Approximately two thirds of U.S. adults and one fifth of U.S. children are obese or overweight as per the Center for Disease Control (CDC). Obesity is a national health epidemic with a major impact on the health and health care costs for society. Being either obese or overweight increases the risk for many chronic diseases such as heart disease, type 2 diabetes, metabolic syndrome, certain cancers, and stroke. The office of the Surgeon General attributes approximately 300,000 deaths per year to obesity. The incidence of obesity is high due to many different reasons. Access to a healthier lifestyle may be limited by the knowledge on how to eat healthy and make a healthier lifestyle choice. Awareness about proper nutrition is not there. Physical activity in schools is limited and being cut due to budgetary constraints. Time limitations and lack of priority to participate in physical activity decrease the amount of physical activity. There are limited parks and facilities where children can partake in physical activity. The lack of education about the impact of the chronic illness of obesity leads to no action. Uninsured and patients with poor insurance often lack medical homes where preventive care measures can be taught. The patients who do have a medical home may not have primary care providers who are in tune with the problems of obesity. With shorter encounters in the doctor’s office, less time is spent on preventive counseling and education. Care is fragmented due to frequent usage of emergency room settings.
One of the most important negative associations with obesity is the development of Coronary Artery Disease (CAD) or heart disease. Research shows that the risk among Asian Indian Immigrants is at least two-fold higher than in other populations. This population represents the second largest Asian immigrant group in the United States. The high rates of CAD in Asian Indian Immigrants are presumed to be due to a combination of genetic predisposition and lifestyle factors. Several theories for this increased risk have been proposed, including predisposition for insulin (hormone that regulates body sugar) resistance, increased genetic susceptibility or familial inheritance patterns, and an inability to adapt to the Western environment after coming from their home country. Therefore, focus on prevention and methods of early detection are needed. A major challenge associated with primary prevention of CAD in this population involves the early and accurate detection of CAD risk factors in younger population so that interventions can be made to prevent and reduce future risk for the progression of heart disease and heart attacks.
Reversing the obesity epidemic requires a comprehensive and coordinated approach which includes policy and environmental change to transform communities into places that support and promote healthy lifestyle choices. One such effort described here comes from the Shaping NJ initiative, a public-private partnership of more than 150 organizations in the state of New Jersey through the Office of Nutrition and Fitness (ONF) at the Department of Health and Senior Services (DHSS). Shri Krishna Nidhi (SKN) Foundation is one of those partners that is taking a step towards a healthier lifestyle and fighting obesity through the “Move it to Lose it”(MITLI) program. Madsen et.al’s. original research article about After-school programs to reduce childhood obesity discusses the importance of establishing programs to combat obesity which can become community partners for primary health care providers. Their after school program, SCORES, in California, increased fitness in a significant proportion of children enrolled. Chen et.al described the effectiveness of an ongoing nutrition education program to help reduce obesity in Chinese children. Community based after school programs where children can enroll to learn about obesity in a fun filled environment with activities that they can enjoy can help to curb this epidemic.
MITLI is a unique and innovative childhood obesity prevention project of the SKN Foundation developed in collaboration with the Rhythmic Arts Center for Music and Dance highlighting the various ways high energy dance like Bhangra, Bollywood, and Hip-Hop can be a great way to exercise. MITLI is a 6 week physical activity and healthy living nutrition instruction intervention for school aged children 8 to 13 years of age. Fifteen to twenty to children are recruited at a time from the school system to participate in a weekly class instruction in the after school setting. The weekly high intensity dance class and nutrition and healthy eating education class teach the children the importance of these factors in the prevention of obesity. The instructional sessions are held in the after school setting so that they do not compromise their regular curriculum and help occupy their time in a constructive manner. The effectiveness of this program is evaluated by the enrollment, attendance, and retention of the children in the MITLI classes. A questionnaire is administered to evaluate the knowledge of these children about healthy eating habits, good nutrition, and the role of physical activity in fighting this national epidemic. The MITLI program was presented at the National Institute of Health’s “Science of Eliminating Health Disparities” conference in December, 2012 and also at the annual convention of the American Academy of Pediatrics (AAP) in October, 2013. MITLI has received the highly competitive Community Access to Child Health (CATCH) award from the AAP. The goals of the MITLI program are to continue to grow and raise awareness at all levels to ensure a vibrant and healthier community.
Naveen Mehrotra, MD, MPh
Shri Krishna Nidhi Foundation is a not-for-profit organization with a mission to promote total wellness of the person and community through education.