children under the age of 5 are overweight indicating a trend linked to fast
food consumption (Jeffery et al., 2006). There is a possible mechanistic
link between fast foods, energy density and obesity (Jebb, 2003).
Prevalence of overweight and obesity is high among the children of
working mothers. The main reason for this problem is that children of
working mothers eat more fast food than the children of non-working
mothers (Malayala Manorama Daily, 2011a). Padmavathi suggests that the
government should regulate fast food culture, which, she says is one of the
prime reasons for many lifestyle problems (The Hindu Daily, 2009).
Another frequently studied source of energy is soft drinks. As with
fast food, studies generally establish that drinking these beverages results in
higher overall energy intake. Buying a 600 ml bottle of cola on the way
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from school has become routine for children. Research has proved that a
glass of fizzy soft drink is nothing less than a killer assault on the body
(Lall, 2009). There is a positive link between overweight and soft drink
consumption (Ludwig et al., 2001).
Another much studied source of energy intake is snacks. Snack
foods such as potato chips are available around the corner, in a variety of
flavors and sizes to suit everyone’s palate and pocket (Gulati, 2003a).
Snack foods are often densely caloric, prepared, processed and packaged
foods (Nielsen et al., 2002). A significant and positive relationship
between Energy Dense Snack (EDS) food consumption and television
viewing is found to exist among 8 to 12 year old girls (Phillips et al., 2004).
5.5.1.2 Energy Expenditure
The other equally important side of energy balance is energy
expenditure both through physical activity and through dietary
thermogenesis and the Basal Metabolic Rate (BMR). Dietary
thermogenesis refers to the energy required to digest meals, and the basal
metabolic rate refers to the energy required to maintain the resting body’s
functions. Several studies examine the link between physical activity and
BMI. Increased hours of sedentary activities such as television viewing
have been linked positively with childhood overweight (Gable and Lutz,
2000). 19% of children who spend more than two hours a day in front of a
screen are overweight, compared to 15% of those children who do so for
less than one hour per day (Fisher et al. 2006). The Report of Cardiological
Socity of India revealed that obesity, unhealthy eating habits and modern
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lifestyle increase the risk of heart problems in India (Malayala Manorama
Daily, 2009a).
The reductions in television viewing could have a positive effect on
physical activity, which in turn could possibly increase the likelihood of
decreasing childhood obesity (You and Nayga, 2005). Watching TV is
sedentary, and reduces available playtime. Moreover, each year it exposes
child viewers to an average of 40,000 advertisements, many promoting
junk food and fast food. In short, the more watching of television by
children, more likely they are to be overweight (www.kff.org/entmedia/
7030.cfm). It is found that an additional hour to television per day
increased the prevalence of obesity by 2 per cent (Dietz and Gortmaker,
1985). They note that television viewing may affect weight in several ways.
First, it may squeeze out physical activity. Second, television
advertisements may increase children’s desire for, and ultimately their
consumption of energy dense snack foods. Third, watching television may
go hand in hand with snacking, leading to higher energy intake among
children watching television. Video games also are more likely to make one
obese (Manuraj, 2008). Unsafe neighborhoods and limited access to
recreation areas in some urban environment discourage leisure time
physical activities (Pucher and Dijkstra, 2003). Breast feeding is not only
good for children but also for mothers. It reduces 500 calories of feeding
mothers daily. It also prevents the onset of type-2 diabetes (Malayala
Manorama Daily, 2010).
Modern marketing strategies also do not adhere to the principles of
social responsibility and marketing ethics. The young and ambitious
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advertising executives resort to striking campaigns to increase the sale of
their unhealthy products without considering their negative impact on the
consumers. Unfortunately, some school officials relay on food marketing
in schools for revenue for school programs. Concern about food marketing
tactics and pressure they exert on decision making of children about food
purchases are highlighted in many studies (Dixon et al., 2006).
Another factor responsible for obesity is the increased value of time
especially for working mothers. More women are entering the formal
labour force; they have less time to spend for preparing food and as a result
there is an increased substitution of convenience foods; also there is an
increased demand for unsupervised after school activities for adolescents.
It changed the leisure time activities of adolescents and children (often,
with an increased number of hours spent watching TV and playing video
games neither of which require much or any physical exertion).
In short, the major factors which have contributed to positive
energy balance of children and adolescents are: (a) Deviations from
traditional micro-nutrient rich and home made food. (b) Over consumption
of calorie-rich junk food, fast foods, fried items, soft drinks and snack
foods. (c) Deep frying technique, re use of oil and reheating of foods stored
in refrigerator. (d) Inadequate level of physical activity, lack of exercise
and low aerobic fitness. (e)Availability of Television from 1982 as source
of cheap indoor entertainment dramatically reduced the recreational energy
expenditure. (f) The technological revolution, urbanization, the economic
boom and liberalizations have brought down the transport energy
expenditure of children in modern times. Moreover, due to unsafe roads,
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children are discouraged from walking or cycling to school. (g) Increased
focus on academic excellence reduced physical education hours and drill
periods at school. The intense competition for admission to schools and
colleges with flourishing tuition classes right from nursery classes force the
children to forgo their play time for additional studies. (h) Unsafe
neighborhoods and improper urban and town planning discourage leisure
time physical activities.
5.5.2 Genetics or Heredity
Heredity has recently been shown to influence fatness, regional fat
distribution and response to over feeding. Genetics also plays a big role in
developing obesity. Recent studies have concluded that about 25 to 40
percent of BMI is heritable (Anderson and Butcher, 2006b). A child with
an obese parent, brother or sister is more likely to become obese (Rao et al.,
2010). The result of several studies suggests that the very fact of a women
being obese during pregnancy may predispose her children to obesity
(Judson, 2008).
5.5.3 Medical, Social and Emotional Factors
Obesity may follow due to damage to the hypothalamus after head
injury because it is not able to regulate appetite. Endocrine factors may
also contribute to obesity. Obesity is common at puberty, pregnancy and
menopause. Several studies have shown an association between depression
in children and development of obesity (Chandla et al., 2009a).
Prevention of obesity from childhood and adolescents and
appropriate early intervention is a simple and feasible solution for obesity
that is creeping up in global pandemic proportions.
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