Sir,
In the article titled “Prevalence of obesity and bariatric surgery among medical students in Riyadh, Saudi Arabia” published in the December 2023 issue (p3064-3067, December 2023), the researchers uncovered the prevalence of obesity, its risk factors, and bariatric surgery among medical students. Recognizing the importance of early screening, I would like to emphasize the proactive approach of integrating routine screening into medical education and healthcare practices. This step is essential for ensuring better health outcomes in addressing obesity.
Obesity is the main cause of “New World Syndrome,” a grave menace brought about by the forces of industrialization and acculturation. The World Health Organization’s 2022 data show that one in eight people worldwide suffer from obesity, indicating the rise in the obesity epidemic. Of the adults who are 18 years of age or older, 2.5 billion are overweight, and 890 million are obese. Moreover, 37 million children under five were overweight, along with over 390 million children and adolescents aged 5–19 years, among whom 160 million were obese.[1]
Obesity is a significant risk factor for several conditions, such as metabolic syndromes, diabetes, secondary insulin resistance, cancer, hypertension, heart disease, arthritis, and Alzheimer’s disease. As a result, obesity screening is important.
An accumulation of fat in the upper body, particularly with increased visceral adipose tissue, is strongly associated with cardiovascular disease, glucose intolerance, hyperinsulinemia, diabetes, hypertriglyceridemia, gout, and uric calculus. Gold standard methods like computed tomography (CT), magnetic resonance imaging, and DEXA scans offer precise measurements of visceral fat, but their costliness limits widespread use.[2] While body mass index (BMI) is commonly used as an anthropometric tool, it does not fully reveal body composition and fails to assess central adiposity or visceral fat. Additionally, its calculation can be cumbersome and requires stadiometers and weighing machines.
Waist and hip ratio measurements are influenced by factors such as respiration, postprandial distension, and pregnancy, and may face resistance from certain communities due to cultural or privacy concerns, especially when individuals of a different gender are involved in the measurement process.
Neck circumference (NC), serving as a proxy for upper body subcutaneous fat, emerges as a promising solution. It reflects the distribution of subcutaneous fat in the upper body and exhibits strong correlations with visceral adiposity, as validated by CT scans. Notably, NC correlates significantly with established obesity measures such as BMI, waist circumference, and hip circumference.[3] In a large population-based study, NC was found to correlate with various components of metabolic syndrome, including elevated triglycerides and fasting glucose levels, low levels of high-density lipoprotein cholesterol, and insulin resistance index.
NC emerges as a superior screening tool due to its demonstrated good sensitivity and specificity, cost-effectiveness, minimal time requirement, and simplicity of use, requiring only a basic measuring tape, especially in resource-constrained settings. NC also showcases minimal intraobserver and interobserver variability. For the Indian population, the identified NC cut-offs are approximately 35.25 cm for males and 34.25 cm for females, based on available literature.[4] NC has also been proven to be a good screening tool for children.[5] While diverse studies have suggested different cut-off points for NC, there is a need for standardized guidelines to ensure effective mass screening and intervention strategies against obesity-related health complications.
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References
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