Childhood Overweight and Obesity

What is the prevalence of obesity?

Obesity is rapidly becoming a common problem, especially among urban children. According to the World Health Organization (WHO), there were about 1.6 billion overweight adults aged 15 years and above, and at least 400 million adults are obese worldwide in 2005. It is a serious public health problem that is growing in countries with low or middle income. According to IOTF (International Obesity Task Force), it was estimated that the prevalence rate of obesity could reach 45% to 50% in the USA, 30% to 40% in Australia, England and Mauritius and more than 20% in Brazil by 2025. 

Of note, many developing countries like India, face the double burden of obesity and undernutrition. The worldwide prevalence of childhood overweight and obesity increased from 4.2% in 1990 to 6.7% in 2010 and is expected to reach 9.1% or 60 million, in 2020. Data on the prevalence of overweight and obesity in children & adolescent age group in India is limited.  Several cross-sectional surveys have shown a high urban prevalence of childhood obesity in India and studies done in AIIMS has shown such prevalence to be around 20 per cent among school going children of Delhi.

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Why is it increasing?

The common factors attributed for increasing prevalence of obesity is increased and easy availability of junk food, provision of such food in the school canteen, decreased physical activity, unrestricted TV watching and indoor games, lack of space for outdoor games.

Is there any other cause?

Yes. Other than the common factor of decreased physical activity, there are various endocrinological disorders which can lead to obesity. Usually, these disorders are associated with compromised height, so if any child is not growing in height but have excessive weight, their parents should always meet their endocrinologist as early as possible to prevent from the child from short stature and also to rule out various endocrinological etilogy. There are some genetic disorders of obesity which run in family and early recognition of these can be of help the future progeny.

What if my child is obese?

Obesity could be the root cause of various disorders. Early onset of obesity leads to increased chances of Diabetes among children as early as by 10 years of age. It also increases the chances of hypertension, heart disease, breathing difficulty and poor school performance due to its complication. 

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What can I do if my child is obese?

From the beginning, you should always watch your child`s height and weight and follow the growth chart as suggested by the paediatrician. If you observe that your child is deviating from the growth chart, become alert as there is a good probability that the diet of a child is inappropriate or physical activity is minimal or non-existent. Do not allow your child to watch TV or sit near the desktop screen for more than 2 hours in a stretch and help them indulge in physical activities such as swimming, dancing and many more. Consult your endocrinologist for ruling out endocrinological disorders.

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Cancer Screening - Early Detection is the Best Protection

INTRODUCTION

All of us know that prevention is better than cure and its importance cannot be overemphasized. However, not every disease is preventable and screening provides us with the second best option by catching them early. Although there are various definitions for screening, it can simply be summed up as detecting the disease early in asymptomatic (those without any symptoms) individuals.

SCREENING – WHY AND WHEN?

It is estimated that screening results in mortality reduction ranging from 3 to 35% depending on various factors. Cervical cancer is an excellent example of mortality reduction as a result of screening. Apart from a reduction in deaths from cancer, screening also gives us an opportunity to detect cancer at a stage where minimal treatment is required. For example, very early breast cancer may just require a small surgery and the patient may be able to avoid chemotherapy and radiation therapy completely. Also, most of the screen-detected cancers would require less mutilating operations with much lesser hospital stay and the cost of treatment. However, you must discuss the pros and cons of any screening investigations with your oncologist before having it done.

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SCREENING – HOW?

Screening can be broadly divided into having the following components:

1. Self-examination (wherever feasible)
2. Examination by trained health personnel (clinician or a paramedical staff specifically trained for screening)
3. Appropriate investigations

GENERAL GUIDELINES (for normal risk general population)

High-risk individuals by virtue of their family history, habits or any other risk factor need to be counselled separately and usually require more intense screening methods.

Breast Cancer Screening:

1. Self-examination periodically starting at the age of 20 years
2. Clinical examination 1-3 yearly between 20-40 years and yearly after 40
3. Mammogram every 1-2 years after 40-50 years of age.

Cervical Cancer Screening:

Should begin approximately 3 years after the beginning of vaginal intercourse. It includes pelvic examination every 3 years and Pap smear yearly for three years and, if found normal for three consecutive years, thereafter the frequency can be decreased. If pap smear is combined with HPV DNA testing the frequency of screening can be decreased and it can safely be done every three years

Colon Cancer Screening:

One of the following is recommended for a normal risk individual above 50 years of age:

1.  Colonoscopy (endoscopy of the large intestine) every 10 years
2.  Stool test of occult blood yearly and 5 yearly sigmoidoscopies (only partial endoscopy of the large intestine)
3.  Double contrast barium enema every 5 years

Individuals with family history of colon cancer or personal history of precancerous lesions like polyps (small benign growths in colon/rectum) require the screening to begin at a younger age and done more frequently depending on the level of risk.

Prostate Cancer:

A combination of clinical examination and a serum PSA test (blood test) may be beneficial in reducing deaths for individuals between the age of 55 and 69 years.

Oral Cancer:

Although there are no guidelines for oral cancer screening (largely due to the fact that it is a unique problem of our country and is seen much less in developed), it is a good idea to keep doing monthly self-examination of inside of the mouth for any ulcer, white or red patches and neck for any lump.

CONCLUSION

Screening is an effective tool to diagnose cancers at a pre-clinical stage thereby providing an opportunity to attain high cure rates by using less aggressive treatment options thus improving the quality of life as well.

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KEY POINTS

1. Screening is a strong tool to detect cancer at an early stage
2. Screening has been found to reduce death due to cancer significantly in some cancers
3. It is not cost effective for all cancers and must be done under specialist guidance
4. Individuals at higher than normal risk of particular cancer by virtue of family or personal history require more intense screening
5. Be alert towards warning symptoms/signs (see box) and get an expert opinion on it.

Reference: http://delhi.manipalhospitals.com