|Year : 2020 | Volume
| Issue : 1 | Page : 28-33
Overweight and obesity among school-going adolescents in Bengaluru, South India
Anangamanjari D Pedapudi1, Ryan A Davis1, Priya Rosenberg2, Priya Koilpillai3, Bhavya Balasubramanya4, Avita Rose Johnson5, Ambuj Kumar6, Lynette Menezes6
1 Medical student, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
2 Medical Student, Graduate Entry Medical School, University of Limerick, Limerick, Ireland
3 Department of Internal Medicine, University of Calgary, Calgary, Canada
4 Department of Community Medicine, Rural Unit for Health and Social Affairs, Christian Medical College, Vellore, Tamil Nadu, India
5 Department of Community Health, St. John's Medical College, Bengaluru, Karnataka, India
6 Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
|Date of Submission||26-Aug-2019|
|Date of Decision||17-Apr-2020|
|Date of Acceptance||22-Apr-2020|
|Date of Web Publication||5-Jun-2020|
Avita Rose Johnson
Department of Community Health, St. John's Medical College, Bengaluru - 560 034, Karnataka
Source of Support: None, Conflict of Interest: None
Introduction: Adolescent obesity is an emerging public health problem in urban India. This study assessed the prevalence of overweight and obesity and its associated factors among school-going adolescents in Bengaluru, India.
Material and Methods: Cross-sectional study of 734 male and female students aged 10 years and older from two private schools in Bengaluru city, India. Students were administered a questionnaire that recorded socioeconomic, and family-related factors and lifestyle behaviors. Anthropometric measurements done to determine overweight and obesity using the WHO body mass index for age charts. Nominal variables were described in terms of frequency and proportion, and odd's ratio (OR) (with 95% confidence interval) as test of association.
Results: The prevalence of overweight and obesity among adolescents was 21.7% and 6.1% respectively. Age, gender, religion, education level of parents, mother working outside the home, participation in vigorous physical activities, vegetarian diet, and consumption of junk foods as snacks were not found to be significantly associated with overweight/obesity.
Conclusion: The prevalence of overweight/obesity among school-going adolescents in Bengaluru, India was 27.8%. Adolescents from the higher income families, OR = 2.35 (1.43–3.85) as well as students who indicated a family history of obesity, OR = 2.4 (1.72–3.33) were more likely to be overweight or obese. Since young adolescents spend a significant portion of their day in school, a comprehensive school health service including growth monitoring, nutrition education, and exercise programs remains one of the most cost-effective public health measures.
Keywords: Adolescent, body mass index, diet, obesity, urban
|How to cite this article:|
Pedapudi AD, Davis RA, Rosenberg P, Koilpillai P, Balasubramanya B, Johnson AR, Kumar A, Menezes L. Overweight and obesity among school-going adolescents in Bengaluru, South India. Indian J Community Fam Med 2020;6:28-33
|How to cite this URL:|
Pedapudi AD, Davis RA, Rosenberg P, Koilpillai P, Balasubramanya B, Johnson AR, Kumar A, Menezes L. Overweight and obesity among school-going adolescents in Bengaluru, South India. Indian J Community Fam Med [serial online] 2020 [cited 2021 Apr 18];6:28-33. Available from: https://www.ijcfm.org/text.asp?2020/6/1/28/286033
| Introduction|| |
Obesity has reached epidemic proportions in urban India, affecting about 5% of the country's urban population. Specifically, obesity is an emerging problem among urban Indian adolescents. The substantial increase in adolescent obesity prevalence over recent decades is concerning as it is associated with a number of negative health consequences during adult life, such as hypertension, diabetes, coronary artery disease, osteoarthritis, and overall increase in morbidity and mortality., Adolescent obesity may be attributed to physical inactivity and unhealthy diets rich in sugar and fats, and other environmental factors.
In low- and middle-income countries, obesity has traditionally been a disease of the affluent, and of urban populations. Given that Indian and Western fast foods are widely available, accessible and affordable in India, and the marketing of processed, high sugar and high fat foods (junk food), through mass media targeted specifically at the young population, there has been a cultural shift in the diet of adolescents. This change in diet combined with the increasingly sedentary adolescent lifestyles resulting from lack of public spaces for physical activity and dependence on television and gadgets for entertainment has resulted in increasing obesity levels among adolescents in India. Bangalore with a population of more than 8.5 million, is an example of a city which has undergone rapid urbanization with consequent health issues.
Previous studies on overweight and obesity among Indian school-going adolescents were limited to reporting only the prevalence, using anthropomorphic measurements, However, a few studies have focused on the factors contributing to obesity rise among this population, but these have investigated a few variables such as gender and socioeconomic status, overlooking the diverse range of factors that contribute to overweight/obesity such as family health history, physical activity, and diet. In other regions of the world, level of physical activity,, socioeconomic status and ethnicity, quality and quantity of food, including lack of fruits and vegetables,, are factors found to have significant associations with overweight and obesity among adolescents. Thus, this study aimed to assess overweight and obesity prevalence among school-going adolescents in Bengaluru, India, as well as evaluate factors including socioeconomic characteristics, family health history and lifestyle behaviors associated with overweight and obesity. Investigating these diverse factors can inform the development of targeted interventions within the Indian socio-cultural context to address their influence and reduce overweight and obesity prevalence in this neglected population.
| Materials and Methods|| |
This cross-sectional study assessed the prevalence of obesity and overweight among adolescents enrolled in two private schools, specifically an all-girls school and a co-educational school, both located in Bengaluru city, India. Based on a previous study, where the prevalence of overweight adolescents was found to be 15% in urban Indian schools the minimum sample size was calculated with a precision of 5%, and a power of 80%, to be 195 participants. However, the school authorities requested that the nutritional status be determined for all adolescents in the school. Therefore, all the students who met the inclusion criteria were enrolled in the study. Inclusion criteria: students aged 10 years and older, who gave assent, and who got parental consent. Exclusion criteria: Students who were absent on the days of the visit by the investigators. A list of all the students aged 10 years and above was obtained. The sample size covered was 448 out of 497 eligible students (90.1%) in the all-girls school and 286 out of 303 eligible students (94.4%) in the co-educational school. The study received approval from the Institutional Ethics Committee of St. John's Medical College, Bengaluru and the Institutional Review Board of the University of South Florida, USA. Data collection was done over a 2 weeks in each school and the data analysis and manuscript writing over 3 months in 2018.
Each participant completed a pretested, self-administered, structured questionnaire that recorded socioeconomic details, family health history, dietary patterns, and physical activity of the students (exposure variables). This questionnaire was validated by two experts in the field of adolescent obesity. For outcome variables, anthropometric measurements (height and weight) were recorded. Weight was measured to the nearest 100 g using a Salters digital weighing scale. Height was measured to the nearest millimeter using a nonstretchable measuring tape. These anthropometric measurements were then used to calculate body mass index (BMI) for age and classify the nutritional status of the subjects using the WHO Anthroplus software, developed by the Department of Nutrition, World Health Organization, Geneva, Switzerland. As per the WHO BMI-for-age classification system (5–19 years), the participants were categorized into the following groups based on BMI-for-age z-scores: ≤−3 = severe thinness, >−3 –to − 2= thinness, >−2 to + 1= normal, >+1 to + 2= overweight, >+2 to +3= obese, and > +3 = severely obese. Students found to be overweight/obese and thin/severely thin were referred to a nutritionist at St. John's Medical College Hospital.
Data were analyzed using Standard Package Statistical Software (SPSS) version 16 SPSS, manufactured by IBM, New York, USA. Descriptive statistics such as frequencies, proportions, mean and standard deviation were used to measure the variables. Odds ratio (OR) with 95% confidence intervals (CIs) were used to evaluate the association of exposure variables: socioeconomic factors, family health history, diet, and physical activity with the outcome variable of obesity and overweight. Obesity and overweight were clubbed together as a single outcome variable for the analysis. A P < 5% was considered as statistically significant.
| Results|| |
Demographic characteristics and prevalence of overweight/obesity
A total of 734 adolescent school students aged 10–16 years old participated in the study, of whom 636 (86.6%) were female and 98 (13.4%) were male. The mean age was 12.3 years (±1.83). Students ranged from grade 5–10. Approximately, 14.7% of students identified themselves as vegetarian [Table 1]. The overall prevalence of overweight/obesity was 27.8% with 159 (21.7%) overweight and 45 (6.1%) obese [Figure 1].
|Figure 1: Weight distribution of students as per the WHO adolescent body mass index standards|
Click here to view
Factors associated with overweight/obesity
Overall, there was a statistically significant association between income level and obesity. Compared with adolescents in the lower income group (monthly household income of ≤50,000 rupees), adolescents in the higher income group (>50,000 rupees) were significantly more likely to be obese (OR = 2.35; 95% CI = 1.43–3.85; P = 0.001) [Table 2]. Age, gender, religion, parents' education level, and mother working outside the home were not significantly associated with overweight/obesity.
|Table 2: Risk factors of overweight and obesity in urban adolescents (n =734|
Click here to view
Family health history
Students who reported a history of obesity in their family were more likely to be overweight/obese than both students who did not indicate the presence of family obesity and those who were not aware of their family's obesity status (OR = 2.44; 95% CI = 1.72–3.33; P ≤ 0.001). Overweight/obesity prevalence was higher among adolescents who reported a family history of diabetes (28.7%) or hypertension (28.7%) than those who did not (25.5% and 26.2%), but this was not statistically significant [Table 2].
The prevalence of overweight/obesity was higher among students who did not participate in vigorous physical activity (33.8%) and those who usually consumed junk food (30.9%), as compared to those who reported participation in vigorous physical activities (25.8%) and those who did not usually consume junk foods as snacks (24.7%). However, this was not statistically significant [Table 2]. The type of diet (vegetarian or nonvegetarian) was not associated with overweight/obesity.
| Discussion|| |
Our study findings show that the overall prevalence of overweight/obesity in school going adolescents from private schools of Bengaluru city is high at 27.8%. This high prevalence of overweight and obesity is similar to other metropolitan cities in India; among adolescents attending private schools in urban Mumbai (22.9%) and among middle-class adolescents in urban New Delhi (33%). Given that 30% of India's population live in urban areas and one in five persons is an adolescent, this high prevalence suggests a critical need for preventive action for adolescent overweight and obesity.
Our study found that higher family income was statistically significantly associated with adolescent overweight/obesity. Likewise, a study among adolescents in urban Hyderabad revealed that the prevalence of overweight was four times higher among adolescents of higher socioeconomic status than those from a lower socioeconomic group (OR = 4.1; 95% CI = 2.25–7.52). Unlike developed countries, where the majority of overweight and obese adolescents are from lower income families, obese Indian adolescents are more likely to be from higher income families. Adolescents from higher income families have increased access to fast food in urban areas and lower levels of physical activity owing to lack of spaces to play and increasing time spent in sedentary activities. Although the proportion of overweight/obesity was higher among students who were less physically active and consumed junk food regularly, this was not statistically significant, unlike in other studies among urban adolescents in the states of Karnataka and Bihar, where this association was found to be significant. This may have been because those studies had a more detailed and in-depth analysis of diet and physical activity to accurately measure consumption of junk food and physical inactivity, which was not possible from the data collected in the present study.
Family history of obesity was significantly associated with adolescent overweight/obesity similar to a study among urban adolescent school children in Odisha. This association might be explained by genetic predisposition, behavioral and dietary factors as shown in twin and adoption studies., It has been theorized that certain genes are programmed to overreact to the “obesogenic” environment of high caloric intake and low energy expenditure. However, parents' lifestyle and practices can shape children's early experience and perception of food intake, since healthy eating habits are often learned from parents. Parental attitude toward diet and eating, specifically disinhibition in dietary intake, has been found to significantly increase the risk of excess weight gain in children. Children of obese parents often report a greater preference for fatty, less-nutritious foods and sedentary activities than children of nonobese parents.
Previous studies reflect a similar high prevalence of overweight/obesity among adolescents from private schools than those from government-operated schools. Several factors possibly influence this high prevalence, particularly rising household incomes and the resulting increased accessibility to processed and junk foods and sedentary modes of transportation and entertainment. School-going adolescents are a relatively easy to reach population. What is instructed, observed, and practiced at this age will result in a long-lasting effect, which will most likely continue into, and influence their adult life. An added benefit of school health education is that adolescents can share health messages regarding obesity prevention to members of the family and community. Since younger adolescents spend a significant portion of their day in school, a comprehensive school health service including growth monitoring, nutrition education, and exercise programs remains one of the most cost-effective public health measures.,
Our study had some limitations. The study participants were mainly middle and upper-middle class and thus the results may be generalized to this particular socioeconomic class and may not be representative of the entire urban adolescent population. In addition, data from older adolescents (17–19 years) were not captured in this study, as high school is mostly completed by the age of 16 years. Although the outcome variable (overweight/obesity) was measured accurately based on the BMI, the exposure variables were based on self-report and therefore, it was not possible to verify data or accurately measure consumption of junk food, levels of physical inactivity, and family history of diabetes and hypertension. Furthermore, participants were predominantly females as one school had only girls which could influence overweight/obesity prevalence in the overall sample.
| Conclusion|| |
This study demonstrates a high prevalence of overweight/obesity among urban school-going adolescents in Bengaluru, India. Adolescents from the higher income families, as well as students who reported a family history of obesity, were more likely to be overweight or obese. Our findings suggest a critical need for comprehensive public health interventions including growth monitoring, nutrition education and promotion of physical education and exercise programs in schools and communities to combat this rising threat to adolescent health in India.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Obesity: Preventing and Managing the Global Epidemic. Report of a WHO Consultation (WHO Technical Report Series 894). Geneva: World Health Organization; 2000. p. 16-34.
Pathak S, Modi P, Labana U, Khimyani P, Joshi A, Jadeja R, et al
. Prevalence of obesity among urban and rural school-going adolescents of Vadodara, India: A comparative study. Int J Contemp Pediatrics 2018;5:1355-9.
Kaur S, Kapil U, Singh P. Pattern of chronic diseases amongst adolescent obese children in developing countries. Curr Sci 2005;88:1052-56.
Hariram V, Talwar K. Healthy weight, healthy shape. Indian J Med Res 2005;122:187-90.
Subramanyam V, Rafi M. Prevalence of overweight and obesity in affluent adolescent girls in Chennai in 1981 and 1998. Indian Pediatr 2003;40:332-6.
Bhardwaj S, Misra A, Khurana L, Gulati S, Shah P, Vikram NK. Childhood obesity in Asian Indians: A burgeoning cause of insulin resistance, diabetes and sub-clinical inflammation. Asia Pac J Clin Nutr 2008;17 Suppl 1:172-5.
Friel S, Chopra M, Satcher D. Unequal weight: Equity oriented policy responses to the global obesity epidemic. BMJ 2007;335:1241-3.
Monteiro CA, Conde WL, Lu B, Popkin BM. Obesity and inequities in health in the developing world. Int J Obes Relat Metab Disord 2004;28:1181-6.
Narayana MR. Globalization and urban economic growth: Evidence for Bangalore, India. Int J Urban Reg Res 2011;35:1284-301.
Lobstein T, Jackson-Leach R, Moodie ML, Hall KD, Gortmaker SL, Swinburn BA, et al
. Child and adolescent obesity: Part of a bigger picture. Lancet 2015;385:2510-20.
Sood A, Sundararaj P, Sharma S, Kurpad AV, Muthayya S. BMI and body fat percent: Affluent adolescent girls in Bangalore City. Indian Pediatr 2007;44:587-91.
Chhatwal J, Verma M, Riar SK. Obesity among pre-adolescent and adolescents of a developing country (India). Asia Pac J Clin Nutr 2004;13:231-5.
Unnithan AG, Syamakumari S. Prevalence of overweight, obesity and underweight among school going children in rural and urban areas of Thiruvananthapuram Educational District, Kerala State (India). Internet J Nutr Wellness 2008;6:1-6.
Centers for Disease Control and Prevention. Childhood Obesity Causes and Consequences. Atlanta, USA: Centers for Disease Control and Prevention; 2018. Available from: https://www.cdc.gov/obesity/child hood/causes.html
. [Last accessed on 2018 July 07].
Gordon-Larsen P, Adair LS, Popkin BM. Ethnic differences in physical activity and inactivity patterns and overweight status. Obes Res 2002;10:141-9.
Sulemana H, Smolensky MH, Lai D. Relationship between physical activity and body mass index in adolescents. Medi Sci Sports Exerc 2006;38:1182-6.
Gordon-Larsen P, Adair LS, Popkin BM. The relationships of ethnicity, socioeconomic factors, and overweight in U.S. Adolescents. Obes Res 2003;11:121-9.
Tate NH, Dillaway HE, Yarandi HN, Jones LM, Wilson FL. An examination of eating behaviors, physical activity, and obesity in African American adolescents: Gender, socioeconomic status, and residential status differences. J Pediatr Health Care 2015;29:243-54.
Lowry R, Wechsler H, Galuska DA, Fulton JE, Kann L. Television viewing and its association with overweight, sedentary lifestyle, and insufficient consumption of fruits and vegetables among US high school students: Differences by race, ethnicity, and gender. J Sch Health 2002;72:413-21.
Ramachandran A, Snehalatha C, Vinitha, R, Thayyil M, Kumar CS, Sheeba L, et al
. Prevalence of overweight in urban Indian adolescent school children. Diabetes Res Clin Pract 2002;57:185-90.
World Health Organization. AnthroPlus for Personal Computers Manual: Software for Assessing Growth of the World's Children and Adolescents. Geneva: World Health Organization; 2009. Available from: http://www.who.int/growthref/tools/en/
. [Last accessed on 2018 Apr 28].
Madan J, Gosavi N, Vora P, Kalra P. Body fat percentage and its correlation with dietary pattern, physical activity and life-style factors in school going children of Mumbai, India. J Obes Metab Res 2014;1:14-9. [Full text]
Gupta R, Rasania SK, Acharya A, Bachani D. Socio-demographic correlates of overweight and obesity among adolescents of an urban area of Delhi, India. Indian J Community Health 2013;25:238-43.
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.
Kumar S, Mahabalaraju DK, Anuroopa MS. Prevalence of obesity and its influencing factor among affluent school children of Davangere City. Indian J Community Med 2007;32:15-7. [Full text]
Ghosh A, Sarkar D, Pal R, Mukherjee B. Correlates of overweight and obesity among urban adolescents in Bihar, India. J Family Med Prim Care 2015;4:84-8.
] [Full text]
Panda SC. Overweight and obesity and lifestyle of urban adolescent school children of Eastern state of India. Int J Res Med Sci 2017;5:4770-5.
Turnbaugh PJ, Hamady M, Yatsunenko T, Cantarel BL, Duncan A, Ley RE, et al
. A core gut microbiome in obese and lean twins. Nature 2009;457:480-4.
Bell CG, Walley AJ, Froguel P. The genetics of human obesity. Nat Rev Genet 2005;6:221-34.
Low LCK. Childhood obesity in developing countries. World J Pediatr 2010;3:197-9.
Hood MY, Moore LL, Sundarajan-Ramamurti A, Singer M, Cupples LA, Ellison RC. Parental eating attitudes and the development of obesity in children. The Framingham Children's Study. Int J Obes Relat Metab Disord 2000;24:1319-25.
Wardle J, Guthrie C, Sanderson S, Birch L, Plomin R. Food and activity preferences in children of lean and obese parent. Int J Obes 2001;25:971.
Jagadesan S, Harish R, Miranda P, Unnikrishnan R, Anjana RM, Mohan V. Prevalence of overweight and obesity among school children and adolescents in Chennai. Indian Pediatr 2014;51:544-9.
Story M, Nanney MS, Schwartz MB. Schools and obesity prevention: Creating school environments and policies to promote healthy eating and physical activity. Milbank Q 2009;87:71-100.
Prasad KR. School health. Indian J Community Med 2005;30:3. [Full text]
[Table 1], [Table 2]