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 Table of Contents  
ORIGINAL ARTICLE
Year : 2014  |  Volume : 1  |  Issue : 3  |  Page : 138-142

Prevalence of obesity and its influencing factors among affluent school children of Bangalore City


1 Department of Pedodontics and Preventive Dentistry, Sardar Patel Postgraduate Institute of Dental and Medical Sciences, Lucknow, Uttar Pradesh, India
2 Department of Pedodontics and Preventive Dentistry, M S Ramaiah Dental College and Hospital, Bengaluru, Karnataka, India
3 Department of Orthodontics and Dentofacial Orthopaedics, Sardar Patel Postgraduate Institute of Dental and Medical Sciences, Lucknow, Uttar Pradesh, India

Date of Web Publication19-Sep-2014

Correspondence Address:
Nishita Garg
B-1463, Indira Nagar, Lucknow - 226 016, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2347-9906.141139

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  Abstract 

Objective: The problem of overweight (OW) and obesity (OB) is not confined only to developed countries but is also widely prevalent in developing countries. The objective of this study was to assess the prevalence of OW and OB among affluent school going adolescents in Bangalore, India, and identify its associated factors. Materials and Methods: A cross-sectional and institutional study, adopting a multistage stratified cluster sampling procedure, was carried out on 1750 adolescents 12-15 years of age of both sexes from Bengaluru, India. Results: The prevalence of OW was 17.4% among boys and 17.0% among girls. Prevalence of OB was 7.4% in boys and 7% in girls. There was a higher prevalence of OW and OB in boys compared with girls, but difference was not significant. Junk food and chocolate eating habits had more prevalence of OB and OW than underweight indicating that the caloric intake is associated with an increase in body mass index (BMI). On assessing the relationship between caries and nutritional status, OW children had mean decayed missing filled surfaces (DMFS) of 1.57 ± 3.104 while obese children had a mean DMFS of 0.91 ± 1.702. The relation between BMI and DMFS was statistically significant. Conclusion: The increasing trend of the modern day epidemic of OW/OB in children calls for immediate action in both rural and urban areas to reduce the incidence through appropriate nutritional intervention programs involving school children, their parents, and school authorities.

Keywords: Body mass index, decayed missing filled surfaces, obesity


How to cite this article:
Garg N, Anandakrishna L, Jain AK. Prevalence of obesity and its influencing factors among affluent school children of Bangalore City . J Obes Metab Res 2014;1:138-42

How to cite this URL:
Garg N, Anandakrishna L, Jain AK. Prevalence of obesity and its influencing factors among affluent school children of Bangalore City . J Obes Metab Res [serial online] 2014 [cited 2019 Sep 20];1:138-42. Available from: http://www.jomrjournal.org/text.asp?2014/1/3/138/141139


  Introduction Top


Obesity (OB) is defined as a condition of abnormal or excessive fat accumulation in adipose tissue, to the extent that health may be impaired (World Health Organisation [WHO] consultation on OB, 2000). It can be seen as the first wave of a defined cluster of noncommunicable diseases called "New World Syndrome" creating an enormous socio-economic and public health burden in poorer countries. [1] Following the increase in OB in adults, the proportion of children and adolescents who are overweight (OW) and obese have also been increasing. [2] Globally, an estimated 10% of school-aged children, between 5 and 17 years of age, are OW or obese. [3] The prevalence of OB has more than doubled for preschool children 2-5 years of age and adolescents 12-19 years old and has more than tripled for children 6-11 years old. This increasing number of obese children and youth has led policy makers to rank it as a critical health threat. [4] Once considered a problem of affluence, OB is fast growing in many developing countries also. [5] Even in countries like India, which are typically known for a high prevalence of undernutrition, a significant proportion of OW and obese children now coexist with those who are undernourished. [6] Studies among school children in different parts of the country have demonstrated increasing prevalence of OW and OB, with great disparity between rural and urban parts of the country. Over the past few years, childhood OB is increasingly being observed with the changing lifestyle of families with increased purchasing power, increasing hours of inactivity due to television, video games, and computers that have replaced outdoor games and other social activities. [7] The two most important factors that contribute to a sudden increase in the incidence of OB in our country are changes in dietary practices and urbanization. At present, there is the inclusion of more fats and oils, more sugar, and less fiber in the diets of people. Convenience foods, fast foods, and sugar-sweetened beverages have found increasing acceptance. Apart from dietary changes, reductions in school physical activity programs and increased time in schools dedicated to sedentary activities have resulted in reductions in general physical activity that have been correlated with the rising incidence of childhood and adolescent OB. [8] Limited studies have been conducted on the prevalence of OW and OB in the children of Bangalore city. On the basis of internationally based cut-off points, we designed a study to determine the prevalence of OW, OB and its influencing factors in adolescent (12-15 years) school children in Bangalore city.


  Materials and methods Top


A cross-sectional study was carried out in middle-schools (7 th standard) and high-schools (8 th -10 th standard) of affluent public schools in Bangalore city. The city was divided into north and south zone. From each zone, private schools were randomly selected from the list given by Education Department of Bangalore. All school going children from 7 th to 10 th standard of 12-15 years of age group from all the selected schools were included in the study. Informed consent was obtained from the school authorities to make anthropometric measurements, dental examination and also to collect data by questionnaire from the children. 1750 adolescents from private schools of 12 to 15 years were selected by simple random sampling. After removing heavy warm clothing, belts, and shoes all children were weighed using a standard physician's scale. Each child was made to stand still and upright with weight evenly distributed between two feet. A calibrated vertical bar with a horizontal headboard was used for measuring the height which was recorded to the nearest 0.5 cm. Based on the weight and height, the body mass index (BMI) was calculated as per the formula BMI = Wt (kg)/Ht (m) 2 . The cut-off values of BMI, at each age and for each gender obtained by Cole, et al. [9] were used to classify children as Normal, OW and obese. The children were questioned about their dietary habits, daily consumption of sweets and beverages. Questions regarding frequency of consumption of junk foods such as soft drinks, soda pop, instant drink mixes, fruit juice, burgers, pizzas and potato chips, milk (including all types, white, chocolate, or other flavors, drinks made with milk or milk on cereal) was assessed [Annexure I]. All selected children were clinically examined for dental caries by a specialist utilizing the WHO criteria (1997) for diagnosis of dental caries. A trained assistant recorded the findings on data collection forms. The decayed, missing, and filled permanent tooth surfaces (DMFS) index was determined. If both the deciduous and permanent teeth were present, only the permanent teeth were evaluated. Group comparisons were performed using ANOVAs or Chi-square tests as appropriate.


  Results Top


A total number of 1750 with age group between 12 and 15 years from different affluent schools was screened for their height, weight and BMI. Of 1750 children, 1060 (61%) were boys and 690 (39%) were girls [Table 1]. The height, weight, and BMI were higher in boys than girls. However, these differences were not significantly different with respect to gender at any given age. The overall prevalence of boys and girls having normal BMI were 75.3% and 76.1%, respectively. The prevalence of OW was 17.4% among boys and 17.0% among girls. Prevalence of OB was 7.4% in boys and 7% in girls. There was a higher prevalence of OW and OB in boys compared with girls, but difference was not significant [Table 1]. Junk food and chocolate eating habits had more prevalence of OB and OW than underweight indicating that the caloric intake is associated with an increase in BMI. Children belonging to low normal weight group had a mean DMFS of 1.31 ± 2.245; OW children had a mean DMFS of 1.57 ± 3.104 while obese children had a mean DMFS of 0.91 ± 1.702. The relation between BMI and DMFS was statistically significant [Table 2].
Table 1: The distribution according to gender and BMI in private school children


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Table 2: Relation between BMI and DMFS in private school children


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  Discussion Top


There is widespread reports regarding the trend of increasing prevalence of OW and OB among children and adolescents. [10],[11],[12],[13] The WHO has declared OW as one of the top ten health risks in the world and one of the top five in developed nations. [14] Existing WHO standards and data from 79 developing countries including a number of industrialized countries suggest that about 22 million children above 5 years old are OW worldwide. [15] Published data regarding this aspect, from India is scarce. Worthy of mention, there are still controversies over the use of a series of universal BMI cut-offs to define OB or OW in different populations of either adults or children. Many countries have published BMI-for-age charts for their populations, and some have also defined cut-off points on these charts to define OW and OB. There are no Indian studies to generate internationally accepted standards for defining OW and OB. The BMI charts that can be used as a reference for Indian children, as of now, is an absolute and internationally relevant definition of child overweight and OB given by Cole, et al. [9] A large internationally representative sample from six different countries (not India), with widely differing prevalence rates for OB have been published. Age- and sex-specific BMI cut-off points for defining OW and OB in children have been derived by identifying percentiles in children analogous to adult BMIs of 25 kg/m 2 and 30 kg/m 2 , respectively. In the last few decades, Indian studies have revealed an increasing prevalence of OW and OB among children and adolescents. A study conducted in 1990 amongst 3,861 school children reported the prevalence of OB as 7.5%. [16] The magnitude of OW ranges from 9% to 27.5% and OB ranges from 1% to 12.9% among Indian children. [17 ],[18],[19],[20],[21],[22],[23],[24],[25] A recent cross-sectional study in affluent school children from Western Suburbs of Mumbai shows that the prevalence of childhood and adolescent OW and OB among children from uppersocioeconomic stratum of society has remained high at 25-30%. [26]

The present study showed that the prevalence of OW was high among children, 17.4% in boys, 17% in girls. The OB was seen in 2.9% of boys and 1.5% of girls. Our results are consistent with previous studies by Chhatwal et al. [20] and Khadilkar and Khadilkar. [27] The relatively low prevalence of OB among Indian children (3-2%) may be surprising, but the relatively high prevalence of OW (14-9%) is alarming. OW children often become OW adults and OW in adulthood is a health risk. [28],[29] There was a higher prevalence of OW and OB in boys compared with girls. This indicates that gender difference was the effect modifier which correlates well with previous reports. [30] Junk food and chocolate eating habits had more prevalence of OB and OW than underweight indicating that the caloric intake is associated with an increase in BMI. The diets of the children in the higher socioeconomic group are known for their greater fat content, and the subjects are involved in more sedentary activities. These observations are consistent with results of previous studies. [31] Madan et al. in their study concluded that there was a marked shift in children from underweight and normal category to OW and obese category in both socioeconomic statuses when body fat percentage was used as criteria for classification. Body fat percentage was significantly correlated to quality of eating including quantum of salad consumption, refined flour products, and bakery products. [32] Klesges et al. [33] also reported the effect of watching television on metabolic rate, and OW and OB in children. In urban areas, considering the safety of keeping children away from heavy traffic, parents feel more comfortable if their children play indoor games or watch television and, therefore, do not encourage them to participate in outdoor sports and games. Palmer [34] implicated that the relationship between OB and caries in children needs further exploration as it is clear that there are common denominators that both diseases share. Negative changes in eating and activity patterns, increased frequency of snacking and increased consumption of fermentable carbohydrates are common in both OB and caries in children. A lingering question, derived mainly from speculation based on the common risk factor, has been whether obese children are at higher risk for dental caries development. Overall the mean DMFS index in the normal weight children were less than OW children but more than the obese children. It was hypothesized that BMI-for-age would be associated with increased dental caries prevalence and the present study revealed that there is an association between BMI-for-age and DMFS index (P < 0.05). The children at risk of OW had the highest DMFS values as with previous studies done by Moreira et al., Willerhausen et al. and Alm et al. [35],[36],[37] Adolescents with lower rates of caries belonged to the low weight and obese groups. In addition, the highest severity of dental caries was in the OW group, while the lowest rate was in the obese group. According to Zardetto, [38] being OW may be considered a risk factor for higher caries severity. The high rates of dental caries and OW adolescents in this study emphasize the need for interventions that focus on healthy eating habits, including the restriction of sugar consumption, and aim at preventing and controlling chronic diseases.


  Conclusion Top


As members of the pediatric health team, we have a commitment to understand, prevent, and intervene in the development of both OB and dental disease. As clinicians in frequent contact with children and their parents, we also have the perfect opportunity to do so. Healthy eating patterns in childhood and adolescence promote optimal childhood health, growth, and intellectual development; prevent immediate health problems such as OB and dental caries; and may also prevent related long-term health problems such as coronary heart disease, cancer, and stroke.



 
  References Top

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