|LETTER TO THE EDITOR
|Year : 2014 | Volume
| Issue : 2 | Page : 110
Assessment of obesity in school children
Mahmood Dhahir Al-Mendalawi
Department of Pediatrics, Al Kindy College of Medicine, Baghdad University, Baghdad, Iraq
|Date of Web Publication||6-May-2014|
Mahmood Dhahir Al-Mendalawi
PO Box 55302, Baghdad Post Office, Baghdad
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Al-Mendalawi MD. Assessment of obesity in school children. J Med Nutr Nutraceut 2014;3:110
The study by Dhole and Mundada  on the assessment of obesity in school children was read with interest. The rapidly changing dietary practices and a sedentary lifestyle have led to increasing prevalence of childhood obesity in developing countries recently: 41.8% in Mexico, 22.1% in Brazil, 22.0% in India, and 19.3% in Argentina. Moreover, the secular trends indicate an increasing prevalence rates in these countries: 4.1 to 13.9% in Brazil during 1974-1997, 12.2 to 15.6% in Thailand during 1991-1993, and 9.8 to 11.7% in India during 2006-2009.  Dhole and Mundada  addressed 6.3% prevalence of obesity in their studied cohort. Though such low obesity prevalence compared to those previously reported in India and other developing countries  apparently appeared to be greatly pleasing, I presume that the actual prevalence of obesity in the studied cohort might be higher than 6.3% reported by Dhole and Mundada.  My assumption is based on the presence of three limitations that were not considered by Dhole and Mundada.  These include the followings: (1) Dhole and Mundada  employed body mass index (BMI) to calculate the prevalence of obesity in their study. However, they didn't mention which BMI reference they employed. It is well-known that the prevalence of obesity in a given population can be determined using four different diagnostic criteria namely, International Obesity Task Force reference (IOTF), Center for Disease Control data (CDC2000), World Health Organization reference (WHO) 2007, and national reference. Using different BMI references can result in marked differences in obesity prevalence.  To the best of my knowledge, no Indian sex-specific BMI-for-age references are yet present to be employed in the clinical settings. (2) When defining obesity, BMI has been commonly used as the main criterion. However, it indicates only the nutritional status, whereas body fat (BF) demonstrates the real body composition picture. There is an inconsistency between BF% and BMI as well as age- and gender-dependent variations of BF% in normal weight and obese children. Asian populations were found to have a higher BF% at a lower BMI compared to Caucasians. Generally, for the same BMI, their BF% was 3-5% points higher compared to Caucasians. For the same BF%, their BMI was 3-4 units lower compared to Caucasians. The high BF% at low BMI can be partly explained by differences in body build, i.e. differences in trunk-to-leg-length ratio and differences in slenderness. The differences in muscularity might also contribute to the different BF%/BMI relationship.  (3) Indian population is polygenetic and is an amazing amalgamation of various races and cultures. Dhole and Mundada  didn't mention in their study the ethnic groups of their studied cohort. This is important to be considered as significant differences in BMI among different ethnic groups do exist.  Hence, for comparisons of obesity prevalence among ethnic groups, universal BMI cut-off points are not appropriate. Finally, despite the aforementioned limitations, the recommendations presented by Dhole and Mundada  are tentative to impede further rise in the prevalence of childhood obesity in India.
| References|| |
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