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Obesity remains an incompletely understood multifactorial disease. Genetics, ethnic risk factors, energy availability in modernized settings, and reduced energy expenditure can contribute to obesity. The effect of these various factors on individuals varies considerably. The effect of diet and exercise on weight loss varies significantly between individuals.

Laziness is not a cause of obesity. Reduced physical activity and sedentary lifestyles are linked to childhood and adult obesity. Increased screen times have been linked to childhood obesity. (Robinson,2017) However, the response of individuals to various lifestyle interventions including diet and exercise is highly variable. Various reasons are linked to a sedentary lifestyle in overweight persons: physical limitations due to weight, associated diseases like diabetes and hypertension, tiredness due to sleep apnea, poor access to appropriate weight loss methods (e.g., gym equipment which are not suitable), the social stigma associated with weight and body image dissatisfaction leading to social anxiety. Studies suggest that individuals who are less active are more prone to become overweight when compared to those who are alert and physically active.

So next time you come across a person with overweight, do not think they are lazy. They are not. Many of them have tried and are still trying extremely hard to lose weight. Let us support them.

It is important to measure “the fatness” of person. Increased body fat contributes to various medical problems associated with obesity. Body Mass Index (BMI) is the most common and basic method used to determine whether a body is fat or fit. BMI is the ratio of weight to height, calculated as weight (kg),height (m2). The advantages of using BMI are that it is easy to measure, inexpensive and there are standardized cutoff points for overweight and obesity. There is also a strong correlation between BMI &and body fat levels. Also, available evidence from studies suggests that ‘’high BMI’’ predicts higher risk of chronic disease.

But BMI has certain limitations. It is an Indirect and imperfect measurement. It does not distinguish between body fat and lean body mass. The lean body mass includes muscles, organs, skin, and bones. Someone with a higher and healthy muscle mass may be labeled as ” high BMI”. BMI varies with age, so it is not as accurate a predictor of body fat in the elderly as it is in younger and middle-aged adults. It varies with sex as well as ethnicity. At the same BMI, women have, on average, more body fat than men, and Asians have more body fat than whites. So, for accurate measurement of body fat content, other metrics of basic body measurements like waist circumference or waist to hip ratio may be used along with BMI. Scans like Dual Energy X-ray Absorptiometry (DEXA) provide accurate body fat estimates.

Obesity is a complex health issue in which weight gain has reached the point where it poses significant risks to health. It is now a worldwide public health problem, affecting all age and socio-economic groups. According to WHO estimates over 4 million people die each year as a result of being overweight or obese. Obesity is closely related to several other chronic diseases, including heart disease, hypertension, type 2 diabetes, sleep apnea, certain cancers, joint diseases, and more.
Professional organization like American Medical Association and World Health Organization considers obesity as a disease. This makes obesity more than just a lifestyle disorder. It results from a combination of causes and individual factors such as behavior and genetics. Behaviors can include physical inactivity, dietary patterns, medication use, and other exposures. Obesity occurs due to increased accumulation of fat which cannot always be attributed to eating too many calories or lacking physical activity. Individuals with obesity can have abnormalities in metabolic pathways, disordered signaling for hunger, satiety (the feeling of fullness), and fullness. Considering obesity as a disease will help physicians and patients take it more seriously. Therefore, management of obesity requires a multifaceted approach targeting changes lifestyle, nutrition, mental health, and environment.

Children with pubertal delay will require investigations and treatment. Investigations are tailored to understand the reason for pubertal delay.
Once chronic medical disease and normal variants are excluded, we need to understand if the pubertal delay is due to problems with the end organs (ovaries and testes) or with their central controls (pituitary and hypothalamus). Tests are done accordingly to find out source of the disease. Imaging tests like MRI and genetic tests may be required.

Treatment is done to make sure that the child develops features of puberty appropriate for his age. The medicines are adjusted so that the child develops all secondary sexual characteristics by 18 years of age.
In boys, testosterone is commonly used and in girls, estrogen is used. Gonadotropins (hCG, hMG or FSH) can be used at appropriate age to induce fertility. Endocrinologists can help regulate this fine adjustment of medicines.

Delayed puberty can be a sign of underlying serious medical condition. Various lesions of the brain like pituitary adenoma and craniopharyngioma can present with delayed puberty. Kids who have undergone brain surgery or radiation to the brain may have delayed puberty.
Various chronic medical diseases involving the kidneys, liver, gastrointestinal system, and lungs can present with delayed puberty. Puberty may be delayed in eating disorders and in various diseases which affect the hormonal system like thyroid diseases or diseases of the adrenals.

Boys may have damage to their testes producing delayed or arrested puberty. One of the common genetic reasons for this is Klinefelter syndrome. They have an extra X chromosome (XXY instead of XY) Boys with this medical problem may have behavioural problems in childhood, delay or slow progression of puberty associated with slow shrinkage of testes. These children will benefit from treatment with testosterone.

Some boys and girls may have features of delayed puberty and poor sense of smell. This is due to a genetic defect called Kallmann syndrome. They may have other features like deafness, cleft lips, and various neurological defects. Some forms of these disease may be inherited and run in families. Genetic analysis can be used to pinpoint the specific defect.

Many short girls with delayed puberty have Turner syndrome. In Turner syndrome, one of the X chromosomes (XO instead of XX) is missing. Girls with Turner syndrome have short stature in addition to delayed puberty and various other external features.
Girls with Turner syndrome need endocrine evaluation to detect a host of problems related to the heart, kidneys, and the skeletal system. If they are detected early, there is a valuable opportunity to improve their height with growth hormone therapy.

Various reasons can cause delayed puberty in boys and girls. The endocrinologist will systematically look for chronic diseases which can interfere with growth. Common diseases like thyroid diseases and certain drugs like steroids needs to be evaluated. Then they will look for various diseases which may cause reduced production of testosterone (in boys) and estrogen (in girls).
One of the most important things done by the endocrinologist is a careful clinical examination of the child. As the hormones in this age can be very variable, only a clinical examination and follow up can help understand the progression of puberty.