Increasing prevalence of obesity in primary school children: cohort studyBMJ 2001; 322 doi: https://doi.org/10.1136/bmj.322.7294.1094 (Published 05 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
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: http:digilander.iol.it/semeioticabiofisica)
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,
Competing interests: No competing interests
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
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
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.
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obesity in primary school children : cohort study. BMJ 2001; 332:1094-
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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
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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:
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:
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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-
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
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Competing interests: No competing interests