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Countries of
the world are currently in different
stages of demographic and developmental
transition. The pace of this transition
has been particularly marked in recent
times. Changes in dietary practices,
physical activity levels and lifestyles
associated with rising affluence
contribute to increasing prevalence of
overweight/obesity in all the age groups
of society. Obesity can be seen as being
the tip of the iceberg of a defined
cluster of noncommunicable diseases (NCDs)
which are observed both in developed and
developing countries. There is a
disturbing escalation in these chronic
degenerative diseases such as NIDDM, CVD,
hypertension and certain types of cancers.
It is imperative that we curb the
escalation of obesity before it emerges as
the single most important public health
problem.
The
Foundation had carried out a study on this
issue with the following objectives:
- To
assess the prevalence of obesity in
adult males and females, belonging to
different socio-economic groups in
urban Delhi by using the criteria of
BMI and waist-hip ratio.
- To
determine the severity and type of
obesity in men and women.
- To
assess metabolic aberrations with
respect to blood pressure, blood
glucose and insulin and blood lipid
profile in obese subjects.
- To
compare the prevalence of
obesity/overweight in different income
groups.
- To
investigate the effects of the
lifestyle factors including, dietary
practices and occupation pattern, on
prevalence and nature of obesity.
- To
identify factors which provide
practical leads for the control of
pattern of obesity.
The study
made an attempt to capture fairly
representative segments of the middle
class and of the poor in urban Delhi. It
was carried out in two locations:
- A large
office establishment employing several
hundreds of people, drawn largely from
what may be termed the 'middle class'
consisting of officers (high-income),
clerks (middle income), and
peons/attendants (low-income).
- A slum
in Delhi inhabited mostly by poor,
unorganised labour, the slum being
typical of numerous others in Delhi
and its environs.
Techniques
of Data Collection
The techniques used for data collection
for the study included:
- General
details of the subject/family.
- Anthropometric
measurements.
- Assessment
of physical activity pattern by
physical activity pro forma.
- Dietary
survey by food frequency pro forma
(dietary information) and menu recall
(dietary recall).
- Blood
pressure measurements.
- Haemoglobin
estimation.
- Biochemical
analysis (including estimations of
serum lipid profile, serum insulin and
sugar level).
- ECG
Results
A striking difference in the
prevalence of overweight between the
middle class and the slum dwellers was
found, clearly showing how, with the
ascent in the socio-economic scale, the
overweight problem worsens. Thus, as
against the prevalence rate of overweight
of 1 per cent for males and 4 per cent for
females in the slums, the corresponding
figures for the high-income group among
the middle class were 32.2 per cent and 50
per cent. More females than males were
found to be overweight in all age groups
in both locations. It was found that the
prevalence of overweight/obesity was
higher in the age group >40 years. The
prevalence of obesity (BMI>30) is about
3 per cent in males and about 14 per cent
in females above 40 years.
The
prevalence of abdominal adiposity in the
subject of this study was higher than the
prevalence of overweight/obesity
(BMI>25). When all subjects of the
middle class were considered together,
abdominal adiposity was found in 49.7 per
cent of males and 34.9 per cent of
females; on the other hand, the figures
for general overweight (BMI>25) were
19.6 per cent in the males and 44.5 per
cent in females. Abdominal obesity did not
always go hand in hand with
overweight/obesity. Abdominal obesity was
found in 68.1 per cent of males with
overweight (BMI>25) and 58 per cent of
females. In these subjects, greater the
grade of BMI, the greater was the
abdominal adiposity. It was noteworthy
that nearly a third of overweight males
and more than 40 per cent of overweight
females did not show abdominal obesity. On
the other hand, nearly 19 per cent of
non-overweight male subjects with
BMI<25 and 22 per cent females showed
abdominal obesity.
Careful
analysis of bio-chemical findings of the
study showed that higher the tertile
values of BMI, higher were the mean values
for cholesterol, triglycerides, blood
sugar LDL,VLDL and blood pressure.
Similarly, with an increase in the tertile
values of WHR, there was a significant
increase in the mean values of blood
pressure, cholesterol and triglycerides.
Subjects suffering the additive effects of
high BMI were significantly worse. These
observations serve to underline the role
of overweight/obesity and the additive
deleterious effects of abdominal obesity
in the pathogenesis of disordered lipid
and carbohydrate metabolism, leading to
coronary heart disease and diabetes
mellitus (NIDDM). Overweight/obesity may
not be considered a specific 'disease' but
it is certainly the 'mother' of important
degenerative diseases in adult life.
Prevention and control of this problem
must, therefore, claim priority attention.
Scientific
Report number 15, describing the results
of the study, has been published. Some of
the copies of this publication have been
purchased by WHO for distribution.
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