Fayth Clinic conducts workshops in Mumbai to help teens combat obesity

Dr. Paula Goel is a practicing adolescent pediatrician with special interest in adolescent obesity and its influence on lifestyle diseases in teenagers and young Indians. She is currently the adolescent pediatrician and director of Fayth Clinic, Mumbai – the only clinic specializing in adolescent health services in Mumbai. I got the opportunity to interview Dr. Goel through email about obesity among adolescents, the effects, preventive measures, and the workshops and treatment offered by Fayth Clinic.

 

For the last 6 years, you have worked extensively in the field of adolescent medicine dealing with problems of obesity and its effects in teenagers and young Indians. How would you rate the adolescent obesity ratio in India as compared to other countries? Is it growing at an alarming rate in India?

 

The incidence of obesity in Indian adolescents is about 1/3 of the developed countries, but it is growing at an alarming rate.

 

What do you attribute as the main causes for obesity in adolescents and children in India?

 

• Overeating
• Lack of Exercise
• Increased sedentary activity with lack of exercise like TV viewing for more than 20 hrs per week with decreased physical activity
• Children exposed to food advertisements and increase in caloric intake
• Other screen time includes video games, internet use, telephone use, home viewing of movies
• Heredity factors which reduce basal metabolic rate
• Socio economic status: More obese in higher socio economic status in poorer countries and more obese in lower socioeconomic status in richer countries
• Insulin resistance leading to sugar build up causing obesity and diabetes
• Low leptin levels – does not allow brain to get signal that food intake is enough
• Endocrine and chromosomal abnormalities

What are the major complications that an obese adolescent can face during adolescence and as an adult

 

Following are the complications faced as young adults:

 

• Cardiovascular system: high blood pressure, heart attack, brain stroke
• Respiratory system: breathlessness, asthma, frequent sleep apnoea, hypoventilation. High amount of fat in chest wall / abdomen limits the respiratory excursions which lead to frequent awakening and resultant sleep deprivation leading to daytime somnolence
• Metabolic disorders: elevated cholesterol, diabetes, insulin resistance, menstrual irregularities
• Gastro intestinal system: fatty liver, cirrhosis, hemorrhoids, hernia, colorectal cancer , gall stones
• Malignancy: breast cancer, endometrial cancer, prostratic cancer , cervical cancer
• Musculoakeletal problems : back pain , joint pains, frequent strains, sprains, limp, groin pain leg bowing
• Poly cystic ovarian syndrome in young girls : dysmenorrhea, excess body hair ( hirsutism), acne, hair loss on scalp, central obesity, insulin resistance, infertility
• Behavioural complications: disordered eating ,depression ,negative body image, decreased school performance, social isolation ,decreased self esteem ,bullying, being bullied
• Metabolic syndrome in young adults characterized by central obesity, hypertension, DM, premature coronary artery disease

How much is the awareness for obesity in adolescents in India? What steps are being taken by you and your clinic to spread the awareness?

Awareness of obesity in India especially in the young population is increasing. Many adolescents suffer from BODY IMAGE PROBLEM and this also results in bulimia, anorexia nervosa and eating disorders which may lead to depression. We hold regular seminars, workshops, community camps and media awareness programs.

 

You have been conducting various workshops for rehabilitating adolescents. Are these workshops conducted only in Mumbai? Are the workshops also conducted in other parts of India? How successful have these workshops been?

 

We are holding these workshops only in Mumbai at present. The results have been rewarding with positive feedbacks from the participants. The take home message has been implemented.

 

Regarding treatment, what are the various plans that you provide to the patient? Who comprise the team (doctor, dietician, counsellor, etc.)? Could you tell us in brief what are the various steps in the treatment and rehabilitation process? In terms of percentage can you tell us how much of medication and counselling is involved?

The Medical Management of Obesity consists of a detailed plan comprising of medical examination to determine the cause of obesity, diet and exercise protocol as per individual needs, detailed history will include onset, progression of obesity, growth and development, family history of obesity and complications. Exploring diet practices, family structure and habits. Over weight child with less than 50^th percentile for height are screened for endocrine or genetic conditions. Screening for complications is important. certain conditions like high blood pressure, asthma and orthopaedic problems may require treatment before exercise regimen can be prescribed treatment .Laboratory screening is also required for base line investigations and associated complications .The team comprises of doctor(adolescent paediatrician),dietician and counsellor and exercise therapist. Review is done on a periodic basis .However, medications are not provided for to lose weight. Medication is required as per the medical requirement and counselling is done for all patients.

 

Talking with an adolescent is definitely different from talking to a child or an adult. So do you have to use a different approach in the treatment and rehabilitation of adolescents? (By approach I mean the method of treatment, the counselling done afterwards, even any symptoms and side effects during diagnosis).

 

Approach definitely has to be different. Understanding and gaining trust of the adolescent is very important to maintain compliance during the treatment. Vast majority suffer from problems of body image and also early depression. They are also very sceptical and have their own set of value system which is as per the peer group. So gaining the trust is most important. Once they are comfortable, they open up and counselling is then easier. Diet also has to be looked into carefully as this is a growing phase and severe restriction of diet is not possible as this will hamper growth and development. Moreover, adolescents if put on to a strict diet will always binge and will never comply with the diet plan. Certain weight training exercises are also not recommended as it damages the growth plate which is at the end of the bones and this will also affect the final height of the adolescent. Moreover, if there is any muscle injury, it is more dangerous than bone injury as bone injury is picked up by X-rays while muscle injury cannot be picked up and it takes a longer time to heal. Hence complete physical and medical examination is mandatory before starting exercise protocol.

 

Today we lead a fast pace lifestyle and stress accompanied with studies, competition among peers, peer pressure, etc. What are your suggestions to prevent adolescence obesity in India?

 

• Lead a disciplined lifestyle
• Breakfast provides food for the brain and should never be missed
• A balanced diet with fruits and vegetables
• Prevent obesity at an early stage of life
• No child should be forced to complete the portion left behind on the plate in pre adolescent phase as it leads to obesity
• Should not be given energy-dense foods: chocolates, ice-creams, chips, as rewards for good behavior
• Fast foods/cold drinks be avoided
• Life style modification -walking, cycling, playing outdoor games rather than video-games, outings- trekking/walking on the beaches instead of malls every week ends
• Television viewing-a sedentary activity must be restricted. Snacking during TV viewing be condemned
• May have medical reasons-evaluation required
• Positive peer pressure through friends and peer educators may also be used to motivate to lose weight and to cope with body image problem, emotional taunts and emotional blackmail

How many workshops have you conducted on adolescence obesity? When is the next workshop scheduled to take place?

 

We have conducted about 4 to 5 workshops. The next workshop is due in January 2011.

How does one register for attending the workshop?

 

Either by phone (Mansi Kothari, Fayth Clinic admin 9869505556, tel: 02224311616/14) or by email services@faythclinic.com. For further details about Fayth Clinic visit www.faythclinic.com.