Delhi school kids are becoming obese, developing BP: Why AIIMS study is sounding alarm bells

What’s the obesity map?

The prevalence of obesity was much higher in private schools, which reported 24.02 per cent general obesity and 16.77 per cent central obesity, as compared to 4.48 per cent general obesity and 1.83 per cent central obesity in public schools.

Both private and public schools, however, reported similar figures for hypertension at 7.4 per cent. But it found that private school students were twice as likely to have high blood sugar and three times as likely to have metabolic syndrome (a cluster of conditions that precedes diabetes and heart disease), as compared to their other counterparts. What is alarming is the presence of dyslipidemia (abnormal levels of fats in the blood) in children, at approximately 34 per cent. The condition indicates abnormal readings of cholesterol, triglycerides, high density lipoprotein (HDL) or good cholesterol and low density lipoprotein (LDL) or the bad cholesterol.

Private school students had 2.37 times higher prevalence of impaired fasting plasma glucose and 3.51 times higher prevalence of metabolic syndrome than public school students.

What’s the nature of obesity?

Dr M Kalaivani, assistant professor of Biostatistics at AIIMS-Delhi and the principal investigator of the study, explains that metabolic syndrome is identified based on five key factors: blood pressure, waist circumference, fasting blood glucose, HDL or high density lipoprotein (good cholesterol), and triglycerides. If any three of these are abnormal, a child is considered to have metabolic syndrome.

“Among children attending public schools, many had normal weight but were still found to have metabolic syndrome,” she says. “In the future, these children may face health issues related to blood pressure, waist size, blood sugar levels and cholesterol,” she adds.

The thin fat syndrome

Of the 2,160 adolescents, about 68 per cent reported a normal body mass index (indicator of total body fat). However, about 43 per cent of them were still found to be unhealthy — a condition known as metabolically obese normal weight. This does not mean that the children look fat. In fact, they may look skinny but have a high body fat percentage and low muscle mass.

This was more common in public schools (46 per cent) than in private schools (35 per cent). The most common health issue in this group was low levels of good cholesterol or HDL, affecting more public school students (62 per cent) than private school students (53 per cent).

The overall prevalence of underweight children was 4.95 per cent, with a significantly higher prevalence in public schools than private schools.

Why are the findings significant?

Explaining the findings, Dr Nikhil Tandon, Professor and HOD, Endocrinology and Metabolism, AIIMS, and co-principal investigator, says, “A lot of parameters in early life project what will happen in later life. The current obesity might not be causing diabetes now but increase the chances and beget adult obesity. With an increase in non-communicable diseases, obesity is a big factor that we must talk about. Culturally, we have to change our perception. Malnutrition isn’t just about under nutrition but also over nutrition, which is equally bad.”

What’s behind the abnormal readings of students?

While access to junk food is usually associated with the affluent class, what has been overlooked is that even students from lower middle classes are now eating unhealthy food. “What’s happening is that they buy the cheaper and smaller packets of branded processed snacks. Street vendors peddle highly fried food or high sugar food at low prices which students of government schools find pocket-friendly. The quantity becomes more important than the quality of food. On top of it, they are not spending their energy. These children, too, are sitting in one place with a mobile, equally addicted as their private school counterparts. So the screen time has increased. Unspent calories are being converted to fat, which are being deposited around the organs. However, even the percentage of obese students is increasing in public school children,” says Dr Kalaivani.

Why we need changes in diet and exercise

It’s important to make some changes in the mid-day meal scheme, which was conceived at a time when under-nutrition was a public health concern. “For example, increasing protein and fibre in mid-day meals instead of too much carbs, increasing their daily physical activity quota and working out a cellphone use hygiene can help. Educating parents on what food they are giving to their children is also important,” says Dr Kalaivani.

The study was conducted by doctors from endocrinology, cardiac biochemistry and biostatistics departments of AIIMS and funded by the Indian Council of Medical Research (ICMR).