Increasing prevalence of obesity in primary school children: cohort study

BMJ 2001; 322 doi: (Published 5 May 2001)
Cite this as: BMJ 2001;322:1094

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A noticeable increase in the prevalence of obesity in primary school children is certainly important and well-considered by the authors of this interesting paper. In addition, a long "clinical" experience allows me to state that obesity in children is always accompanied by hiperinsulinemia, secondary to abdominal fat insulin- resistance (1, 2). Moreover, under such condition, micro- as well as macro -vessel reaction of every biological system to this hormone is really different from that observed in healthy people. In fact, in healthy people an acute peak of insulin-secretion (1) activates the microvessels and dilates macrovessels, increasing tissue blood supply. On the contrary, under pathological conditions, like central obesity, due to endothelial "functional" dysfunction, both arterial and arterioles react in pathological manner, as we observe analogously in case of acetylcholine vascular stimulation.

In conclusion, in obese children tissue microvascular units are already suffering from the "functional" point of view, conditio sine qua non of successive disorders (for further information See:

Stagnaro Sergio MD.
Member NYAS and AAAS

1.Stagnaro-Neri M., Stagnaro S., Semeiotica Biofisica: la manovra di Ferrero-Marigo nella diagnosi clinica della iperinsulinemia-insulino resistenza. Acta Med. Medit. 13, 125 1997

2.Stagnaro-Neri M., Stagnaro S., Semeiotica Biofisica: valutazione clinica del picco precoce della secrezione insulinica di base e dopo stimolazione tiroidea, surrenalica, con glucagone endogeno e dopo attivazione del sistema renina-angiotesina circolante e tessutale – Acta Med. Medit. 13, 99 1997

Competing interests: None declared

Sergio Stagnaro, Specialist in Blood, Metabolic and Gastrointestinal Diseases

Riva Trigoso (Genoa) Italy

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Dear sir,

The morbidity and mortality associated with childhood obesity may pesist independent of adult body weight and the problem of obesity in the developing world is a significant one. However, it was still surprising to note that its prevalence is increasing in the study by Rudolf et al.(1) , mainly because of the high level of awareness in the developed countries. The picture in developing nations is less clear and also contradictory. Even wayback in the early 1980s, high prevalence of obesity in children 7- 12 years of age was noticed in Brazil.(2) High prevalence of obesity in all age groups has been seen in India (3,4), Thailand (5), and China (6). Adolescent girls in Bahrain had even higher body fat than their counterparts in the western countries (7). This is due to several ecological and economic factors, like diet and nutrition, which are changing dramatically as a result of economic and nutrition transition (8), and it is debatable whether this is progress or a prelude to a health disaster (9).

There is a significant difference between developing and developed nations as far as childhood obesity is concerned that is less well appreciated. While some developing countries are facing obesity-related problems, it is not uniform. Countries with the highest prevalence rates of overweight are mainly the Middle East, North Africa, and Latin America; on the other hand, in Africa and Asia, wasting rates are 2.5-3.5 times higher than the overweight rates (10). Micronutrient deficiency, parasitic infestations and stunting are more significant problems requiring primary health care interventions like supplementation and deworming (11).

The other difference between the developing and the developed countries is the influence of the socioeconomic status on childhood obesity. Whereas in the developed world, children belonging to the lower socioeconomic strata are at increased risk of developing obesity, in the developing nations, higher prevalence rates of obesity are seen in children from the higher socioeconomic strata, especially in urban areas (12). Our own preliminary findings have shown much higher prevalence rates of obesity in children studying in public schools as compared to government schools.

It is true that the prevalence of obesity in some developing countries is rising, and suitable interventions like parental education and promotion of physical exercise must be planned. However, this should not be done at the expense of decreasing international commitments to alleviating undernutrition (10) as obesity may not be a significant health problem in Asian and Sub-Saharan African children (12). We feel that the phrase “obesity in developing countries”, as is often used, is not appropriate, and we should not generalize, as different developing countries have highly variable prevalence rates of childhood obesity.


1. Rudolf MCJ, Sahota P, Barth JH, Walker J. Increasing prevalence of obesity in primary school children : cohort study. BMJ 2001; 332:1094- 1095.

2. Arteaga H, Dos Santos JE, Dutra de Oliviera JE. Obesity among school children of different socioeconomic levels in a developing country. Int J Obesity 1982; 6: 291-297.

3. Dhurandhar NV, Kulkarni PR. Prevalence of obesity in ombay. Int J Obes Relat Metab Disord 1992; 16: 367-375.

4. Gupta R, Goyle A, Kashyap S, Agarwal M, Consul R, Jain BK. Prevalence of atherosclerosis risk factors in adolescent school children. Ind Heart J 1998; 50: 511-515.

5. Mo-suwan L, Junjana C, Puetpaiboon A. Increasing obesity in a transitional society and the effect of the weight control program. Southeast Asian J Trop Med Public Health 1993; 24: 590-594.

6. Popkin BM. The nutrition transition and obesity in the developing world. J Nutr 2001; 131: 871S-873S.

7. Musaiger AO, Al-Ansari M, Al-Mannai M. Anthropometry of adolescent girls in Bahrain, including body fat distribution. Ann Hum Biol 2000; 27: 507-515.

8. Caballero B. Introduction. Symposium: Obesity in developing countries: biological and ecological factors. J Nutr 2001; 866S-870S.

9. Shetty PS. Obesity in developing children in developing societies: indicator of economic progress or a prelude to a health disaster. Ind Pediatr 1999; 36: 11-15.

10. De Onis M, Blossner M. Prevalence and trends of overweight among preschool children in developing countries. Am J Clin Nutr 2000; 72: 1032- 1039.

11. Jinabhai CC, Taylor M, Coutsoudis A, Coovadia HM, Tomkins AM, Sullivan KR. A health and nutritional profile of rural school children in HwaZulu- Natal, South Africa. Ann Trop Paediatr 2001; 21: 50-58.

12. Sakamoto N, Wansorn S, Tontisirin K, Marui E. A social epidemiologic study of obesity among preschool children in Thailand. Int J Obes Relat Metab Disord 2001; 25: 389-394.

Competing interests: None declared

Anita S Malhotra, Senior Lecturer, Dept. of Physiology

Samir Malhotra

Govt. Medical College & Hospital, Chandigarh, India

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