*5.8.2 Orthopaedic*

The most serious orthopaedic disability associated with childhood obesity is slipped capital epiphysis of the femur. Blount disease is another disorder that has

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*Obesity in School Children in India*

common [83].

*5.8.3 Psychosocial*

*DOI: http://dx.doi.org/10.5772/intechopen.89602*

disorders which further worsen their obesity [104].

**6. Interventions to tackle obesity in school children**

a strong association. About 50–80% of children with Blount disease are obese. Minor problems like flat feet, knock knees and frequent ankle sprains are also more

Obesity is described as 'one of the most stigmatising and least socially acceptable

conditions of childhood'. [103]. Not surprisingly, low self-esteem and poor body image adversely impacting scholastic performance are common in obese children. They are bullied and excluded from group activities, especially sports and games, because they are slower and less agile. They get marginalised and withdraw from society. This makes them more sedentary and also predisposes them to eating

The plateauing of BMI of children and adolescents in high-income countries may be due specific initiatives by governments, community groups, schools and individuals and increased public awareness about the hazards of childhood obesity. Findings from the i3C study identified obesity, hypertension and dyslipidaemia as the three key modifiable factors in childhood that result in high cIMT in adulthood. All can be addressed effectively by lifestyle modification and medication. Obesity is easily apparent but difficult to treat on a sustained basis due to a variety of reasons. Hypertension and dyslipidaemia are more difficult to identify due to confusing cut-offs and multiple guidelines. Lifestyle modification is easy to suggest but difficult to implement. Care-givers and parents lack sufficient knowledge about dietary modifications and exercise programmes to advise children. Depression, low self-esteem, lack of peer and parental support and rebellious nature of adolescents make implementation of lifestyle changes difficult. Thus, a multi-modal approach to childhood obesity is required. Even modest loss of weight can lead to significant reduction in TG levels and increase in HDL-C levels. Even without weight loss,

regular exercise training can have the same effect on serum lipids [105].

lastly treating obese children to improve their current and future health.

There is enough evidence to support the fact that undernutrition during pregnancy, excessive weight gain during pregnancy, hyperglycaemia during pregnancy and smoking and exposure to other toxins increase the risk of obesity in the child during infancy and childhood. Even obesity in fathers can increase risk of obesity in the child through epigenetic factors. Ensuring good health during pregnancy and a safe delivery are both important for the child's health. The WHO guidelines include dietary advice to prospective parents before conception and during pregnancy, avoidance of smoking, alcohol and other toxins. Early detection of gestational diabetes and hypertension, monitoring and managing gestational weight gain are other important measures suggested. Ensuring that the baby is exclusively breast-fed during the first 6 months of life and that breast feeding is continued even after complementary feeding is started are important to prevent malnutrition and deposition of excess fat in the baby. The magnitude of the gap between policy and implementation can be gauged from the Indian NFHS 2015–2016 data which show that despite recommendations for exclusive breast feeding up to an age of 6 months, only 55% of Indian infants were actually

The WHO has included tackling childhood obesity as one of its priority areas. It has suggested a three-pronged strategy: reducing the risk of obesity by addressing critical elements in the life course, tackling obesogenic environment and norms and a strong association. About 50–80% of children with Blount disease are obese. Minor problems like flat feet, knock knees and frequent ankle sprains are also more common [83].
