EPIDEMIOLOGY OF

OBESITY
Background

■ One of the most commonest expression of unhealthy diet often combined with lack
physical activity.
■ Indeed we are amidst an epidemic of obesity.
■ Over the past few decades there has been dramatic rise in the prevalence of obesity
throughout the world including India.
■ It is estimated by WHO that globally over 1 billion (16%) adult are overweight and
300 million (5%) are obese.
■ In india prevalence of obesity among women is 12.6% & 9.3% in men. In other words
more than 100 million individuals are obese in India.
 The human phenotype is changing rapidly

Increased body size and fatter body composition

Response to environments that make low demands on

energy expenditure, together with greater energy-
density diets

This change is occurring within one to three generations,

around the world

Not entirely an urban phenomenon, but more pronounced in

big cities
Current scenario: Global &
India
India : Double Burden of Disease

Under nutrition due to Poverty 30 % below BPL

Over nutrition and Obesity 5-7% MIG and HIG Urban area

This is most productive workforce

of the country Academics/Planners/
Administrators/ Professionals

SHOULD BE GIVEN PRIORITY

 Obesity Trends in India : Recent studies: Adults

Author Year Country/ Criteria Prevalence Prevalence

of State used of over- of obesity
Study weight (M/F)
(M/F)
Gopinath et.al 1994 Delhi BMI>25 21.3% (M) INA
33.4% (F)
Singhal et al 1998 Jaipur BMI>25 14.6% (M) INA
6.6% (F)

Asthana et al 1997 Varanasi BMI>25 30.2% (F) INA

Chadha et al 1997 Delhi BMI>25 20.7 (M) INA

32.6% (F)
 Obesity Trends in India : Recent studies

Author Year Country/ Criteria Prevalence Prevalence

of State used of over- of obesity
Study weight (M/F)
(M/F)
Singh et.al 1999 5 Cities BMI>23 50.9% (F)
BMI>25
BMI>27
Vasanthanani 2000 Coimbatore BMI>30 36.0% (M)

Mohan et al 2000 Chennai BMI>25 38.0% (M)

33.1% (F)
Easwaran et al 2001 Coimbatore BMI>25 65.0% (M)
BMI>24 65.0% (F)
Gupta et al 2002 Jaipur BMI>27 24.5% (M)
30.2% (F)
NFHS-II 1998- India BMI>25 8.6% MIG
 Trends in Body Mass Index of Adult Women

Survey Normal (%) Obese (%)

BMI 18.5-25 BMI>25
NNMB (75-79) 48.8 3.4
NNMB (88-90) 46.6 4.1
NNMB (94) 46.3 6.6
NNMB Slum (93-94) 51.7 11.6

Body Mass Index (BMI) is defined as weight (kg)/height²

(m)
Obesity Trends in India : Recent studies
Children

S.No Author Name State/ Prevalence of

country obesity

1.* Umesh Kapil Delhi 8% boys

etal, 2001 (India) 6% girls

2.** Vedavati S etal, Chennai, 6% obese

1998 India

1. * Indian Pediatrics, 2002 May, 17: 449-452

2. ** Indian Pediatrics, 2003 Aug, 40: 775-779.
 Obesity Trends* Among U.S. Adults
BRFSS, 1990

No Data <10% 10%–

14%
*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person
http://www.cdc.gov/nccdphp/dnpa/obesity/
 Obesity Trends* Among U.S. Adults
BRFSS, 1998

No Data <10% 10%–14% 15%–19%

≥20%
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
 Obesity Trends* Among U.S. Adults
BRFSS, 2006

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

What are the determinants of obesity?
■ Obesogenic environment:
– Affluent lifestyle, sedentary home environment, vanishing old family tradition and
cultures, energy rich food, lack of exercise & out door activities.
■ Age:
– Incidence increasing with age till age of 60 due to hormonal and other biological
changes in a body.
■ Gender:
– Females are more likely to prone as compare to male due inherent physiological
factors.
■ Ethinicity:
– Unexplained variation are prevalent in different ethnic groups.
What are the determinants of obesity?
■ Educational level:
– In India it is seen that educated people are more likely to be obese compared to less
educated, as they are more likely to be affluent but in western countries it is revers
as educated people are more likely to be aware and concern about health problems.
■ Income:
– Directly proportional of income in India.
■ Marital status:
– Obesity is more among married people.
■ Parity:
– Women with more parity are likely to be obese.
■ Diet:
– Diet rich in fat, sugar & refined food is responsible for obesity.
What are the determinants of obesity?

■ Smoking:
– Smoking per se reduces obesity by virtue of Nicotine being an anorexic agent.
■ Alcohol:
– Alcohol provides 7Kcal/gm double than the carbohydrate and more over snacks
consumed along with alcohol provide additional calories.
■ Physical inactivity:
– High physical activity is a vital component to keep high fat & obesity under
check.
What are the causes of obesity?

■ Increased energy intake

■ Passive over eating: Physiological hunger & psychological hunger.
■ Binge eating
■ Decreased energy expenditure
■ Metabolic factors: Cushing’s syndrome, hypothyroidism etc.
■ Genetic factors
■ Fetal programming: Barker’s hypothesis
Critical period of obesity
■ Age range of 12 to 18 months
■ Age range of 12 to 16 years
■ During pregnancy
Quantification of Obesity:
■ BMI: weight (Kg)/Height (m)2
■ Waist circumference: 90 cm for men & 80 cm for women
■ Waist-Hip ratio: <0.9 for men & <0.8 for women

Types of Obesity
■ Gynoid / pear shaped: Fat evenly distributed
■ Androd / apple shaped: Fat is deposit centrally or on abdominal region.
 Risk factor for Non Communicable Diseases
Obesity

 Cardiovascular diseases
CAD, CHF, Stroke
 Oesteoprosis  Insulin Resistance and
 Mental Health  Type-2 Diabetes Mellitus
 Psychological  Reproductive disorders
well being  Pulmonary diseases
 Accidents  Gall stone disease
  Cancer- Colon, Rectum, Prostate-Male
Muscloskeletal  Gall stone–bile duct, breast, endometrium
injuries cervix, ovary- Female
 Bone: Joint and skin diseases

Hazards of obesity
 Relative risk of health problems associated
with obesity in developed countries.

Greatly increased Moderately increased Slightly increased

(relative risk (relative risk (relative risk
>>3) ca 2-3) ca 1-2)

Diabetes Coronary heart disease Cancer (breast cancer in

Gall bladder disease Osteoarthritis (knees) postmenopausal women,
endometrial cancer, colon
Hypertension Hyperuricaemia and cancer)
gout
Dyslipidaemia Reproductive hormone
Insulin resistance abnormalities
Breathlessness Polycystic ovary syndrome
Sleep apnoea Impaired fertility
Low back pain
Increased anaesthetic risk
Foetal defects arising from
maternal obesity
High Prevalence of Metabolic Syndrome

(Syndrome X)

Hypertension
Increased
Insulin
Resistance
Central Obesity
Dyslipidemia
Obesity and Mortality

Morbidly obese individuals (more than 200% ideal

body weight) have as much as a twelve fold
increase in mortality
Obesity and Diabetes
As many as 80% of patients with type-2 diabetes
mellitus are obese
Obesity and Diabetes

Mild obesity Two fold risk of Diabetes

Moderate obesity Five fold risk of

Diabetes

Severe obesity Ten fold risk of Diabetes

Indian Scenario : Diabetes

Between 1988 and 2000, there was a

70% increase in the prevalence of
Diabetes
in the city of Chennai

The recent study document a prevalence

of 13% in adults
Life style changes between 1972-
2000 Increase in Sedentary Life
style Decrease Physical activities
Intake of calories remaining same
Increase in Fat intake
Most manual jobs have been replaced by mechanized
jobs
Transportation to school /work place universally by
use of motor car/Bus/Bicycles
Increase in hours for activities :TV viewing/
Role of Physical Activity
According to WHO at least 30 minutes ofcumulative moderate
exercise (equivalent to walking briskly) for all ages plus for
children , an additional 20 minutes of vigorous exercise
( equivalent to running) three times a week .
(These recommendations are basically for
prevention of CHD).
The prevention of obesity may require combination of
both : more Physical Activity and Dietary interventions.
 BMI in relation to morbidity over 18
years
6 Type 2 diabetes
Women Cholelithiasis
Coronary Heart
5
Disease Hypertension

Relative Risk
4

0
<21 22 23 24 25 26 27 28 29 30
Body Mass Index

Willett, Dietz & Colditz, N.E.J.M. 1999. 341, 426-434 Aged 30-55 at
start.
How to prevent?

■ “Most obese people won’t enter treatment, most who

do won’t lose weight and most who lose weight regain it”.
- Stukard
Prevention
■ Universal prevention:
– Targeted towards all the individual in the community irrespective of their weight.
– Measures like health diet, physical activity, shunning sedentary life style forms as
strategy. Nutrition education also plays vital role.
■ Selective prevention:
– High risk individuals are targeted. Adolescent, pregnant, middle aged and those
with sedentary life style consuming high energy food under psychological stress.
■ Indicated prevention:
– Secondary prevention for those with existing problems of overweight & obesity.
How to reduce weight?