Indian J Pediatr (September 2014) 81(Suppl 1):S2–S4 DOI 10.1007/s12098-014-1538-9
COMMENTARY
Children Obesity from Global Determinants to Local Consequences: The Indian Perspective Dario Gregori & Achal Gulati & Haralappa Paramesh & Elizabeth Cherian Paramesh & Mohan Kameswaran & Ileana Baldi
Received: 25 June 2014 / Accepted: 7 July 2014 / Published online: 2 August 2014 # Dr. K C Chaudhuri Foundation 2014
Obesity in children is a worldwide recognized epidemic and a global health challenge [1]. Prevalence of overweight in children, indeed, is at high risk in developing chronic pathologies in adult age, especially non-communicable diseases: from diabetes [2] to coronary disorders [3]. Well known, traditional obesogenic factors and genetic determinants of childhoodrelated weight gain [4] have been studied over the last two decades, side by side with the fast growing individual, social and cultural changes of post-modern societies. Among these, the built environment, in particular, has been advocated as one of the principal promoters in co-causing this phenomenon [5]. Especially TV watching and food advertising have been identified as the factors, mostly influencing children’s food choices and consequently their overall eating habits [6]. Such variables are for sure a consequence of the macroscopic transitions, which occurred in Europe about 65 y ago, when, after World War II, the rise in economic conditions of large part of rural and urban areas gave access to a wide stratum of population to a high range of personal choices, living alternatives [7] and new employment opportunities [8, 9]. D. Gregori (*) : I. Baldi Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Via Loredan, 18, 35121 Padova, Italy e-mail:
[email protected] A. Gulati Department of Otorhinolaryngology (ENT), Maulana Azad Medical College, New Delhi, India H. Paramesh : E. C. Paramesh College of Nursing, Lakeside Institute of Child Health, Lakeside Hospital, Bangalore, India M. Kameswaran Madras ENT Research Foundation (P) Ltd. (MERF), Chennai, India
Italy, especially, underwent a consistent cultural and social transition, due to the economic boom of the fifties and sixties [10]. The traditional structure of Italy’s symbolic context changed radically, since big industrial progresses became part of a country, whose economy was principally based on agriculture and small family entertainments [11]. Above all, the northern regions saw a rapid burden of industries, namely the automobile sector in Piedmont, the metal-mechanic production in Lombardy and textile factories in Veneto [12]. Such macroscopic modifications altered permanently not only the landscape, along with an alerting rise of air and water pollution [13], but even more the social representations about infrastructures, technologies and energy sources [14]. As most of industrial concerns are localized in big metropolitan agglomerates, especially the cities of Milan and Turin, a considerable part of Italian rural population moved from the south to the north of the nation [10]. The traditional extended families, living in a same community, were split into essentially nuclear ones, mostly composed of parents with one or maximum two children [15]. Such a condition, along with the expensive life in larger cities, saw the need of dual earners, consequently abolishing the classical role of female caregivers [8]. Lifestyles, costumes, attitudes, interactions and eating patterns have been adapted to the busy realty of urbanized environments. The introduction of new technologies, communication systems and rapid infrastructures, along with a general rise of family income, contaminated Italian culture and society with post-modern expedients, mostly imported from the United States [16]. Somehow similar, the consistent transformation of India’s symbolic and historical background, from a traditional, agricultural based culture to an urbanized and technological advanced society resulted associated with modifications in general lifestyles, including nutrition patterns [17, 18], leisure activities [19] and communication practices [20].
Indian J Pediatr (September 2014) 81(Suppl 1):S2–S4
In particular, cities like Chennai and Kolkata underwent an impressive technological and industrial advancement due to the institution of motor factories, new communication artifacts (computer, mobile phones, etc.) and a general rise in high-tech products turned these metropolises as two of the most blooming realities in South-Asia [21, 22]. Furthermore a re-migration of Indian academics, in particular engineers, from the United States to their homeland contributed to a rapid rise of new employment opportunities [23, 24]. Such a phenomenon also regarded the Italian reality, a country similarly to India, which saw impressive migration waves towards the industrialized societies of northern Europe and the USA [25]. Once returned back, the experiences gained abroad contributed to an economic growth in Italy. In such a perspective, the aim of this scientific cooperation between India and Italy, which has the endorsement and support from the Indian Ministry of Science and Technology and the Italian Ministry of Foreign Affairs, consists in providing a complex and widespread database in order to propose an integrated approach for the understanding of the interaction among different risk factors, promoting obesity and overweight within pediatric population. The present special issue of the Indian Journal of Pediatrics, collects seven inter-discipliner contributions, developed by a pluri-professional team of experts in nutrition related diseases, namely otolaryngologists, epidemiologists, nurses, statisticians and psychologists. Such a poly-scientific pool allowed investigating on the interaction among several structural (cultural and social) [26, 27], functional (behavioral and cognitive) [28, 29], as well as psychological (motivational and emotional) aspects [30], implicated in children’s excessive and unhealthy energy intake, strictly associated to TV exposure [31], marketing campaigns [32], brand awareness [33] and physical inactivity [34]. The experiences gained while carrying out large pan surveys on children’s nutrition disorders in Latin-America [32], contributed to the realization of this challenging research project, focused on understanding how overnutrition could be considered a cultural-specific topic, along with foreign, globalization related variables. Factors concerning mothers’ perception of their children’s weight status [35], public policy themes like the impact of Obstructive Sleep Apnea (OSA), inducing obesity [36], or behavioral patterns involved in appetite mechanisms [37] should be understood as local specific, evidencing the urgent need in modifying some universal statements, promoted up to day by the World Health Organization on a global level. Different quasi axiomatic definitions of diseases result to be obsolete and merely cross-cultural [38, 39], without taking into account the peculiarity of ethnical, social and cultural coordinates, along with their complex intersectionality and interdependence [40].
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The main objective of this research, despite investigating on cross-sectional, non-traditional factors promoting obesity in children, was to propose a local specific perspective of this phenomenon within the Indian Republic, a country whose dimensions do not allow defining overall national standards and health policies. Each paper had been, therefore, specifically focused on a contextual, psychological, as well as physiological driven variable, confronting continuously regional differences among seven Indian major cities, chosen from north to south of this enormous Asian subcontinent. Climatic variations, geopolitical differences, religious pluralism and a high amount of several cultural and social identities makes obesity in Indian children an ever-changing task, which, rather than explained, should be understood in its complexity. What principally emerged out of the research findings, regards the impact of culture and society, less than cognition and genetics, on humans’ consumption habits. Considering, therefore, several socio-demographic determinants, globalization and urbanization processes, along with secular trends and technological advancement, new and more efficient strategies, promoting a progressive reduction of overweight prevalence in Indian children, should be implemented and empowered for preventing more than treating childhood obesity on a local level. Contributions, therefore, not only out of medical and epidemiological sciences, but even more studies realized in economics, sociology, developmental and social psychology as well as anthropology enriched the observation and comprehension processes of approaches to overweight related diseases in Indian kids. This interdisciplinary view, indeed, caught internal and organizational aspects, which hardly would emerge, whether adopting a merely etiological conception, based on linear causeeffect relations. We hope that data and results, as well as methodological and analytical procedures, will contribute for a better understanding of the most recent challenges in research on childhood obesity across the various states of India. Finally, we gratefully acknowledge the help and constant support, along with all the precious and indispensable suggestions offered by the Editor-in-Chief of the Indian Journal of Pediatrics, Prof. Ishwar C. Verma, along with the whole editorial staff, which collaborated for the realization of this monographic issue. Conflict of Interest None. Source of Funding This work is partially supported by an unrestricted grant from the Italian Ministry of Foreign Affairs, Directorate General for Country Promotion, and from Prochild ONLUS (Italy).
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