|BRIEF RESEARCH ARTICLE
|Year : 2018 | Volume
| Issue : 2 | Page : 153-155
Is obesity a problem among school children?
Rajesh Kunwar1, Sukhmeet Minhas2, Vipra Mangla3
1 Col Health and Senior Adviser Community Medicine, HQ 3 Corps (Med), Army Hospital (R&R), Delhi, India
2 Classified Specialist Community Medicine, HQ 10 Corps (Med), Army Hospital (R&R), Delhi, India
3 Classified Specialist Community Medicine, Army Hospital (R&R), Delhi, India
|Date of Web Publication||14-Jun-2018|
Col Health, HQ 3 Corps (Med), C/o 99 APO
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Reduction of premature mortality due to noncommunicable diseases through prevention and control forms the core issue of target 3.4 of sustainable development goals. Childhood obesity is an important public health challenge today. The current study was carried out in a large military station of North East India to find out prevalence of obesity among schoolchildren using World Health Organization body mass index-for-age charts for boys and girls. A total of 793 schoolchildren comprising of 328 girls and 465 boys between the age groups of 6 and 19 years were included. The prevalence of overweight and obesity among girls was 9.76% and 1.22%; and among boys, it was 10.97% and 3.23%, respectively. Overweight and obesity were more common among boys as compared to girls under the age of 13 years but trend changed afterwards. Lower prevalence of overweight and obesity found in our study could be because of availability of healthful environment in schools.
Keywords: Body mass index-for-age, childhood obesity, schoolchildren, sustainable developmental goals
|How to cite this article:|
Kunwar R, Minhas S, Mangla V. Is obesity a problem among school children?. Indian J Public Health 2018;62:153-5
The UN General Assembly's 2030 agenda for transforming our world comprised of 17 sustainable development goals (SDGs). Of these, target 3.4 of SDG-3 deals with reduction of premature mortality due to noncommunicable diseases through prevention and control. One of the most common, most concerning, and above all, a preventable risk factor for noncommunicable diseases is obesity which has the potential of negating the health benefits achieved so far toward increasing the life expectancy.
Childhood obesity is one of the most important public health challenges the world is facing today. The problem is global and is slowly acquiring epidemic proportions. In India too, the prevalence of overweight as well as obesity among children and adolescents has shown an increasing trend in all strata of society. It is because majority of today's children are living in obesogenic environment. Inclination to fast foods and sugar-sweetened beverages and preference for screen games to outdoor games are leading to energy imbalance and increasing obesity which, once acquired, persists during adulthood and rest of the life. Childhood, therefore, is the critical time to detect overweight/obesity and start preventive action to ward off the scourge of noncommunicable diseases.
Body mass index (BMI) is considered the most comprehensive measure of fatness. Depending on its value, adults are classified into normal, overweight, and obese categories. However, the same scale does not hold good for schoolchildren because rate of change of BMI varies with age as well as sex. Accordingly, World Health Organization (WHO) has brought out different BMI-for-age charts for boys and girls.
The current study was carried out to find out the prevalence of obesity among schoolchildren using WHO BMI-for-age charts for boys and girls.
This cross-sectional study was carried out in a large military station of North East India. The garrison is self-reliant, has a strength of approximately 8500 army personnel and their dependents. There are only two schools and each has classes from 5th standard to 12th standard. All the students are wards of army personnel and come from almost similar socioeconomic status class.
Assuming the combined prevalence of overweight and obesity as 20%, based on the recently published article, and acceptable margin of error as 3%, the sample size at 95% confidence interval was estimated at 682. As the combined strength of students in both the schools of garrison was 886, all students were included in the study to enhance the precision.
All apparently healthy students were included in the study. Students suffering from any systemic illness or chronic illness were excluded from the study. Information regarding age, sex, and class in which studying was obtained from school records. Age was recorded to nearest completed years. Prior consent for carrying out medical examination of children was taken from parents and school authorities.
Medical examination of children was carried out by a team of medical officers and paramedics. It included recording of height, weight, and clinical examination of all systems. Height was recorded with the help of a steel-detachable height-measuring rod with an accuracy of 0.1 cm. Weight was recorded using electronic weighing machine with an accuracy of 0.1 kg. All students were weighed with uniform but without shoes, and weight was recorded after deducting 200 gm (0.2 kg) for uniform. The weighing machine was checked with standard weights every day before the start of the study. All members of the team were adequately trained about measurement procedures, and a reliability check was carried out by the investigator.
BMI in respect of all the students was computed by the investigator and compared with the median of standard BMI-for-age chart of WHO. All children with one standard deviation above BMI for age and sex were defined as overweight and those with two standard deviations above BMI for age and sex were defined as obese.
Data were compiled in Excel and were analyzed using statistical software.
In the present cross-sectional study, a total of 793 schoolchildren comprising of 328 (41.4%) girls and 465 (58.6%) boys between the age groups of 6 and 19 years were included. They were, subsequently, grouped based on primary (6–10 years), upper primary (11–13 years), secondary (14–15 years), and senior secondary (16 years and above) levels of education. Their sex-wise distribution according to level of education is given in [Table 1]. As can be seen from [Table 1], the difference in the distribution of boys and girls in various age groups is not statistically significant.
BMI of all schoolchildren was compared with the WHO BMI-for-age chart. As can be seen from [Table 2], the prevalence of overweight among girls was 9.76%, and among boys, it was 10.97%. Only 1.22% of girls and 3.23% of boys were found to be obese. The overall prevalence, boys and girls combined, of overweight and obesity was 10.5% and 2.4%, respectively.
|Table 2: Prevalence of overweight and obesity according to age group and sex|
Click here to view
Overweight and obesity were more common among boys as compared to girls under the age of 13 years; combined prevalence of overweight and obesity among boys up to age of 10 years was 18.75% which is approximately twice more common than that among girls (i.e., 9.73%) of the same age group. It reduced to almost one and half times, i.e., 17.42% among boys and 12.24% among girls, in the age group of 11–13 years. Trend changed afterward and a larger proportion of girls were overweight. However, except in the age group of 6–10 years, difference in the prevalence of overweight between sexes was not found statistically significant.
The present study was carried out as part of school health program. The prevalence of overweight and obesity found in our study was less than that found by Ranjani et al. in their systematic review of 52 studies, published between 1980 and 2013, on childhood overweight and obesity; Pawar et al. in their study of 4 schools in South Mumbai; Jagadesan et al. in their study among schoolchildren and adolescents in Chennai; Pradeepa et al. in their study in Tamil Nadu and Maharashtra; and Misra et al. in their multicentric study of 38,296 schoolchildren.
One of the reasons for lower prevalence of overweight and obesity in our context could be because the schools are located in a garrison where schools aim at all round development of children and place special emphasis on games and physical activities. Students are motivated to participate in various health activities being carried out in the garrison. Such inclusion of mandatory physical activity sessions in schools, according to Khandelwal and Reddy, is one of the important interventions toward controlling obesity. Another reason which is also a limitation of the study could be a small sample size which has not been able to detect the true prevalence of overweight and obesity in schoolchildren.
In our study, we also noted that overweight and obesity were more common among boys as compared to girls under the age of 13 years. Trend changed afterward and a larger proportion of girls were overweight. Similar findings have also been reported by Misra et al. Higher prevalence of obesity among adolescent girls may be linked to an early attainment of puberty as compared to boys. Postpubertal adolescent girls in the sociocultural milieu of developing countries like ours have very low levels of physical activity that is mainly restricted to household chores. Their participation in outdoor games and other health enhancing physical activities are much less as compared to boys.
In India, National Health Policy 2017 envisaged school health programs as a major focus area and laid emphasis on the health challenges faced by the adolescents. The time is ripe to take action and not to wait for the obesity epidemic to strike if we have to achieve the target set under SDG 2030. Technically appropriate and sound intervention backed by political will and committed resources is the need of the hour.
Obesity continues to be the most important preventable risk factor for lifestyle diseases. Childhood is the most critical time to prevent and control obesity. Healthful environment in schools is one of the many technically sound interventions for checking the rising prevalence of overweight and obesity. Large scale trials using healthful environment in schools as intervention may pave the way for a newer strategy in this direction.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Ranjani H, Mehreen TS, Pradeepa R, Anjana RM, Garg R, Anand K, et al.
Epidemiology of childhood overweight and obesity in India: A systematic review. Indian J Med Res 2016;143:160-74.
] [Full text]
World Health Organization. Obesity: Preventing and Managing the Global Epidemic. Technical Report Series 894. Geneva: World Health Organization Publications; 2004.
Pawar SV, Choksey AS, Jain SS, Surude RG, Rathi PM. Prevalence of overweight and obesity in 4 schools of South Mumbai. J Clin Diagn Res 2016;10:OC01-2.
Jagadesan S, Harish R, Miranda P, Unnikrishnan R, Anjana RM, Mohan V, et al.
Prevalence of overweight and obesity among school children and adolescents in Chennai. Indian Pediatr 2014;51:544-9.
Pradeepa R, Anjana RM, Joshi SR, Bhansali A, Deepa M, Joshi PP, et al.
Prevalence of generalized & abdominal obesity in urban & rural India – The ICMR-INDIAB study (Phase-I) [ICMR- NDIAB-3]. Indian J Med Res 2015;142:139-50.
] [Full text]
Misra A, Shah P, Goel K, Hazra DK, Gupta R, Seth P, et al.
The high burden of obesity and abdominal obesity in urban Indian school children: A multicentric study of 38,296 children. Ann Nutr Metab 2011;58:203-11.
Khandelwal S, Reddy KS. Eliciting a policy response for the rising epidemic of overweight-obesity in India. Obes Rev 2013;14 Suppl 2:114-25.
Government of India. National Health Policy 2017. New Delhi: Ministry of Health & Family Welfare, Government of India; 2017.
[Table 1], [Table 2]