Abstract:
Overweight and obesity in school-going children have become significant public health concerns globally, often leading to physical and psychological issues. In the twenty-first century, obesity is becoming a global epidemic. It not only poses a serious risk for the onset of non-communicable diseases including diabetes, hypertension, and cardiovascular disease, but it also hinders the economic development of both industrialized and developing nations. While conventional treatments focus on diet and exercise, there is growing interest in alternative therapies like homeopathy for managing childhood obesity. Homeopathy is the most popular since, in addition to its many benefits over other treatments, it has very few, if any, negative effects after administration.
Keywords. Childhood Obesity, Overweight Children, Homeopathy, Individualized Treatment, Psychosocial Well-Being
Introduction:
The term overweight refers to excess body weight for a particular height, whereas obesity is used to define excess body fat.[2] Obesity and overweight in children are defined using BMI percentiles for those over 2 years old and weight/length percentiles for infants under 2 years old. Obesity is defined as a BMI at or above the 95th percentile, while overweight is defined as a BMI between the 85th and 95th percentiles.[1]
Epidemiology and Childhood Obesity Burden
By 2030, almost 27 million children in India—or one in ten children worldwide—are expected to be obese, according to the UNICEF World Obesity Atlas for 2022. In terms of readiness to address obesity, it is ranked 99th out of 183 countries. The economic burden of overweight and obesity is predicted to increase from $23 billion in 2019 to an astounding $479 billion by 2060.[4]
Incidence And Prevalence of Childhood Obesity:
The global prevalence of childhood obesity has increased twofold in the 2–4 y age group and eightfold in the 5–19 age group in the past four decades.[4]India is currently placed third after China and United States in the global burden of paediatric obesity.[4]
A meta-analysis of 21 studies estimates the pooled prevalence of childhood obesity at 8.4% and the prevalence of childhood overweight at 12.4%. Notably, male children were found to be at a higher risk of developing obesity compared to their female counterparts.[5]
Covid-19 Effect On Childhood Obesity
In comparison to the pre-pandemic period, the rate of increase in body mass index (BMI) virtually doubled during the COVID-19 pandemic, according to a study involving 432,302 children between the ages of 2 and 19 [5]. In 2020 (the long-haul COVID-19 period), the prevalence of obesity among adolescents aged 12 to 18 years rose to 12.1% from 11.1% in 2019 (the pre-COVID-19 era) [1]. It is
anticipated that by 2030, there will be 250 million obese children in India. It is estimated that the percentage distribution of obesity in males and females by 2050, will be 60% and 50%.[6]
Criteria for Obesity
The main measurement used to diagnose obesity is body mass index (BMI. Age and sex have an impact on a child’s normal BMI range. Tables for assessing childhood obesity have been released by the Centers for Disease Control. To find the matching BMI-for-age percentile, the BMI value for children and adolescents (ages 2 to 19 years) is plotted on the CDC growth charts. A BMI that is below the 95th percentile and at or above the 85th percentile is considered overweight, BMI at or above the 95th percentile is considered obese.
Anthropometric and clinical measures utilized as indicators of obesity
Body Mass Index: Body mass index (BMI) is the most widely used parameter to define obesity. It takes into account weight as well as height. It is calculated by the formula:
BMI = Weight (kg) ÷ height (m)2
Children with BMI more than 85 percentile for age are considered at-risk for obesity while those more than 95 percentiles for age are obese. BMI is a good indicator of body fat but is unreliable in short muscular individuals.
Weight for height: This compares the child’s weight to the expected weight for his/her height. Weight for height more than 120% is diagnosed as obesity.
Skin fold thickness: Skin fold thickness measured over the subscapular, triceps or biceps regions is an indicator for subcutaneous fat. Age specific percentile cut-offs should be used with values more than 85 percentile being abnormal.
Waist circumference: This is a marker of abdominal adiposity, a key risk factor for metabolic and cardio-vascular effects of obesity.
Ideal body weight: Ideal body weight is calculated as
IBW (kg) = 22.5 x height (m)2
Ideal body weight more than 20% is considered obesity.
Risk Factors Contributing For Childhood Obesity
- Reduced physical activity
- Increased sedentary life style: additional hours of television per day
- Decreased sleeping time
- Increased screen time: playing video games and getting more access to social media leads to anxiety, depression and inattention
- Parenting style and parent life style
- Parenting feeding style
- Watching TV while eating
- The consumption of fast foods, including items such as chips, baked goods, and candy.
The first 1,000 days from conception to age 2 are crucial in influencing the risk of childhood obesity. Factors such as parental obesity and prenatal conditions (like high preconception weight, gestational weight gain, and maternal smoking) increase this risk. Interestingly, intrauterine growth restriction followed by rapid growth in infancy can lead to central adiposity and cardiovascular risk in adulthood. Breastfeeding offers modest protection against obesity, while infants with high negative reactivity are at greater risk for becoming obese.[1]
Sleep is a critical factor in obesity risk, Research shows that short sleep duration in young, healthy men leads to lower leptin levels and higher ghrelin levels, increasing hunger and appetite. Additionally, sleep debt negatively impacts glucose tolerance and insulin sensitivity, with potential connections to orexins and neuropeptide Y, which influence feeding and metabolic processes.[1]
Etiology of Obesity
Obesity in children is the result of a complex interplay of a number of environmental, genetic, and ecological factors, including the family, community, and school.
Satiety control is a crucial aspect of appetite and weight management, influenced by the interplay between the hormone leptin and ghrelin, along with other cytokines and hormones. Low leptin levels during fasting increase appetite and decrease energy expenditure, while increased leptin levels decrease appetite and increase energy expenditure during feeding and weight gain.[9]
Etiology of obesity
- Constitutional- 95% case it includes- environmental factors
Environmental Factors
Childhood obesity is influenced by various factors, including psychosocial distress, maladaptive coping strategies, parental feeding styles, stress, depression, Various perinatal factors—such as- birth size, breast-feeding status, antibiotic use, environmental chemicals, microbiota, and adverse life experiences. Increased caloric consumption, such as sugar-sweetened beverages and fast foods, is linked to obesity. The environment, including reduced physical activity and increased time spent in sedentary activities, such as television and electronic games, also contributes to obesity. The school environment, where children spend a significant portion of their daily calories, also plays a role in the development of childhood obesity.[10]
- Pathological
- Endocrine: Cushing syndrome, GH deficiency, hypo- thyroidism, pseudohypoparathyroidism • Hypothalamic: Head injury, infection, brain tumor, radiation, post-neurosurgery • Drugs: Antiepileptic drugs, steroids, estrogen
- Genetic syndromes: Prader Willi, Laurence Moon Biedl Bardet, Beckwith Weidemann, Carpenter syndromes
- Monogenic disorders: Leptin deficiency, leptin resistance, abnormalities of MC4 receptor and proconvertase
Complication/ Obesity- Associated Comorbidities –
- Cardiovascular- Dyslipidemia, Hypertension
- Endocrine-Type 2 diabetes mellitus, Metabolic syndrome, Polycystic ovary syndrome • Gastrointestinal-Gallbladder disease, Nonalcoholic fatty liver disease
- Neurologic-Pseudotumor cerebri, Migraines
- Orthopedic-Blount disease (tibia Vara), Musculoskeletal problems, Slipped capital femoral epiphysis
- Psychologic-Behavioral complications
- Pulmonary-Asthma, Obstructive sleep apnea
Prevention and Management
It has been discovered that bariatric surgery helps teenagers with extreme obesity lose excess weight and improve their comorbidities. However, little is known about the long-term safety and effectiveness of bariatric surgery in teenagers.
Behavioral Interventions for Childhood and Adolescent Obesity [10]
Dietary Approaches
- Encourage consumption of at least five servings of fruits and vegetables each day • Reduce consumption of foods high in calories, such as saturated fats, salty snacks, and high glycemic foods like candy;
- limit consumption of beverages that contain sugar; limit eating out, especially fast food; • Eat breakfast every day; and
- Refrain from skipping meals
Physical activity
- Reduce sedentary behavior to less than two hours per day, including watching television, using the Internet, and playing video games.
- Take part in enjoyable, age-appropriate, and skill-appropriate activities.
- Gradually increase the amount of time, frequency, and intensity of exercise as tolerated. 4. Engaging in physical activities for over an hour every day
HOMOEOPATHIC APPROACH
Homoeopathy has a great scope in managing overweight and obesity through its dynamic, individualized, and holistic perspective, which recognizes that although apparently an organ is diseased, but actually the man as a whole is sick. Various factors play a significant role in the development of overweight and obesity, including age, sex, genetic predisposition, physical inactivity, socioeconomic status, eating habits, psychosocial influences, familial tendencies, endocrine factors, alcohol consumption, education, smoking, ethnicity, and drug use.
According to Samuel Hahnemann’s teachings in the Organon of Medicine, particularly Aphorism 5, it is essential to consider these factors to identify the fundamental cause of chronic diseases, often linked to chronic miasms. Hahnemann emphasized the importance of understanding the patient’s complete history, including their physical constitution, moral and intellectual character, occupation, lifestyle habits, social and domestic relationships, age, and sexual function, to provide effective treatment.[12]
Homoeopathic Therapeutics Of Overweight And Obesity [13] Indications of common homoeopathic medicines for obesity
Antimonium Crudum: Tendency to grow fat, obese people with thickly coated white tongue and digestive disturbances of varying degrees. The constitutions are very irritable and fretful. child cannot bear to be touched or looked at. The child has a desire for acids and pickles. All the complaints are aggravated by heat and cold bathing.
Calcarea Carbonicum: Calcarea carb is often recommended for individuals who are generally overweight or tend to gain weight easily. Children who need Calcarea carb may have a tendency to sweat excessively, particularly on the head during sleep. They may also be slow to develop both physically and mentally.
These children often have a strong desire for eggs and indigestible things like chalk or pencils and they are prone to diarrhea. Calc. child is fat, fair, flabby, perspiring, cold, damp and sour. Calc is especially suited to Scrofulous constitutions who take cold easily with increased mucoid secretions, children who grow fat, are large bellied with a large head, pale skin, chalky look, and the so-called leuco
phlegmatic temperament. they are prone to diarrhea.
Capsicum Annum: suited to persons who are fat, indolent, opposed to physical exertion, aversion to going outside in their routine and get homesick easily. Persons having feeble digestion and lax fiber. Chilly subjects with lack of vital heat. There is a general uncleanliness of the body. Children; dread open air; always chilly; clumsy, fat and disinclined to work or think.
Ferrum Metallicum: Flabby, anemic and plethoric persons with false plethora and relaxed muscles. Easily irritable constitutions having voracious appetite. From the least pain, emotion or exercise child face is flushed.
Fucus Vesiculosis: obesity associated with non-toxic goiter with flatulent tendency and obstinate constipation. It Increase the rapidity of digestion.
Kalium Bichromicum-It is especially indicated in fleshy, fat, light complexioned children subjected to catarrhs. Catarrh with tough, stringy, viscid secretion. Snuffle in children, especially for fat, chubby babies. Symptoms tend to increase in the morning and all pains migrate quickly with rheumatic and gastric symptoms alternating.
Senega– It is suited to plethoric persons; or persons tending to obesity; tall, slender, sprightly women; fat chubby children. Faintness when walking in open air. Anxiety; with hasty respiration.[18]
Sulphur–Sulphur is used as a constitutional medicine in obesity, especially when children exhibit symptoms such as a dislike for bathing, a strong craving for sweets, offensive perspiration, worsening of symptoms while standing, unhealthy skin, and abrupt or ill-mannered behaviour. It is often prescribed to address underlying constitutional issues contributing to both physical and behavioural imbalances.
Nux Vomica-It is especially suited to children who gained weight due to sedentary life, found in prolonged office work and overstudy. The child is quick, active, nervous and irritable and has a zealous fiery temperament. desire for stimulants. Children are easily chilled, and avoid open air.
Phytolacca Berry: Clinically found to be efficacious in obesity.
Other Medicine-
- Phytoline
- Esculentine
- thyroidinum
- kali carbonicum
- Lac defloratum
- graphites
- pulsatilla
- Calotropis gigantea
REPERTORIAL APPROACH
KENT REPERTORY [16]
- MIND-SADNESS-obesity, with
- EXTERNAL THROAT-COMPLAINTS of external throat – Thyroid gland – accompanied by obesity (see GENERALS Obesity-children-thyroid)
- STOMACH APPETITE-diminished-accompanied by obesity (see GENERALS Obesity accompanied appetite)
- STOMACH INDIGESTION-accompanied by- obesity
- ABDOMEN-OBESITY
- FEMALE GENITALIA/SEX-MENSES-painful – accompanied by- obesity • EXTREMITIES-THICK-Thighs and buttocks (see GENERALS-Obesity-thighs) • GENERALS-FAT people (see Obesity)
- GENERALS OBESITY
- GENERALS-OBESITY-accompanied by-goitre (see EXTERNAL-Goitre accompanied – obesity)
- GENERALS-OBESITY-accompanied by indigestion (see STOMACH – Indigestion accompanied obesity)
- GENERALS-OBESITY-accompanied by respiration-asthmatic (see RESPIRATION Asthmatic-accompanied – obesity)
- GENERALS-OBESITY-accompanied by-respiration – difficult (see RESPIRATION – Difficult accompanied – obesity)
- GENERALS-OBESITY-accompanied by-respiration-wheezing (see RESPIRATION Wheezing-accompanied
- GENERALS-OBESITY-accompanied by-weakness (see Weakness – accompanied – obesity) • GENERALS-OBESITY-accompanied by-Heart; weak (see CHEST-Weakness-heart accompanied obesity)
- GENERALS-OBESITY-sadness; during (see MIND-Sadness-obesity)
- GENERALS-STOUT people (see Obesity)
- GENERALS-WEAKNESS-accompanied by- obesity
- GENERALS-WEIGHT, increasing (see Obesity)
- GENERALS WEIGHT, puts on easily (see Obesity)
- STOMACH APPETITE-diminished-accompanied by-
PHATAK REPERTORY [14]
- corpulence, see obesity
- obesity
- obesity, atrophy, limbs, of, with
- obesity, body fat, legs thin
MURPHY REPERTORY [15]
- constitution, obesity
- constitution, obesity body fat, but legs thin
- constitution, elderly, people dyspepsia, in those in great loss of vitality
- constitution, elderly, people obesity
- constitution, young people
- children, obesity, in
- children, obesity, in young people, in
- constitution, obesity children
- sugar obesity, and
- fat people (see obesity)
- diseases, obesity body fat, but legs thin
- diseases, obesity children, in
- diseases, obesity elderly people
- diseases, obesity stout and robust
BOERICKE REPERTORY [13]
- Generals, OBESITY (adiposis, corpulence),
- OBESITY, in children
A CLINICAL REPERTORY BY JOHN HENRY CLARK-[18]
- Obesity-Asa., Ca. ar., Cap., Gph., Lc. v. d., Li. c., Lrs, Sbl, Thyr, Thri.
- Corpulence-Am. br., Aur., Ca. ar., Calc., Fuc., Pho., Phyt., Ts. fg. See also Obesity. COMPLETE REPERTORY [17]
- GENERALITIES- OBESITY- children, in: alum. Ant-c. Bac. Bad. Bar-c. Bell. CALC. Caps. Cina. Ferr. Graph. Ip. Kali- bi. Lac-d. Lap-a. Sacch-a. Seneg. Sulph. • GENERALITIES- OBESITY- children, in – fat anaemic babies with iodine appetite: lap a.
- GENERALITIES – OBESITY – young people, in: Ant-c. Calc. Calc- act. Lac-d. Lach.
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Acknowledgements: I would like to express my heartfelt gratitude to Dr. J.P. Tripathi, my guide, for his unwavering support, expert guidance, and insightful feedback throughout the preparation of this article. I would also like to extend my sincere thanks to Dr. Ajay Singh Parihar, Head of the Department of Pediatrics, for his encouragement and invaluable assistance. Their combined expertise and mentorship have been instrumental in the successful completion of this work.
ABOUT AUTHOURS:
Dr. Rahul Yadav
MD Scholar,
Department of Paediatrics,
Government Homoeopathic Medical College and Hospital, AYUSH Campus, MACT Hills, Bhopal, Madhya Pradesh, India
Dr. J P Tripathi
Assistant Professor
Department of forensic medicine and toxicology
Dr. Ajay Singh Parihar
Professor and H.O.D,
Department of Paediatrics,
Government Homoeopathic Medical College and Hospital, AYUSH Campus, MACT Hills, Bhopal, Madhya Pradesh, India
