172 Asia Pac J Clin Nutr 2008;17 (S1):172-175 Review Article Childhood obesity in Asian Indians: a burgeoning cause of insulin resistance, diabetes and sub-clinical inflammation Swati Bhardwaj MSc 1 , Anoop Misra MD 1,2 , Lokesh Khurana MBBS 1 , Seema Gulati PhD 1 , Priyali Shah PhD 1 and Naval K Vikram MD 3 1 The Center for Diabetes, Obesity, and Cholesterol Disorders (C-DOC), Diabetes Foundation (India), SDA, New Delhi, India. 2 Department of Diabetes and Metabolic Diseases, Fortis Hospital, Vasant Kunj, New Delhi, India. 3 Department of Medicine, All India Institute of Medical sciences, New Delhi, India. Recent data indicate a rise in obesity both in children and adolescents in developing countries. The overall preva- lence of overweight/obesity in urban children in New Delhi has shown an increase from 16% in 2002 to about 24% in 2006-2007. Our recent data show that the prevalence among adolescent children was 29% in private schools and 11.3% in government funded schools. While India already has highest number of patients with type 2 diabetes mellitus (T2DM) globally, rapid rise of obesity in children is the prime reason for increasing insulin resistance, the metabolic syndrome, dyslipidemia, polycystic ovarian syndrome and raised levels of C-reactive protein. Excess body fat, thick truncal subcutaneous fat, and abdominal adiposity are important predisposing fac- tors for development of insulin resistance in Asian Indian children. As compared to other ethnic groups, children with ancestral origin in South Asia manifest adiposity, insulin resistance and metabolic perturbations earlier in life and these derangements are of higher magnitude than white Caucasian children. Since the metabolic syn- drome and obesity track into adulthood, these clinical entities need to be recognized early for effective preven- tion of T2DM and coronary heart disease. Therapeutic lifestyle changes, maintenance of high levels of physical activity and normal weight are most important prevention strategies. Both high-risk surveillance and cost- effective population intervention programs are urgently needed. In this context, we have launched one of the largest program (“MARG”, The Path) to curb childhood obesity in India. Key Words: Childhood obesity, Asian Indians, diabetes, metabolic syndrome, subclinical inflammation INTRODUCTION Obesity has reached epidemic proportions globally. More than 1 billion adults are overweight, and at least 300 million of them are clinically obese. Significantly, obesity is in- creasing rapidly in developing countries undergoing rapid nutrition and lifestyle transition, and it often coexists with under-nutrition. The rising prevalence of obesity in develop- ing countries is largely due to rapid urbanization and mechanization which has led to reduction in the energy expenditure along with an increase in energy intake due to increased purchasing power and availability of high fat, energy-dense fast foods. Obesity is associated with in- creased risk of the metabolic syndrome, type 2 diabetes mellitus (T2DM), hypertension, dyslipidemia, polycystic ovarian syndrome (PCOS), and coronary heart disease (CHD), and some of these metabolic derangements start in childhood. PREVALENCE Nearly 22 million children under the age of five are esti- mated to be overweight worldwide. The calculated global prevalence of overweight (including obesity) in children aged 5-17 y is 10%, and the prevalence varies from over 30% in America to <2% in sub Saharan Africa. Recent trends in Indian population indicate a rise in obesity both in children as well as adults. Almost 38-65% of adult urban Indians in Delhi fulfil the criteria for either over- weight/obesity or abdominal obesity (Table 1). The nation- ally representative data on childhood obesity in developing countries are scarce, with very few reports on the prevalence of obesity among children (Table 2). The prevalence of overweight/obesity in urban children in Delhi has shown an increase from 16% in 2002 to about 24% in 2006. Accord- ing to our recent data, the prevalence among adolescent children (14-17 y) was 29% in private schools and 11.3% in government funded schools in 2006-2007. (Table 3) Corresponding Author: Professor Anoop Misra, Director and Head, Department of Diabetes and Metabolic Diseases Fortis Flt. Lt. Rajan Dhall Hospital, Vasant Kunj, New Delhi 110070, India. Tel: 91-11-4277-6222 (Ext: 5030); Fax: 91-11-4277-6221 Email: anoopmisra@metabolicresearchindia.com Manuscript received 9 September 2007. Accepted 3 December 2007.