|BRIEF RESEARCH ARTICLE
|Year : 2014 | Volume
| Issue : 2 | Page : 121-124
Influence of behavioral determinants on the prevalence of overweight and obesity among school going adolescents of Aligarh
Tabassum Nawab1, Zulfia Khan2, Iqbal M Khan2, Mohammed A Ansari3
1 Senior Resident, Department of Community Medicine, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
2 Professor and Chairman, Department of Community Medicine, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
3 Associate Professor, Department of Community Medicine, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
|Date of Web Publication||12-May-2014|
Dr. Tabassum Nawab
Senior Resident, Department of Community Medicine, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Obesity has reached epidemic proportions globally and the prevention of adult obesity will require prevention and management of childhood obesity. A study was conducted to determine the prevalence and behavioral determinants of overweight and obesity in school going adolescents. A total of 660 adolescents from affluent and nonaffluent schools were taken. Overweight and obesity was defined as per World Health Organization 2007 growth reference. Prevalence of overweight and obesity was 9.8% and 4.8%, respectively. Prevalence of both overweight and obesity was higher among males. Statistically significant difference was found in prevalence of overweight and obesity among affluent schools (14.8% and 8.2%) and nonaffluent schools (4.8% and 1.5%). Important determinants of overweight and obesity were increased consumption of fast food, low physical activity level and watching television for more than 2 h/day. The prevalence of obesity is high even in small cities. Dietary behavior and physical activity significantly affect weight of adolescent children.
Keywords: Adolescents, Dietary habits, Overweight, Obesity, Physical activity level
|How to cite this article:|
Nawab T, Khan Z, Khan IM, Ansari MA. Influence of behavioral determinants on the prevalence of overweight and obesity among school going adolescents of Aligarh. Indian J Public Health 2014;58:121-4
|How to cite this URL:|
Nawab T, Khan Z, Khan IM, Ansari MA. Influence of behavioral determinants on the prevalence of overweight and obesity among school going adolescents of Aligarh. Indian J Public Health [serial online] 2014 [cited 2019 Dec 15];58:121-4. Available from: http://www.ijph.in/text.asp?2014/58/2/121/132289
Obesity has been stated as the major avoidable risk factor for a wide range of noncommunicable diseases.  About a third of obese preschool children and a half of obese school-age children become obese adults.  The effective prevention of adult obesity will require the prevention and management of childhood obesity. A study was carried out to determine the prevalence and behavioral determinants of overweight and obesity in school going adolescents of Aligarh.
A cross-sectional study was conducted in two affluent (having tuition fees more than Rs. 10,000/annum), and two nonaffluent schools (having tuition fees less than Rs. 10,000/annum), in Aligarh. Type of school has been used as a proxy for socio-economic status. Approval was taken by Institutional Ethical Committee.
Taking estimated prevalence of overweight as 3.23%,  alpha error of 5%, 2% absolute allowable error and after adjusting for nonresponse rate, sample size calculated was 330. Thus, a total of 660 adolescents were taken equally from the affluent and nonaffluent schools.
Purposive selection of two affluent and two nonaffluent schools was done. Probability proportionate to size technique and systematic random sampling was done.
Apparently healthy school children of V to X standard, who had completed 10 years of age on the date of interview and were not more than 16 years of age (as per school records) were interviewed after taking informed consent from the school authorities and the parents. Children having any chronic illness, severe malnutrition, endocrinal problems, physical and mental defects, those with apparent obesity induced or associated with any syndrome and those found to be smokers (defined as any amount of smoking or tobacco chewing at any time during past 6 months) and those not cooperating for anthropometric measurements, were excluded.
A predesigned questionnaire was used to assess dietary habits. Total dietary intakes per day were assessed using individual 24 h recall method. Deficient, adequate, and excess calorie intakes per day were defined as recommended by Indian Council of Medical Research. 
Physical activity level (PAL) of adolescents and the total sedentary time per day was assessed using Global Physical Activity Questionnaire. 
Anthropometric measurements of weight and height were taken by standard methodology. 
Obesity and overweight was defined using body mass index as per World Health Organization growth reference 2007.  The strength of association of all determinants with overweight (including obesity) was studied by unadjusted odds ratio (95% confidence interval). Variables having significant association were subjected to stepwise multiple logistic regression models. Data analysis was performed using SPSS 17 software and P < 0.05 was considered as statistically significant.
57.6% (380 out of 660) were males. The prevalence of overweight and obesity was found to be 9.8% (65 out of 660) and 4.8% (32 out of 660), respectively. The prevalence of overweight and obesity among the males was 11.3% and 5.5%, respectively and in females 7.9% and 3.9%, respectively. A significant difference (χ2 = 99.593, df = 3, P < 0.05) was found in the prevalence of overweight and obesity among affluent (overweight 14.8%, obesity 8.2%) and nonaffluent schools (overweight 4.8%, obesity 1.5%).
Unadjusted bivariate analysis showed a significant relationship between overweight (including obesity) and type of diet, type of cooking medium used, fast food intake, PAL, television (TV) viewing and total sedentary time [Table 1].
|Table 1: Unadjusted bivariate relationship between different variables and overweight (including obesity)|
Click here to view
The variables showing significant association were considered in a stepwise logistic regression model with overweight and obesity as a binary outcome. The adolescents with a vegetarian diet, consuming fast food more than 1-2 times/day, having low PAL and viewing TV more than 2 h/day were found to be more at risk of overweight and obesity [Table 2].
|Table 2: Risk factors for overweight (including obesity) using stepwise logistic regression analysis|
Click here to view
In this study, the prevalence of overweight in school going adolescents was 9.8% which is in accordance with a large scale survey.  Prevalence rates of obesity in affluent sections of some larger cities in India have been reported to be 5.7%.  An increasing trend in prevalence of overweight and obesity has been shown by Raj et al.  in a study done in South India. Our study shows that even in small cities like Aligarh, prevalence of obesity is similar to larger cities, which is a matter of great concern.
We have found that the adolescents having a vegetarian diet were more at risk of overweight than those with nonvegetarian diet, although other researchers have reported vice-versa.  This may be due to the fact that in our study majority of the affluent adolescents were vegetarians.
On univariate analysis, we found a significant association between overweight and use of ghee i.e., saturated fat as a principal cooking medium. However, it was not found to be a significant independent risk factor on logistic regression analysis. Additional analysis regarding the amount of saturated fat used in the diet may explain the observation.
Fast food typically incorporates all of the potentially adverse dietary factors, including saturated and trans fat, high energy density, and increasingly, large portion size.  All these factors favor overweight and obesity. In this study, fast food intake was found to have a direct association with overweight like some other researchers. 
A decrease in energy expenditure through decreased physical activity is likely to be one of the major factors contributing to the global epidemic of overweight and obesity.  The advent of video games, computers, cable TV and public transportation systems have led to a decline in physical activity. Due to unsafe roads (traffic and crime), children are discouraged from walking or cycling to school. Motorized vehicles are popular and they are perceived to be quicker and safer for transport. Lack of open spaces for exercise and lack of parental time to supervise play, are all responsible for the new obesogenic lifestyles. Many authors have reported an inverse relationship between obesity and physical activity.  In this study also risk of overweight was found to increase with decreasing PAL.
Among all sedentary activities, TV viewing has received special attention, and in this study, it was found to be a significant independent factor affecting overweight and obesity. Some other authors have also reported similarly.  TV viewing is thought to promote weight gain not only by displacing physical activity, but also by increasing energy intake.  Children seem to passively consume excessive amounts of energy dense foods, while watching TV. Furthermore, TV advertising could adversely affect dietary patterns at other times throughout the day.
Limitations of the study include purposive selection of schools and use of 24 h recall for assessment of dietary intake.
It can be concluded from this study that increased fast food intake, decreased physical activity and increased sedentary pursuits like watching TV are important risk factors for obesity. Therefore, this study recommends that school health programs should be structured to create awareness for weight management in adolescents. Physical activities should be encouraged both in and outside of schools, and fast food intake should be monitored. Parents should be part of behavior change communication activities.
| Acknowledgment|| |
We thank all the participants of study for their co-operation.
| References|| |
|1.||WHO. Diet, Nutrition and the Prevention of Chronic Diseases. Report of a Joint WHO/FAO Expert Consultation. WHO Technical Report Series 916. Geneva: World Health Organisation; 2003. |
|2.||Serdula MK, Ivery D, Coates RJ, Freedman DS, Williamson DF, Byers T. Do obese children become obese adults? A review of the literature. Prev Med 1993;22:167-77. |
|3.||Raj M, Sundaram KR, Paul M, Deepa AS, Kumar RK. Obesity in Indian children: Time trends and relationship with hypertension. Natl Med J India 2007;20:288-93. |
|4.||Indian Council of Medical Research. Nutrient Requirements and Recommended Dietary Allowances. A Report of the Expert Group of the ICMR; 1990. |
|5.||Global Physical Activity Questionnaire (GPAQ). Available from: http://www.who.int/chp/steps. [Last accessed on 2009 Aug 10]. |
|6.||Physical status: The use and interpretation of anthropometry. Report of a WHO Expert Committee. World Health Organ Tech Rep Ser 1995;854:1-452. |
|7.||WHO Growth Reference, 2007. Available from: http://www.who.int/growthref/who2007_bmi_for_age/en/index.html. [Last accessed on 2009 Dec 05]. |
|8.||Global School-Based Student Health Survey. India (CBSE) 2007. Fact Sheet. Available from: http://www.2007_India_CBSE_fact_sheet.pdf. [Last accessed on 2010 Jul 21]. |
|9.||Khadilkar VV, Khadilkar AV. Prevalence of obesity in affluent school boys in Pune. Indian Pediatr 2004;41:857-8. |
|10.||Aggarwal T, Bhatia RC, Singh D, Sobti PC. Prevalence of obesity and overweight in affluent adolescents from Ludhiana, Punjab. Indian Pediatr 2008;45:500-2. |
|11.||Kelishadi R, Ardalan G, Gheiratmand R, Gouya MM, Razaghi EM, Delavari A, et al. Association of physical activity and dietary behaviours in relation to the body mass index in a national sample of Iranian children and adolescents: CASPIAN Study. Bull World Health Organ 2007;85:19-26. |
|12.||Laxmaiah A, Nagalla B, Vijayaraghavan K, Nair M. Factors affecting prevalence of overweight among 12-to 17-year-old urban adolescents in Hyderabad, India. Obesity (Silver Spring) 2007;15:1384-90. |
|13.||Robinson TN. Does television cause childhood obesity? JAMA 1998;279:959-60. |
[Table 1], [Table 2]
|This article has been cited by|
||Association between full service and fast food restaurant density, dietary intake and overweight/obesity among adults in Delhi, India
| ||Opal Patel,Safraj Shahulhameed,Roopa Shivashankar,Mohammad Tayyab,Atiqur Rahman,Dorairaj Prabhakaran,Nikhil Tandon,Lindsay M. Jaacks |
| ||BMC Public Health. 2018; 18(1) |
|[Pubmed] | [DOI]|
||An evaluation of outdoor school environments to promote physical activity in Delhi, India
| ||Samiksha Tarun,Monika Arora,Tina Rawal,Sara E. Benjamin Neelon |
| ||BMC Public Health. 2017; 17(1) |
|[Pubmed] | [DOI]|
||Overweight and obesity in early adolescents and its relation to dietary habit and physical activity: A study in Dibrugarh town
| ||Dimpymoni Saikia,Sultana J. Ahmed,Hiranya Saikia,Ratna Sarma |
| ||Clinical Epidemiology and Global Health. 2016; 4: S22 |
|[Pubmed] | [DOI]|
||Prevalence and correlates of achieving recommended physical activity levels among children living in rural South Asia—A multi-centre study
| ||Krithiga Shridhar,Christopher Millett,Anthony A. Laverty,Dewan Alam,Amit Dias,Joseph Williams,Preet K. Dhillon |
| ||BMC Public Health. 2016; 16(1) |
|[Pubmed] | [DOI]|
||Childhood obesity in low- and middle-income countries
| ||E. M. E. Poskitt |
| ||Paediatrics and International Child Health. 2014; 34(4): 239 |
|[Pubmed] | [DOI]|