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BRIEF RESEARCH ARTICLE
Year : 2017  |  Volume : 61  |  Issue : 1  |  Page : 51-54  

Prevalence of obesity and overweight and their comparison by three growth standards among affluent school students aged 8–18 years in Rajkot


1 Medical Director, Department of Medicine, Milestone Hospital, Rajkot, Gujarat, India
2 Associate Professor, Department of Community Medicine, P. D. U. Government Medical College, Rajkot, Gujarat, India
3 Diabetic Educator, Department of Medicine, Milestone Hospital, Rajkot, Gujarat, India
4 Resident, Department of Community Medicine, P. D. U. Government Medical College, Rajkot, Gujarat, India

Date of Web Publication16-Feb-2017

Correspondence Address:
Rajesh K Chudasama
Vandana Embroidery, Mato Shree Complex, Sardarnagar, Main Road, Rajkot - 360 001, Gujarat
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-557X.200251

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   Abstract 

Obesity and overweight emerged as an important public health problem in India. The present study was conducted to estimate the prevalence of obesity and overweight and compare it using three different standards among affluent school students aged 8–18 years from Rajkot, Gujarat. Anthropometric measurements of students of four schools from 3rd to 12th standards were taken. The prevalence of overweight and obesity was assessed using three standards – revised Indian Association of Pediatrics (IAP) 2015, WHO 2007, and International Obesity Task Force (IOTF) standards. A total of 1496 children including 79.1% boys and 20.9% girls participated in the study. The prevalence of obesity was reported 14% by IAP standards, 11.1% by WHO standards, and 5.1% by IOTF standards. Overweight children prevalence was reported more (19.1%) with IAP standards, followed by 15.8% with IOTF standards and 15.3% by WHO standards. High prevalence of obesity and overweight was reported with IAP 2015 standards and WHO 2007 standards.

Keywords: Affluent school students, obesity, overweight, prevalence, Rajkot


How to cite this article:
Eshwar T, Chudasama RK, Eshwar ST, Thakrar D. Prevalence of obesity and overweight and their comparison by three growth standards among affluent school students aged 8–18 years in Rajkot. Indian J Public Health 2017;61:51-4

How to cite this URL:
Eshwar T, Chudasama RK, Eshwar ST, Thakrar D. Prevalence of obesity and overweight and their comparison by three growth standards among affluent school students aged 8–18 years in Rajkot. Indian J Public Health [serial online] 2017 [cited 2017 Mar 28];61:51-4. Available from: http://www.ijph.in/text.asp?2017/61/1/51/200251

Obesity and overweight among school children are emerging as an important public health problem in India.[1],[2] These problems showed rapid increase, especially in cities and among affluent youth.[3],[4] Obesity in children and adolescents leads to health consequences among them and also increases risk of obesity in adulthood.[1] Different studies conducted during last decade in India reported prevalence of obesity in range of 2.9%–14.3%,[1],[2],[3] and of overweight in range of 1.5%–24.0%.[1],[2],[3],[5] These studies were conducted at different times in India, using different standards with different cutoff points to assess the prevalence of obesity and overweight. The different standards used in these studies included WHO 2007 references, Centre for Disease Control growth charts, International Obesity Task Force (IOTF) references, and Indian Association of Pediatrics (IAP) 2007 reference. Insufficient data are available related to the prevalence of obesity and overweight among school children and adolescents in Gujarat, in context of different growth standards available. Considering this, the present study was conducted to estimate the prevalence of obesity and overweight and compare it using the different standards among affluent school students aged 8–18 years from Rajkot city, Gujarat.

The study included schools having primary, secondary, and higher secondary education system. The top five schools of Rajkot offering education to the children of affluent families were selected for the study. The authorities of selected five schools were informed about the study objective and asked for the permission to conduct study, but four schools agreed to participate in the study. All the four schools had given permission to collect information from 3rd standard to 12th standard children aged 8–18 years. Hence, data were collected from 1496 children and adolescents including 1183 boys and 313 girls studying in these standards. Ethical clearance was taken from the Institutional Ethical Committee to conduct the study.

The study was conducted from January 2015 to April 2015. A team of three members was formed to collect the data and prior training was given to record anthropometric data. The team members remained same throughout the study period. The school authorities were informed prior for the visit of study team with date schedules for different standards. The message was given by school authorities to children to remain present on the day of study team visit. Those children remained present on days of visit of schools and given informed consent to participate were included in the study. One more visit was made to include the students absent during first visit. Those students remained absent during both visits were excluded from the study.

The anthropometric data such as height and weight measurements were made and recorded. The students removed their shoes and any other heavy items before measurement. Weight was measured using a digital scale and the scale was calibrated daily against standard weight. Height was measured using a standardized stadiometer. The weight was recorded to the nearest 0.1 kg and height to the nearest 0.1 cm.

Body mass index (BMI) was used to classify the study participants into obesity and overweight. The BMI was calculated using standard formula of weight in kg/height in squared meter. The participants were classified using age- and gender-specific cutoff points. Three different standards were used to classify them, (1) IAP – revised 2015 growth charts for height, weight, and BMI for 5–18 years old Indian children,[6] (2) WHO 2007 growth reference for 5–19 years,[7] and (3) IOTF reference for 2–18 years.[8] The children were grouped into different age groups such as 8–9 (childhood), 10–12 (early adolescence), 13–15 (mid-adolescence), and 16–18 (late adolescence). The age groups were categorized by the WHO considering the sexual and reproductive health of younger adolescents.[9]

The data were entered and analyzed using the statistical software Epi Info (Version 3.5.1), Center for Disease Control and Prevention, Atlanta, USA.[10] Chi-square test used to test difference in proportion of obesity and overweight. Kappa's statistics was used to compare the prevalence among different standards.

A total of 1496 students aged 8–18 years were present on days of visit to schools from 3rd to 12th standards and participated in the study including 1183 (79.1%) boys and 313 (20.9%) girls. The children were grouped into different age groups to calculate the different prevalence based on their BMI [Table 1]. Prevalence of obesity was reported 14% by IAP standards, 11.1% by WHO standards, and 5.1% by IOTF standards. Overweight children prevalence was reported more (19.1%) with IAP standards, followed by 15.8% with IOTF standards and 15.3% by WHO standards. Obesity prevalence for boys was reported 16.2% by IAP standards, 12.8% by WHO standards, and 5.8% by IOTF standards. Overweight prevalence by IAP standards was 19.2%, followed by IOTF (17.2%) and WHO (16.9%) standards. The prevalence of obesity among girls found low for all three standards (5.5% - IAP, 4.5% - WHO, 2.6% - IOTF). More overweight girls found with IAP standards (16.9%).
Table 1: Different age group prevalence of obesity and overweight of school children and adolescents as per different growth standards for body mass index*

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Weight status wise distribution of obesity, overweight, and normal weight was compared among the entire three standards used [Table 2]. The Kappa agreement between IAP 2015 and IOTF standards found 0.54, between WHO 2007 and IOTF standards was 0.58, and between IAP 2015 and WHO 2007 standards was 0.66 considering the above four weight status. The agreement becomes better when considered two combined categories of obesity/overweight versus normal weight/underweight among all the comparisons.
Table 2: Distribution of participants by weight status and different growth standards (n=1496)

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Obesity is perhaps the most prevalent form of malnutrition. As per recent Indian IAP 2015 standards,[6] the prevalence of obesity was reported to be 14% and of overweight 19.1%. The prevalence rates of overweight and obesity as per IAP 2015 standards were higher than WHO 2007 and IOTF standards. The prevalence of obesity measured by IOTF standards was very lower than IAP and WHO standards, indicating that IOTF standards underestimate the obesity among school children and adolescents in India, for both sexes. Similar findings observed by different studies from India in recent years.[2],[4],[5] In contrast, the IAP 2015 and WHO 2007 standards were very similar in classifying the obesity. A study from New Delhi also reported similar observations in their study among school-aged youth.[4] The differences in prevalence occur because of different study population and cutoff points used to define the BMI status for overweight and obesity as reported by various studies.[2],[5]

The prevalence of overweight and obesity reported in the present study is higher than different studies conducted in different parts of India.[1],[2],[3],[4],[5] As such the school children and adolescents selected in this study belong to very well to do affluent families, their lifestyle, and diet habits probably affect their nutritional status and make them more vulnerable to overweight and obesity considering their BMI status. The higher prevalence of overweight in the present study indicates more children will become obese while they become adult indicating rise in number of obesity in coming decades. Similar observations were reported by study from West Bengal, India.[5] High prevalence of obesity and overweight was reported among boys than girls in the present study. A study has reported obesity as per IOTF standards more among girls than boys.[2] In contrast, the present study reported more obese boys compare to girls like previous study.[3] Similarly, high prevalence of overweight boys was reported than girls in present study with all three standards while other study reported high prevalence among girls.[5]

A moderate agreement (κ = 0.54)[11] was observed among IAP 2015 and IOTF standards when compared for obesity, overweight, normal weight, and thinness among school children and adolescents. Similar agreement (κ =0.58) was observed among WHO 2007 and IOTF standards. A substantial agreement (κ =0.66) was observed among IAP 2015 and WHO 2007 standards. The agreement was better when two weight status categories were compared, i.e., obesity/overweight versus normal weight/underweight. Almost perfect agreement (κ = 0.84) observed among IAP 2015 and WHO 2007 standards indicates that both the standards can be used to estimate the prevalence of obesity and overweight among school children and adolescents in India.

There were few limitations of the present study such as (1) only urban schools were selected; (2) only four schools were selected; (3) no government school was selected; (4) age group of 8–18 years was covered instead of 5–18 years; and (5) enrolment of girl participants was less than boys. Further studies involving larger sample size, urban and rural schools, enquiring about diet pattern and eating habits, involving all socioeconomic class children, age group of 5–18 years will help detect more accurate prevalence of overweight and obesity among the school children and adolescents with different cutoff points and different growth standards. High prevalence of obesity and overweight was reported with IAP 2015 standards and WHO 2007 standards considering the BMI of affluent school students in the age group of 8–18 years in Rajkot. There was an underestimation of obesity with IOTF standards.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
Jain S, Pant B, Chopra H, Tiwari R. Obesity among adolescents of affluent public schools in Meerut. Indian J Public Health 2010;54:158-60.  Back to cited text no. 1
[PUBMED]  Medknow Journal  
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Kumaravel V, Shriram V, Anitharani M, Mahadevan S, Balamurgan AN, Sathiyasekaran B. Are the current Indian growth charts really representative? Analysis of anthropometric assessment of school children in a South Indian district. Indian J Endocr Metab 2014;18:56-62.  Back to cited text no. 2
[PUBMED]  Medknow Journal  
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Maiti S, De D, Ali KM, Bera TK, Ghosh D, Paul S. Overweight and obesity among early adolescent school girls in urban area of West Bengal, India: Prevalence assessment using different reference standards. Int J Prev Med 2013;4:1070-4.  Back to cited text no. 5
    
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Indian Academy of Pediatrics Growth Charts Committee, Khadilkar V, Yadav S, Agrawal KK, Tamboli S, Banerjee M, et al. Revised IAP growth charts for height, weight and body mass index for 5 to 18-year-old Indian children. Indian Pediatr 2015;52:47-55.  Back to cited text no. 6
    
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Cole TJ, Bellizzi MC, Flegal KM, Dietz WH. Establishing a standard definition for child overweight and obesity worldwide: International survey. BMJ 2000;320:1240-3.  Back to cited text no. 8
    
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World Health Organization (WHO). The Sexual and Reproductive Health of Young Adolescents: Research Issues in Developing Countries. WHO; 2011. Available from: http://www.whqlibdoc.who.int/publications/2011/9789241501552_eng.pdf. [Last accessed on 2015 May 24].  Back to cited text no. 9
    
10.
Centers for Disease Control and Prevention. Epi Info Version 3.5.1; 2008. Available from: http://www.cdc.gov/epiinfo/. [Last accessed on 2015 Mar 21].  Back to cited text no. 10
    
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Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics 1977;33:159-74.  Back to cited text no. 11
    



 
 
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