**4. Community/society level factors**

Structural elements like road, transportation, structure of buildings, playgrounds, parks and public spaces influence obesity in children. Research conducted over the past decades provides increasing evidence that there is a direct correlation between easy access to supermarkets laden with cheap and readily available HFSS food and sweetened carbonated drinks and obesity in children. Increased concretisation and loss of public spaces and parks in cities have led to decrease opportunities for sports and a more sedentary lifestyle. Many poorer neighbourhoods are considered unsafe for children because of drug pedlars and predatory adults. Parents prefer to keep their children indoors. Even when they have to go out or attend school, the parents drop them by car. Walking or cycling to school often considered a healthy activity is thus lost [23].

Children are bombarded by commercials of confectionary, chocolates, sweetened cereals and fizzy drinks on TV, billboards and magazines. Celebrity endorsements are a big influence on children. Nothing can be more telling than endorsement of a fizzy drink by a cricketing or football legend. Most cultures also use sweets and food as inducements for good behaviour or rewards. This further reinforces the habit of HFSS food intake.

Some common food myths related to children are shown in **Table 1**.

#### **5. Consequences of obesity in school children**

At least 30% of obesity begins in childhood and 50–80% obese children become obese adults [17]. Obesity is linked to greater and earlier mortality. The GDB collaborator Group found that the lowest overall risk of death was in the BMI range of 20–25 kg/m2 [5]. As in adult metabolic syndrome, hyperinsulinemia is a key to most of the complication of childhood obesity also. Some of the consequences of childhood obesity are enumerated in **Table 2**.

**227**

*Obesity in School Children in India*

Respiratory and sleep

problems Insulin resistance High blood pressure Dyslipidemia Musculoskeletal problems Gall stones Fatty liver

**Table 2.**

**5.1 Hyperinsulinemia**

*Hazards of obesity in school children.*

obese adults is real.

the sexes [61].

**5.3 Childhood diabetes**

**5.2 Paediatric metabolic syndrome**

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

**Physical Psychological Social**

practices

Low self-esteem, increased depressive symptoms and unhealthy dietary

Low participation in social

interaction with peers

Lack of social support due to less

activities

There is an early leaning towards adult South-Asian phenotype in children, probably starting in neonatal period. Hyperinsulinemia and its attendant metabolic perturbations are more common in Asian neonates than in Caucasian ones [56]. Kuriyan and colleagues studied the waist circumference of Indian urban middle-class children between the ages of 6–16 years and found that their waist circumference was more than that of age- and sex-matched British children [57]. About one-third of the urban-Asian children have insulin resistance. The odds for hyperinsulinemia in one study were OR 4.7 (95% CI 2.4–9.4) in overweight children, OR 6.4 (95% CI 3.2–12.9) with high percentage body fat, OR 3.7 (95% CI 1.9–7.3) with high waist circumference, OR 6.8 (95% CI 3.3–13.9) with high waist hip ratio and OR 4.5 (95% CI 1.8–11.3) for sum of four skin-fold thicknesses (Sigma 4SF). Multiple logistic regression analysis showed that percentage body fat and Sigma 4SF were independent predictors of hyperinsulinemia with ORs being 3.2 and 4.5, respectively [58]. This being so, the risk of chubby children becoming

In parallel with increasing prevalence of childhood obesity, the prevalence of paediatric metabolic syndrome, hypertension and type 2 diabetes mellitus are also increasing. Insulin resistance has been clearly been implicated in pathogenesis of hypertension, coronary artery disease and polycystic ovarian syndrome [59]. A study from Shimla in Himachal Pradesh showed prevalence of metabolic syndrome in school children to be 3.3% with odds of having metabolic syndrome being significantly linked to male sex, higher family monthly income, sedentary lifestyle and snacking in the evening [60]. The prevalence of metabolic syndrome in a study by Singh et al. in Chandigarh was 4.2%, and they did not find any difference between

The rise in prevalence of childhood obesity has mirrored the rise in prevalence of type 2 diabetes among children. For a long time, only type I diabetes was associated with childhood. The myth was shattered in 1979, when type 2 diabetes was described in children of Pima Indians. Type 2 diabetes accounts for 80% of childhood diabetes in Japan. The prevalence of type 2 diabetes in Japanese children rose from 0.2 to 7.3 per 100,000 children between 1976 and 1995 [62]. Ehtisham et al. observed that prevalence of type 2 diabetes in white UK children was significantly


**Table 2.**

*Public Health in Developing Countries - Challenges and Opportunities*

**Reality**

Heart disease starts at old age Hardening and blockage of the arteries starts at 11 years in boys and 15 years in girls

HDL-cholesterol

periods in schools.

again later Children by nature are physically active Time on TV, Internet and studies leaves little time for play.

Fat children are not healthy inside. About 28% of fat children have syndrome X. They have a risk for chronic lifestyle diseases

Fat children are at risk of developing early diabetes. Girls may

Children should enjoy being active as such energy will not come

Many do not participate in sports activity in mandatory sports

Many children will have high blood pressure and low

Obesity in children should be viewed with concern

Majority of obese children become obese adults

develop polycystic ovarian syndrome

**Myths related to obesity in school** 

Fat children are healthy, as they are not

With age, children will gain height and

So what, if a child is obese! Obesity is a problem of adults and not of children

Children do not develop high blood pressure or high cholesterol

Childhood will not return

inauspicious

**Table 1.**

Children should eat, drink and be merry.

Observing a child to be fat is considered

**children**

loose fat

undernourished

**4. Community/society level factors**

*Some common myths in India society related to obesity in school children.*

reinforces the habit of HFSS food intake.

hood obesity are enumerated in **Table 2**.

**5. Consequences of obesity in school children**

Structural elements like road, transportation, structure of buildings, playgrounds, parks and public spaces influence obesity in children. Research conducted over the past decades provides increasing evidence that there is a direct correlation between easy access to supermarkets laden with cheap and readily available HFSS food and sweetened carbonated drinks and obesity in children. Increased concretisation and loss of public spaces and parks in cities have led to decrease opportunities for sports and a more sedentary lifestyle. Many poorer neighbourhoods are considered unsafe for children because of drug pedlars and predatory adults. Parents prefer to keep their children indoors. Even when they have to go out or attend school, the parents drop them by car. Walking or cycling to school often considered a healthy activity is thus lost [23]. Children are bombarded by commercials of confectionary, chocolates, sweetened cereals and fizzy drinks on TV, billboards and magazines. Celebrity endorsements are a big influence on children. Nothing can be more telling than endorsement of a fizzy drink by a cricketing or football legend. Most cultures also use sweets and food as inducements for good behaviour or rewards. This further

Some common food myths related to children are shown in **Table 1**.

At least 30% of obesity begins in childhood and 50–80% obese children become obese adults [17]. Obesity is linked to greater and earlier mortality. The GDB collaborator Group found that the lowest overall risk of death was in the BMI range of

of the complication of childhood obesity also. Some of the consequences of child-

[5]. As in adult metabolic syndrome, hyperinsulinemia is a key to most

**226**

20–25 kg/m2

*Hazards of obesity in school children.*
