Obesity and Adolescents: Time for Increased Physical Activity!

Obesity is a monumental dilemma affecting the health and well-being of the world’s population(1-3). This is not a new problem, but rather a rapidly increasing one among children, adolescents and adults(4-6). The reasons for this escalation are multi-factorial; each must be appreciated and precisely addressed before solutions to obesity are practical (7). The National Health and Nutrition Examination Surveys (NHANES cycles I, II & III) have been surveying the prevalence of obesity in American children and youth since 1971. The 1988-91 NHANES cycle III study identified 21% of adolescents 12-19 years of age as being overweight (using BMI or body mass index as criteria)– up from 15% in the 1966-80 NHANES II study(8).
Over the past 25 years the prevalence of overweight or obesity doubled in American children ages 6 to 11 years of age and tripled in American adolescents ages 12 to 17 years(4). A 75% relative increase in obesity in adolescents is noted from 1970 to the present and currently 25% of American adolescents are identified as being obese(9). The increase in childhood and adolescent obesity has resulted in increases in obesity or overweight in adults. At least one-third of American adults (ages 20 and above) are overweight. Overweight 10 to 14 year olds are 20 times more likely to be overweight in their third decade of life than if they were of normal weight as young adolescents(10). Approximately 80% of overweight adolescents become overweight adults(4). Recent research notes that the prevalence of obesity among Americans 18 to 29 years of age is 14%, up to 21% if they had some college education; perhaps 35% of American college students are now overweight(11). Though more studies are needed to understand the precise prevalence of overweight and obesity in India, school-based data demonstrates an obesity range of 5.6% to 24% for the children and adolescents in India(12-14).
Obesity compounds a common adolescent problem of low self-esteem and can disrupt psychosocial development, interfering with the normal process of adolescence, a timeless journey that prepares the child for adulthood. An obese young person may have difficulty dealing with peers and this communication problem can seriously disrupt normal adolescent development. Psychological complications have been associated with obesity in adolescents, including depression, poor self-image, and difficulties in both the home and social environment (including school). Potential medical complications of obesity noted in adolescence and especially in adulthood, include hypertension, coronary artery disease, diabetes mellitus, dys-lipidemia, cholecystitis, premature joint destruction, arthritis, stroke, some cancers, premature death and many others(15-22).
Exogenous obesity is usually caused by a variety of complex factors, including genetics, excess food intake, and reduced exercise lifestyle. Depression can play a primary or secondary role in many cases. Obesity remains a complex disturbance which causes frustration for patients, their families, and health care professionals. Recent research in genetics is focusing on leptin, the ob gene substance, neuropeptide Y(NPY), propio-melanocorticotropin POMC, melanocyte concentrating hormone receptors and other neurobiological factors(6,23).
Perhaps half of obese individuals have inherited a tendency to be overweight.
In a few instances, the cause may be medical, such as being secondary to Cushing’s Syndrome, prolonged use of corticosteroids, hypothalamic lesions (trauma, tumor, tuberculosis, sarcoidosis), Prader-Willi syndrome, Lawrence-Moon-Biedl syndrome, and various other endocrine disorders (hypopituitarism, hypothyroidism, hyperinsulinemia, hyper-cortisolism). Other medications that can induce weight gain include anticonvulsants, neuro-leptics, depomedroxyprogesterone acetate and tricyclic antidepressants.