CHILDHOOD OBESITY: IMBALANCE OF ENERGY EQUATION

Over the last two decades, consistent upward trends in obesity have been reported not only among

adults but also among adolescents and children. This is becoming one of the most important public health issues.

Obesity is a chronic, lifelong disease, therefore there is a greater need to identify preventive strategies. In the

simplest terms, obesity results from a positive imbalance in the energy equation in which energy intake exceeds

energy expenditure, leading to accumulation of energy stores over a period of time, resulting in weight gain.

Dietary intake and physical activity are the modifiable aspects of this balance equation.

We planned to study the role of energy intake (dietary consumption) and energy expenditure (physical

activity).

More than 600 school children aged 9-12 years were screened: thirty-six were found to be obese

(weight for height > 95th centile of NCHS standards). Among the obese group the average daily caloric intake

was 2400 calories of which 1/3rd calories were from snacks, while the controls (age and gender matched children

of the same class) had an intake of 1800 calories of which 1/4th of calories were from snacks: this was highly

significant. Obese children were spending 2 hours on various physical activities both at home and school,

whereas the controls were spending 2-1/2 hours, a difference which was statistically significant. The mean

energy expenditure was 900 calories for the obese children, and 1200 calories for the controls; thus the obese

children had a positive balance of more than 2 ½ times the calories than non-obese children (1500 vs. 600

calories). This appears to indicate that the increasing prevalence of childhood obesity in recent decades is

probably as a result of environmental changes that promote increased food intake and physical inactivity.

Treatment approaches towards obesity in children include family interventions, with education about

nutrition and physical activity, structured exercise and behavior modification. Combining programs to reduce

sedentary behaviors with structured exercise prescriptions along with appropriate dietary prescriptions and

consistent behavior modification serve as promising modalities that are likely to reverse obesity during

childhood and perhaps prevent the onset of adult obesity. Studies have documented that a combination of dietary

intervention with exercise programs enhances weight loss and maintains weight changes better, and thus has

better outcomes than either component alone.

Health care professionals need to emphasize factors within the family, school and community

environments that affect food intake and physical activity levels. They should promote community based

statewide and national campaigns for healthy weight children. Considering the public health ramifications of

obesity, dietary and physical activity lifestyles, primary prevention of this epidemic is not a choice but is

mandatory.