Pediatric Obesity: A Global and Indian Epidemiological and Clinical Review

Abstract

The worldwide prevalence of pediatric obesity constitutes a critical public health crisis, characterized by rapidly accelerating rates, particularly since 2011.¹ The global increase in preschool-age children from approximately 4% in 1990 to 7% in 2010 exemplifies this dramatic shift.² For children and adolescents globally, excess weight is now estimated at 22.2%.¹ India mirrors and, in specific metabolic aspects, exceeds this global trajectory, struggling with the “double burden of malnutrition” (DBM) where undernutrition coexists with increasing rates of overweight and obesity.3 Meta-analyses estimate Indian children face an overweight prevalence of 12.64% and an obesity prevalence of 3.39%.⁴
The etiological framework emphasizes early life determinants, with parental obesity and early adiposity rebound representing extreme risk factors.⁵ Crucially, lifestyle factors such as excessive screen time and inadequate sleep interact with genetic susceptibility, suggesting that behavioural modification can actively counteract inherited risks.⁶ The clinical burden is profound, marked by a high prevalence of endocrine and metabolic comorbidities, most alarmingly Non-Alcoholic Fatty Liver Disease (NAFLD), which affects 63.4% of obese children in India.⁷ Management requires a comprehensive, staged approach, beginning with Intensive Health Behavior and Lifestyle Therapy (IHBLT), and escalating to pharmacotherapy and metabolic and bariatric surgery (MBS) for severe cases.⁸ Effective policy in India necessitates stringent, multi-sectoral legislative controls, including health taxes and marketing restrictions, coupled with culturally congruent family-based interventions to address pervasive socio-cultural barriers like forced feeding and the normalization of excess weight.¹⁰