|Year : 2014 | Volume
| Issue : 1 | Page : 7-13
A cross-sectional study of childhood and adolescent obesity in affluent school children from western suburb of Mumbai 2001-2002 and 2013-2014
Shefali Pandey1, Anupama Bhaskaran1, Shubhada Agashe1, Rama Vaidya2
1 Medical Research Centre, Kasturba Health Society, Vile Parle (W) Mumbai, Maharashtra, India
2 Medical Research Centre, Kasturba Health Society, Vile Parle (W); Centre for Disorders of Growth and Puberty, Vasudha Clinic, Santacruz (W), Mumbai, Maharashtra, India
|Date of Submission||04-Jul-2013|
|Date of Decision||30-Oct-2013|
|Date of Acceptance||07-Nov-2013|
|Date of Web Publication||30-Dec-2013|
Medical Research Centre, Kasturba Health Society, Vile Parle (W); Centre for Disorders of Growth and Puberty, Vasudha Clinic, Santacruz (W), Mumbai, Maharashtra
Source of Support: None, Conflict of Interest: None
Introduction: Change in lifestyle patterns associated with genetic factors is causing increasing prevalence of childhood and adolescent obesity in India. Obesity during childhood and adolescence puts these children at a high risk for adult cardio-metabolic disorders and other chronic diseases. It is important that this avalanche is prevented in time by comprehensive school health education programmes and other timely interventions. An observational cross-sectional study, as a part of the School Health Education and Enlightened Living (SHEEL) project, was conducted to assess the prevalence in childhood overweight and obesity during the academic years 2000-2001 and 2013-2014 at a private school. Materials and Methods: As a part of the SHEEL project, a total of 2421 children consists of 1346 boys and 1075 girls (age ranged, 4 -15 years) were evaluated for their height (stadiometer), weight (electronic weighing scale) and body mass index (BMI) during the academic year 2000-2001 (stage 1 study). We approached the same school again in the academic year 2013-14 (stage 2 study). In this stage, a total of 2056 children (1067 boys and 989 girls; age range 5-15 years) were measured for the same parameters to evaluate in childhood and adolescent obesity when compared with that observed in 2000-2001.The measurements were plotted on gender specific BMI charts (Center for Disease Control and Prevention [CDC] charts) for obtaining percentiles. Identification of overweight and obesity was arrived at by CDC centile charts. Results: The stage 1 study done during the academic year 2000-2001 in school children from an affluent class of society showed a prevalence of overweight, in girls as 16.7% (180/1075) and in boys, 13.7% (185/1346). The prevalence of obesity for the total number of children was 15.3% (14.2% in 1075 girls and 16.1% in 1346 boys). In stage 2 study done during the academic year 2013-2014 in the same school, prevalence of overweight in girls was 16% (158/989) and in boys, 15.3% (163/1067) and the prevalence of obesity was 11.1% (9.1% in 989 girls and 12.9% in 1067 boys). If children at risk for obesity (overweight) and obese were clubbed together, nearly 1/3 of the children, 30.4% in 2001 and 26.7% in 2013, had above-normal BMI percentiles. In this study, the percentage of children showing overweight/obesity increased from the age groups 7 to 8 years and above as compared to the younger age groups. Conclusions: The current cross-sectional study shows that the prevalence of childhood and adolescent overweight and obesity amongst children from a upper-socio-economic stratum of society has remained high at 25-30% during both the periods of the school-based study. However, the trend for the prevalence of overweight and obesity in this >10 years has shown a definite decline of 5.8% in girls, while the decline of 1.6% in boys was not as remarkable.
Keywords: Adolescent, body mass index, children, height, obesity, weight
|How to cite this article:|
Pandey S, Bhaskaran A, Agashe S, Vaidya R. A cross-sectional study of childhood and adolescent obesity in affluent school children from western suburb of Mumbai 2001-2002 and 2013-2014. J Obes Metab Res 2014;1:7-13
|How to cite this URL:|
Pandey S, Bhaskaran A, Agashe S, Vaidya R. A cross-sectional study of childhood and adolescent obesity in affluent school children from western suburb of Mumbai 2001-2002 and 2013-2014. J Obes Metab Res [serial online] 2014 [cited 2018 Dec 18];1:7-13. Available from: http://www.jomrjournal.org/text.asp?2014/1/1/7/123850
| Introduction|| |
The prevalence of childhood and adolescent obesity has been reaching epidemic proportions both in developed  and developing  countries. Though obesity is a chronic condition resulting from interaction of genetic and environmental factors, the adoption of increasingly sedentary life-styles and changing dietary habits is thought to play a major role in childhood and adolescent obesity. ,, Nearly 40-50% of obese children , and 70-80% of obese adolescents  will continue to remain obese/overweight even in adulthood. With the propensity of childhood obesity tracking into adulthood and its association with metabolic, cardiovascular, respiratory, orthopedic, gastrointestinal, endocrine and psychological morbidity,  these figures are alarming. India, like many of the developing countries is facing a problem of two faces of malnutrition-underweight in some  and obesity  in other segments of society.
Experiential data from weight management programs at our centre has shown that many children transiting through puberty underwent excessive weight gain and presented as obese adolescents. This raised the suspicion that pubertal transition may be the time for exaggerated weight gain in adolescents. However, there are only a few studies showing specific age at which obesity prevalence increases, so that an obesity prevention program could be targeted. The 2001 study reports the height, weight and body mass indices of children between 4 and 15 years, from a school catering to the upper middle and affluent classes of society. The 2013 study, done in the same school, details the trend in height, weight and body mass index (BMI) in children between 5 and 15 years of age in comparison to the 2001 study.
| Materials and Methods|| |
This study was undertaken as a part of an ongoing School Health Education and Enlightened Living (SHEEL) project of our centre. This project incorporates the principles of SAPTASHEEL i.e., (1) unity of body, mind and soul through harmonious living, (2) principles of hygiene to prevent diseases (3) principles of nutrition, dietary habits, kitchen gardening (4) exercise and sports for health and fun (5) family life education (6) relaxation and sleep and (7) health skills.
All the children from the ages 4 to 15 years in stage 1 and between 5 and 15 years in stage 2 underwent an examination including standing height and weight during both stages of the study.
Height was measured in centimeters (cm) on a Harpenden stadiometer and weight in Kilograms (kg) and grams (g) by an electronic scale (AMCO, India) (Holtain, Crymych, Wales) by two trained observers (the inter-observer variation was 0.5-1 cm). The child was made to stand barefoot with only school clothes on him/her and height was measured in standing position with heels, buttocks and shoulders touching the vertical bar of the stadiometer with head in the Frankfurt plane. The movable bar of the stadiometer was then moved to fit snugly against the child's head and the standing height measured to the nearest cm and millimeter (mm). The age of the child was obtained from birth records in school registers and the exact chronological age calculated by using standard Tanner charts. 
The BMI was measured using the formula - weight in kg divided by height in m 2 and then plotted on gender specific BMI charts (Centers for Disease Control and Prevention [CDC] charts)  for obtaining percentiles of BMI.
| Results|| |
In the first stage of the study, of the 2421 children who underwent height and weight measurement, 1346 were boys and 1075 were girls. The age groups ranged from 4 to 15 years. In stage 2 of the study, 2056 children (1067 boys and 989 girls) aged 5-15 years underwent similar measurements.
[Table 1] shows the age-wise mean±standard deviation (SD) of height and weight for boys during years 2001-2002 and years 2013-2014.
[Table 2] shows the age-wise mean±SD of height and weight for girls during years 2001-2002 and years 2013-2014.
[Figure 1] and [Figure 2] show comparison in mean heights and weights between stage 1 and 2 of the study in boys and girls respectively. As can be seen from the [Figure 1]a and b as well as [Figure 2]a and b both height and weight of children have increased across ages from 5 to 15 years in both sexes during this >10 years.
|Table 1: Mean height and mean weight (boys) in stage 1 (2001– 2002) and stage 2 (2013– 2014)|
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|Table 2: Mean height and mean weight (girls) in stage 1 (2001– 2002) and stage 2 (2013– 2014)|
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|Figure 1. (a) Comparison in mean heights between the two stages of the study in boys (b) Comparison in mean weights between the two|
stages of the study in boys
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|Figure 2. (a) Comparison in mean heights between the two stages of the study in girls (b) Comparison in mean weights between the two|
stages of the study in girls
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The BMI of all children were plotted on CDC "BMI for age" growth chart. [Figure 3] and [Figure 4] show percentage of overweight and obese boys and girls in different age groups in stage 1 and 2 of the study.
|Figure 3. Mean age-wise percentage of overweight and obese boys (n=402/1346) and girls (n=333/1075) in stage 1 of the study|
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|Figure 4. Mean age-wise percentage of overweight and obese boys (n=301/1067) and girls (n=248/989) in stage 2|
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Stage 1: The BMI of all children were plotted on CDC "BMI for age" growth chart. Of the 1075 girls, 180 (16.7%) were at risk for obesity (>85 th percentile) and 153 (14.2%) were obese (>95 th percentile), 108 (10.1%) were underweight (<5 th percentile) and the rest 634 (59%) had normal BMI (5-85 percentile). In boys (n = 1346), these figures were 185 (13.7%, >85 th percentile), 218 (16.1%, >95 th percentile), 184 (13.6%) were underweight and 759 (56.3%) had normal weight. The percentage of overweight and obese children amongst boys and girls, younger than 8 years was between 10% and 30% and 15-25% respectively. However, in children older than 7 to 8 years this figure jumped to between 35-42% in boys and 27-43% in girls [Figure 3]a and b].
Stage 2: Of the 989 girls 158 (16%) were at risk for obesity (>85 th percentile) and 90 (9.1%) were obese (>95 th percentile). In boys group, these figures were 163 (15.3%, >85 th percentile), 138 (12.9%, >95 th percentile).
Fifteen hundred and six children (62.2%) had normal weight and 262 (10.8%) were underweight. The percentage of overweight and obese children amongst boys and girls, younger than 7 years showed almost similar trend as compared to stage 1 study.
Comparative mean BMI for boys and girls from the 2001 to 2013 studies is shown in [Figure 5]a and b.
|Figure 5. Age-wise mean body mass index of boys and girls in the 2001 and 2013 studies|
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Comparing the mean BMI in both stages of the study, it was seen that there was an upward trend in BMI at 8-9 years of age probably coinciding with the pubertal increase in weight in boys as well as girls. However at 14-15 years of age in the stage 2 study there is a slight plateauing of the mean BMI.
| Discussion|| |
Changing life-style patterns due to globalization in the past few decades have contributed to the epidemic proportions of childhood and adolescent obesity in developing countries. In the current study, the prevalence of overweight and obesity in school-going children and adolescents from affluent class of society has also shown a very high prevalence in 2001 and 2013 studies. In the present study, the trend in childhood and adolescent obesity during the two time cuts 2001-2002 and 2013-2014 has shown that overweight and obesity amongst children and adolescents continued to remain high at almost similar figure for overweight 15.1% in 2001-2002 study and 15.6% overweight in 2013-2014 study. However, the rates for obesity showed a difference of 4.3% as it declined from 15.3% in 2001-2002 to 11.1% in 2013-2014. On adding children in obese and at risk for obesity groups the figure jumped to 30.98% in girls and 29.9% in boys. In comparison these figures from the 2013 to 2014 study from the same school showed combined figures of overweight and obese children were lower at 25.1% in girls and 28.2% in boys. The trend for the prevalence of overweight and obesity in this >10 years has shown a definite decline of 5.8% in girls while the decline of 1.6% in for boys was not as remarkable.
In USA no statistically significant trends in high BMI were found over several time periods from 2001-2002, to 2007-2008 among girls and boys. The prevalence remained high for the periods 2007-2008 and 2009-2010 at 16.9% (95% CI, 14.1-19.6%) at or above the 95 th percentile. ,
However, recently in 2013 a very small decline in childhood obesity is for the first time reported for some part of the United States of America. David L. Katz, MD, Editor-in-Chief of Childhood Obesity, said that the rate of childhood obesity in USA is still around 17% and he has warned against complacency.
Nationwide studies, conducted in eleven affluent urban schools from five geographical zones of India, have also shown a high prevalence of overweight and obesity.  However, the prevalence rates of overweight and obesity in children and adolescents from upper socio-economic strata from different parts of our country have varied widely [Table 3] and [Table 4]. The prevalence for overweight and obesity during the years from 2002 to 2004 reported by various authors from different parts of India has ranged from 11% to 29% for overweight and 2.6-11.1% for obesity. The prevalence rates for 2006-2010 ranged from 15.3% to 22% for overweight and 5-10% for obesity.
|Table 3: Comparison of overweight and obesity in children and adolescents from Indian studies (2002– 2004)|
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|Table 4: Comparison of overweight and obesity in children and adolescents from Indian studies (2006– 2013)|
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The proportion of overweight and obese; in both boys and girls groups increased as children reached 7-8 years and above in the current study. Kapil et al. in their study reported that the maximum-prevalence of obesity was during the pubertal transitional period of 10-12 years.  Though an increase in total body fat is known through pubertal transition, this stabilizes during 'late puberty.  One of the causal/associated factors during this pubertal body compositional shift is physiological hyperinsulinemia that may get exaggerated in some children. In a longitudinal study of Overweight children followed-up into adulthood Maffies et al. reported that the rate of weight gain per year was directly associated with fasting insulin levels and insulin resistance in children may be a risk factor for obesity in adulthood especially in girls. 
Few studies have studied the differences in BMI percentiles among different socio-economic classes. Marwaha et al. reported that the prevalence of overweight children in considerably higher in upper socio-economic class children when compared to those from lower socio-economic class strata of society (USEC - 17.9% for boys and 19.1% for girls vs. LSEC - 2.7% for boys and 2.7% for girls).  Similar findings were reported by Ramachandran et al.  It is important to note that nearly 10% of children were underweight in the present study during both the stages. It is thus essential that nutrition and healthy lifestyle are imparted to both underweight as well as obese children.
| Conclusion|| |
The current study highlights the worrisome trend of increasing prevalence of childhood obesity, with a precipitous increase at adolescence probably coinciding with the increase in physiological insulin resistance and decline in physical activity and changing food habits as children grow into adolescents. As a result of globalization of food markets, developing countries are experiencing convergence towards poor quality obesogenic diets especially in urban areas, further increasing the rapid rise in obesity.  The findings of increase in obesity during the adolescent transitional period needs to be further explored in a longitudinal study in larger numbers. Policy decisions for lifestyle modifications need to be introduced in pre-adolescents to stop the impending epidemic of adolescents to stop the impending epidemic, of adolescent obesity and its health consequents in future generations.
| Acknowledgement|| |
We would like to thank Dr. Ashok Vaidya, Medical and Research Director, Medical Research Centre, Kasturba Health Society for his continuous support and guidance during the study. We thank Mrs. Abha Dharampal, CEO, Mr. Singh PT Teacher, Dr. Nita Shah and Mrs. Amita Timbadiya, Parents Teacher Association Members of Utpal Sanghavi School for the help extended during the study. We would also wish to thank all the teachers and students for their co-operation in data collection. We gratefully acknowledge the secretarial support of Ms. Pallavi Jadhav for 2001 study and Ms. Suparna De, Ms. Priyanka Mertia and Ms. Nidhi Shukla for their assistance in data entry for 2013 study.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]
[Table 1], [Table 2], [Table 3], [Table 4]