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BRIEF RESEARCH ARTICLE
Year : 2014  |  Volume : 58  |  Issue : 2  |  Page : 125-128  

Explaining overweight and obesity in children and adolescents of Asian Indian origin: the Calcutta childhood obesity study


Assistant Professor, Biomedical Research Laboratory, Department of Anthropology, Visva Bharati University, Santiniketan, West Bengal, India

Date of Web Publication12-May-2014

Correspondence Address:
Dr. Arnab Ghosh
Assistant Professor, Biomedical Research Laboratory, Department of Anthropology, Visva Bharati University, Santiniketan 731 235, West Bengal
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-557X.132290

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   Abstract 

The present study was aimed to find out the prevalence of overweight and obesity and its associated factors among Bengalee children and adolescents in the Kolkata, India. A total of 1061 Bengalee school children and adolescents (610 boys and 451 girls) participated and were divided into three age groups: Group I = 8-11 years; Group II = 12-15 years and Group III = 16-18 years. Overweight and obesity were defined as: Overweight (between ≥85 th and <95 th percentile) and obesity (≥95 th percentile). Multivariate regression analyses (adjusted for age and sex) of body mass index (BMI) revealed that about 18% (R2 = 0.185) of total variance of BMI could be explained by monthly family income, participants think obese, consumption of too much junk foodstuffs, breakfast skip, extra consumption of salt, and computer hours. Sedentary lifestyles, including increasing fast food preferences may be responsible for increasing occurrence of pediatric and adolescent obesity in this population.

Keywords: Asian Indians, Body mass index, Body composition, Central obesity, Childhood obesity


How to cite this article:
Ghosh A. Explaining overweight and obesity in children and adolescents of Asian Indian origin: the Calcutta childhood obesity study. Indian J Public Health 2014;58:125-8

How to cite this URL:
Ghosh A. Explaining overweight and obesity in children and adolescents of Asian Indian origin: the Calcutta childhood obesity study. Indian J Public Health [serial online] 2014 [cited 2019 Aug 20];58:125-8. Available from: http://www.ijph.in/text.asp?2014/58/2/125/132290

Obesity has been declared as a global pandemic [1] that constituted one of the leading future threats to public health. [2] This is a chronic, socially, stigmatized and costly disease, which is rarely incurable and is spreading to all the age groups, including children and adolescents. [3]

In people of South Asian origin, central obesity alone is a powerful predictor of morbidity and mortality from a number of chronic diseases, including overweight and obesity. [4] The prevalence of coronary heart disease (CHD) is known to be high in people of South Asian decent (people originally from India, Pakistan and Bangladesh). Moreover, CHD among them is often premature and occurs a decade earlier that seen in Europeans and/or Americans. Although, the prevalence of conventional risk factors, such as, smoking, hypertension and hyper cholesterolemia is not higher in South Asians than other ethnic groups yet, it is quite clear that some risk factors for atherosclerosis are particularly prevalent among them, including central and visceral obesity. [5],[6],[7] Follow-up studies from childhood to adulthood have shown that overweight children may become overweight adults if, obesity persists in teenage years.

In view of the above contemplation, the present school-based study was aimed to find out the prevalence of overweight and obesity among the Bengalee (Asian Indian origin) school children and adolescents in Kolkata (erstwhile Calcutta), India and also to assess the contributing factors responsible for it.

The present cross-sectional study was comprised of 1061 apparently healthy school children and adolescents (boys = 610 and girls = 451) aged 8-18 years. Participants were divided into three age groups: Group I = 8-11 years; Group II = 12-15 years and Group III = 16-18 years. All participants were belonging to Bengalee population and were inhabitants of the Kolkata, West Bengal, India. The study was undertaken between June 2008 and September, 2011. The participants were selected randomly from 10 schools in Kolkata. To obtain a better picture, different categories of schools such as private, government sponsored and government schools were considered randomly from Kolkata. Both secondary and higher secondary schools of private, government sponsored, and government schools were considered. It is important to mention that ~100 participants from each school were recruited in the study. For secondary schools, approximately 12-15 students from each class (class 5 up to 10 standards) were recruited as participants. On the other hand, about 10-12 students as participants were recruited from each class for higher secondary schools (class 5 up to 12 standards). Age of all participants was ascertained from the date of birth. Written and verbal consent was obtained from the school authorities and the guardian(s) respectively before the actual commencement of the work.

An open-ended schedule was used to obtain information on socio-economic and demographic characteristics. The responses to the open-ended schedule were natural, free of bias and respondents were not limited in their replies to a particular question posed to them. It is imperative to mention that items such as gross family income and expenditure, parents' occupation, education, etc., were obtained using telephonic conversation between respective guardian(s) and researcher.

Height, weight, waist circumference as well as skinfold thickness at biceps, triceps, subscapular and suprailiac were obtained using standard techniques. [8] Height and weight of lightly clothed participants were measured to the nearest 0.1 cm and 0.1 kg, respectively. Skinfolds thicknesses at biceps, triceps, subscapular, and suparailiac were measured on the left side of the body to the nearest 0.2 mm using a Holtain skinfold caliper (Holtain Corporation, UK). Sum of four skinfolds (SF 4 ) was calculated subsequently. Circumference of minimum waist (MWC) and hip was measured with an inelastic tape to the nearest 0.1 cm. Waist-hip ratio (WHR) was computed accordingly. Percentage of body fat (%BF) and body mass index (BMI) were measured using an Omron BF analyzer (Omron Corporation, Tokyo, Japan). It is noteworthy for mention that the Pearson's correlation coefficient (r) between the analyzer operated BMI and manually calculated BMI (weight in kg/height in m 2 ) was 0.92 (r = 0.92; P < 0.0001).

For all age groups, the percentiles of BMI (i.e., internally derived percentiles for each age group and sex and the reference values for BMI percentile were adapted from the Indian Academy of Pediatrics Growth Chart) [9] were calculated subsequently to assess the prevalence of overweight (≥85 th -<95 th percentile) and obesity (≥95 th percentile) in the study population. Multivariate regression analysis of BMI (adjusted for age and sex) by socio-economic and behavioral characteristics was undertaken to find out the relative contribution these factors (covariates) to explain BMI during childhood and adolescence.

All statistical analyses were performed using the SPSS (Chicago, IL, USA) (PC + version 10). A P < 0.05 (two tailed) was considered as statistically significant.

It was observed that there existed significant sex differences for %BF, SF 4 , MWC, and WHR in all three age groups. It is noteworthy to mention that a greater %BF, SF 4 , MWC, and WHR were observed among girls compared with boys for Group III (16-18 years). Prevalence of overweight (BMI-for-age between ≥85 th percentile to <95 th percentile) and obesity (BMI-for-age ≥95 th percentile) in the study was 10.2% and 5.2%, respectively. The prevalence of overweight in the three age groups was 13.3%, 19.8%, and 18.5% from Group I to Group III. On the other hand, the prevalence of obesity for the groups was 4.1%, 7.6%, and 5.4%, respectively. Highest prevalence of overweight and obesity was observed for girls in the age group 12-15 years and 16-18 years, respectively [Table 1]. The prevalence of overweight and obesity had increased consistently with increasing monthly family income. However, the prevalence of overweight and obesity had increased less consistently by parental education.
Table 1: Prevalence of overweight and obesity by age groups and sex

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In multiple regression analysis of BMI (adjusted for age and sex), it was observed that about 18% (R2 = 0.185) of the total variance of BMI could be explained by monthly family income, subject think obese, consumption of too much junk foodstuffs, breakfast skip, extra consumption of salt, and computer hours [Table 2].
Table 2: Multiple regression analyses of BMI (adjusted for age and sex)

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The significant age group difference for anthropometric and body composition variables may be associated with the pubertal growth spurt and therefore, provides key information regarding current and future health of children and adolescents. However, generally, in case of boys the fat-free mass (FFM) increase and decrease the fat mass (FM) as well as the total fat of the body compare to girls during adolescence. [5],[10] This could be the most possible reason of why there was a decreasing trend for %BF across the groups in the study population. However, financial limitation to use more direct techniques, e.g., dual energy X-ray absorptiometry as well as lack of appropriate prediction formula (algorithm) did not permit us to predict FM and FFM in the study.

The BMI of the present study, population was observed to be highly associated with a number of factors, such as monthly family income of the study population, thinking of obesity, thinking of taking too much fast and junk foods, breakfast skipping, extra salt consumption, and spending time with computers. Each of these factors contributed independently about 2-3% (result was not shown), whereas, all these factors cumulatively explained about 18% of the total variance of BMI irrespective of age and sex. The monthly family income, self-attitude toward obesity, taking extra salt and spending time with computer all are part of a vicious cycle that lead children and adolescents toward obesity. [5] In the present study, it was also observed that breakfast skipping was found to be associated more strongly with BMI compare to other factors. Missing breakfast has had been associated with increased consumption of snacks and fast foods and findings from the present study support this. This could be due to the fact that children and adolescents of present investigation, who used to skip breakfast, were more frequent consumers of unhealthful snacks/junk foods, as the surrogate to their home-made breakfast, outside their house.

It was also observed that there existed a positive trend for the prevalence of overweight and obesity by increasing family income and parental education; however, the trend was not statistically significant. Increasing capacity to purchase fast foods is invariably associated with the family income and this could be one possible reason to explain the present trend.

Finally, investigation should have to be initiated in the "Indian Diaspora" worldwide to elucidate if, they (migrant Asian Indian children and adolescents) also show similar trend to that of sedentes in India or native population of the respective counties. [4],[5] Such studies would generate valuable information on the childhood prevention of adult chronic diseases, which are becoming a concerned cause of morbidity and mortality among our children and adolescents. [10]


   Acknowledgments Top


Author is thankful to Rupak Dutta and Paramita Mondal for collection of data. Author is also thankful to the school authorities as well as to all the participants for their sincere cooperation during data collection.

 
   References Top

1.WHO Consultation on Obesity. Special issues in the management of obesity in childhood and adolescence. In: World Health Organization, editor. Obesity Preventing and Managing the Global Epidemic. Geneva: WHO; 1998. p. 231-7.  Back to cited text no. 1
    
2.World Health Organization. World Health Report 2002: Reducing Risk - Promoting Healthy Life. Geneva/WHO.  Back to cited text no. 2
    
3.Ghosh A. Childhood obesity: Association with blood pressure and physical activity in 8 to14-year-old Asian Indian children and adolescents. In: Flamenbaum RK, editor. Childhood Obesity and Health Research. New York, USA: Nova Science Publishers, Inc.; 2006. p. 55-70.  Back to cited text no. 3
    
4.Ghosh A. Effects of socio-economic and behavioural characteristics in explaining central obesity - A study on adult Asian Indians in Calcutta, India. Coll Antropol 2006;30:265-71.  Back to cited text no. 4
[PUBMED]    
5.Ghosh A. Factor analysis of risk variables associated with metabolic syndrome in Asian Indian adolescents. Am J Hum Biol 2007;19:34-40.  Back to cited text no. 5
[PUBMED]    
6.Must A, Jacques PF, Dallal GE, Bajema CJ, Dietz WH. Long-term morbidity and mortality of overweight adolescents. A follow-up of the Harvard Growth Study of 1922 to 1935. N Engl J Med 1992;327:1350-5.  Back to cited text no. 6
    
7.Subramanyam V, Jayashree R, Rafi M. Prevalence of overweight and obesity in affluent adolescent girls in Chennai in 1981 and 1998. Indian Pediatr 2003;40:775-9.  Back to cited text no. 7
    
8.Lohman TG, Roche AF, Martorell R. Anthropometric Standardization Reference Manual. Chicago: Human Kinetics Books; 1988.  Back to cited text no. 8
    
9.Khadilkar VV, Khadilkar AV, Choudhury P, Agarwal KN, Ugra D, Shah NK. IAP growth monitoring guidelines for children from birth to 18 years. Indian Pediatr 2007; 44:187-97.  Back to cited text no. 9
    
10.Ramachandran A, Snehalatha C, Vinitha R, Thayyil M, Kumar CK, Sheeba L, et al. Prevalence of overweight in urban Indian adolescent school children. Diabetes Res Clin Pract 2002;57:185-90.b18.  Back to cited text no. 10
    



 
 
    Tables

  [Table 1], [Table 2]


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