|Year : 2015 | Volume
| Issue : 4 | Page : 210-216
Prevalence of overweight and obesity in union territory of Dadra Nagar and Haveli children and adolescents: Impact of diet, physical activity, and socioeconomic status
Chirag A Patel, Jalaram H Thakkar, Girish K Jani, Simpi Sharma, Rahul Rai, Anjali Vishwakarma
Department of Pharmacology, SSR College of Pharmacy, U.T. of D.N.H, India
|Date of Submission||24-Dec-2014|
|Date of Decision||09-Feb-2015|
|Date of Acceptance||02-Jun-2015|
|Date of Web Publication||2-Dec-2015|
Chirag A Patel
Asst. Prof. Chirag A. Patel, Department of Pharmacology, SSR College of Pharmacy, Dadra and Nagar Haveli - 396 230
Source of Support: None, Conflict of Interest: None
Aim: The aim of this study was to find out the prevalence of obesity and overweight in the children and adolescents and association of different factors such as dietary intake, physical activity, duration of sleep, and socioeconomic status with obesity. Methods: Study Design - It was a cross-sectional randomized epidemiological study among school children and adolescent in urban and rural areas of the Union Territory of Dadra Nagar and Haveli (U.T. of D.N.H), India in the year 2013–2014. Informed consent: The consent was taken from the Education Department of U.T. of D.N.H and the Head of the Institute before their inclusion in the study. Participants: Consenting male and female children and adolescents were included in the study. Questionnaire: Five-minute long interviews were conducted with each student involved in the study. A pilot questionnaire was developed and it was divided in demographic information, anthropometry information, physical activity, dietary intake, and socioeconomic status. Results: In this study, the prevalence of obesity and overweight was found to between 3.82% and 7.14%, respectively. The combined prevalence of overweight and obese children was slightly high in the age-group of adolescents (11.56%) as compared to children (10.66%). According to waist circumference (WC) analysis, 5.99% of male and 11.3% of female subjects are abdominally obese. Conclusion: The prevalence of childhood obesity in U.T. of D.N.H. is not very high as compared to other reports from different regions of the country, but the prevalence of underweight is high in U.T. of D.N.H. children and adolescents. The low degrees of physical activity and higher sedentary activity, consuming high-calorie food, less sleep duration, higher socioeconomic status are associated with a higher prevalence of overweight and obesity.
Keywords: Childhood, obesity, prevalence, socioeconomic status
|How to cite this article:|
Patel CA, Thakkar JH, Jani GK, Sharma S, Rai R, Vishwakarma A. Prevalence of overweight and obesity in union territory of Dadra Nagar and Haveli children and adolescents: Impact of diet, physical activity, and socioeconomic status. J Obes Metab Res 2015;2:210-6
|How to cite this URL:|
Patel CA, Thakkar JH, Jani GK, Sharma S, Rai R, Vishwakarma A. Prevalence of overweight and obesity in union territory of Dadra Nagar and Haveli children and adolescents: Impact of diet, physical activity, and socioeconomic status. J Obes Metab Res [serial online] 2015 [cited 2019 Jul 19];2:210-6. Available from: http://www.jomrjournal.org/text.asp?2015/2/4/210/170897
| Introduction|| |
The World Health Organization (WHO) has depicted obesity as one of today's most unattended public health problems, affecting every region of the globe. Obesity in adolescents and children is gradually becoming a central public health problem in India., Obesity is a heterogeneous group of conditions with multiple causes.
Childhood obesity is one of the severe public health challenges of the 21st century. The problem is worldwide and is steadily affecting many middle- and low-income countries, especially in urban settings. It has been estimated that worldwide, more than forty-two million children under the age of five are obese, and 1 in 10 children is overweight. If current trends continue, then the figure might reach up to 70 million children under 5 to be obese by 2025. The ratio of school-age children affected with obesity will almost double by 2010 compared with the most recently available surveys from the late 1990s up to 2003. Indian data regarding current trends in childhood obesity are emerging. Studies on urban Indian school children from different regions describe a high prevalence of obese and overweight children.,,,, In addition, reports on Indian children have also shown that the prevalence of high blood pressure in overweight school-going children is significantly higher than that among normal-weight school-going children. Obesity and overweight are the fifth leading risk for global deaths. They are linked to more death as compared to malnutrition. Childhood obesity is associated with premature death, and a higher chance of obesity and disability in adulthood. Consequences related to childhood obesity include high blood pressure, nonalcoholic steatohepatitis, obstructive sleep apnea, type 2 diabetes mellitus, left ventricular hypertrophy, dyslipidemia, psychosocial, and orthopedic problems.
In India, there is a paucity of data on the prevalence of childhood obesity, which is a rising health challenge. Therefore, we decided to contribute to the data collection by investigating the prevalence of obesity in high school-going children in various schools in Union Territory of Dadra Nagar and Haveli (U.T. of D.N.H.), and to study the association of obesity with different factors, physical activity, dietary intake, and socioeconomic status. Habit formation occurs mainly during childhood and adolescence. Hence, the primary interventions targeting this age group may have high possibility of yielding good results. This is the reason why we have targeted this age group of 9–19 years. This will assist us in estimating the local prevalence of this condition and will prepare us for the challenge of introducing primary prevention in this area.
| Methods|| |
It was a cross-sectional randomized epidemiological study conducted among school children (aged between 6 and 12 years) and adolescents (aged between 13 and 19 years) of U.T. of D.N.H, India.
The consent was taken from the education department (Director of Education and CEODP) U.T. of D.N.H, Head of the Institute, and parents of children before their inclusion in the study. All the data were collected during the period between August 2013 and December 2013.
Consenting male and female children and adolescents were included in the study. We asked schools for permission to conduct our study on their students, from the Government and Private schools in U.T. of D.N.H.
Five-minute long interviews were conducted with each participant of the study. Interviews were taken in class. The interviewers were all pharmacy students and the interview was conducted in the local language and English. A pilot questionnaire was developed in consultation with a qualified nutritionist. The questionnaire was divided into demographic information, anthropometric information, dietary intake, physical activity, and socioeconomic status.
Assessed demographic information: It included name, age, gender, date of birth, and class anthropometric information. It included height (cm), weight (kg), body mass index (BMI), and waist circumference (WC) (cm). BMI was calculated by weight (kg)/height (m 2). A BMI &<5th percentile is an indication of underweight, 5th percentile to &<85th percentile considered as healthy weight, 85th percentile to &<94th percentile is an indication of overweight, and equal or >95th percentile considered as obese.
The exam staff measured the WC (cm) of participants. According to international diabetes federation (IDF), a WC more than 80 cm (31.5 inches) in women and more than 90 cm (35.5 inches) is considered as abdominally obese.
Evaluated dietary intake. It included questions based on the frequency of eating on a normal day, where normally eat (i.e., with the TV on with family/friends and without TV/alone or in the company of others), with regards to the intake of specific foods, it was inquired whether milk, cereals, meat (nonvegetarian), chocolate, vegetables, fast food, fruits/fruit juices, and junk food were taken. As per the eating habits of students points were assigned as follows: The foods which are healthy were given points in increasing order and the nonhealthy food was given points in decreasing order. Then, based on the total points, the participants were categorized into mild, moderate, and severe intake quality.
Evaluated physical activity and sleep duration: It included time, duration of sleep time, and devoted to different sedentary activities which include: Watching TV/videos/computer games, art and craft (e.g., drawing, painting, etc.), doing homework, listening to music, play indoor games, playing musical instrument, reading, sitting/talking on the phone, and time devoted to various physical activities which include a walk/exercise, outdoor games, PT classes, travelling to school walking/cycling, others (dance class, karate class, etc.), for sedentary activities, the score was given/assigned in a decreasing order as the time interval increases and for physical activity the score was given/assigned in an increasing order as the time intervals increases. Then based on the total points, the participants were categorized into mild, moderate and severe physical activity.
Evaluated socioeconomic status., Subjects were classified into low, middle, and high socioeconomic groups as per modified Kuppuswamy's socioeconomic status scale, taking into account the income, education, and occupation of parents.
The Chi-square test was used to calculate the P value for the difference in the prevalence of obesity. The level of significance was set at P &< 0.05.
| Result|| |
Out of 1200 students given the consent form, 994 consented and participated in the study. In this study out of 994 students, 320 children, that is, 32.26% and 674 adolescents, that is, 67.73% [Figure 1]. Utilizing age and sex specific international cut off points, it was found that 2.6% of female and 4.9% of male were obese, 5.43% of male, 9.57% of female were overweight [Figure 2] and [Table 1]. According to WC analysis, 5.99% of male and 11.3% of female subjects were found to be abdominally obese [Table 2].
|Figure 2: Prevalence of underweight, overweight, and obesity on base of body mass index among (a) children and (b) adolescents in Union Territory of Dadra Nagar and Haveli, India (n=994)|
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|Table 1: Prevalence of underweight, overweight and obesity on base of BMI among children and adolescents in U.T. of D.N.H., India (n=994)|
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|Table 2: Waist circumference specific prevalence of obesity among children in U.T. of D.N.H. India (n=994)|
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In the survey report, it was found that both obese and overweight adolescents [Table 3]a and children [Table 3]b are taking &<5 meals per day. Similarly, both obese and overweight adolescents [Table 3]a and children [Table 3]b were found to have their meals in front of the TV and with family. 52.9% obese and 51.0% overweight adolescents [Table 3]a were found to have severe quality of dietary intake, whereas 50.0% obese and 66.7% overweight children [Table 3]b were found to have moderate quality of dietary intake.
|Table 4: Physical activity associated with underweight, overweight and obesity among Children and Adolescent in U.T. of D.N.H., India (n=994) |
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A total of 81.0% overweight and 75.0% obese children were doing less physical activity in comparison with normal and underweight individual and it was statistically significant. Similarly, 56.0% overweight and 54.5% obese adolescents were doing less physical activity in comparison with normal and underweight [Table 4]. Overweight and obese individuals are spending significantly more time on sedentary lifestyle as compared to normal and underweight individuals.
|Table 5: Sleep duration associated with underweight, overweight and obesity among children and adolescents in U.T. of D.N.H., India (n=994) |
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This study showed a negative association between sleep duration and BMI in both children and adolescents. 62.5% obese and 52.6% overweight children were found to have sleeping duration &<8 h. Whereas 63.6% obese and 58% overweight adolescents were found to have sleeping duration &<8 h [Table 5].
|Table 6: Socio-economical status associated with underweight, overweight and obesity among Children and Adolescents in U.T. of D.N.H., India (n=994) |
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The overall prevalence of overweight and obesity and its relationships with socioeconomic status are presented in [Figure 3] and [Table 4]. The prevalence of overweight among children and adolescent were high in the middle socioeconomic status as compared to high socioeconomic status group in both the gender.
|Figure 3: Socioeconomical status associated with underweight, overweight, and obesity among (a) children and (b) adolescents in Union Territory of Dadra Nagar and Haveli, India (n=994)|
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| Discussion|| |
In India, very few studies have been carried out to study the obesity/overweight in school-going children and most were in urban cities.,,,, 7.14% and 3.82% prevalence of overweight and obesity was found in U.T. of D.N.H which is coherent with other reports.,,,, In this study, the prevalence of obesity was more among the male population as compared to that in female population, whereas the prevalence of overweight was seen more in the female population as compared to the male population. According to the WC analysis, the prevalence of abdominal obesity was higher in female than in male subjects.
The combined prevalence of obesity and overweight was seen slightly more in adolescents (11.56%) as compared to children (10.66%), which may be due to hormonal variations, resulting in fat deposition, and weight gain during the pubertal maturation spurt. Underweight is dominant in adolescents and school children.
In the survey report, it was found that both obese and overweight adolescents and children are taking &<5 no of meals per day as well as to have their meals in front of television and with family. Children who have severe quality of dietary intake (extra calories in the diet) had more chances of getting obese and overweight as compared to those who ate fewer calories (low calories in the diet). These findings were found to be parallel to that of a study done by another investigator., A study conducted by Kumar et al. demonstrated that eating junk food for >2 times per week to be associated significantly with obesity and Vohra et al. showed similar results.
In our cross-sectional study, we found that overweight and obese adolescents are doing less physical activity and are spending significantly more time on sedentary activities as compared to normal and underweight individuals. Lack of place for physical activity, unsafe roads, increased sedentary activity such as watching TV and use of the computer have made lifestyle more sedentary. The burden of academic competitiveness and school work also has reduced the involvement in sports in urban areas which has resulted in high prevalence of obesity and overweight. The results revealed that regular physical activity is a crucial element in reducing the prevalence of obesity and overweight. The prevalence was significantly lesser in children who were involved regularly in household tasks, engaged in outdoor games, and executed physical exercise.
Various large population studies have identified an important dose–response relationship between short-sleep duration, excess body weight, and metabolic disturbances in several ethnic groups.,, This study showed a negative association between sleep duration and BMI in both children and adolescents. As it is believed that sleep is important for brain development and plasticity, this suggests that sleep loss at a young age may considerably alter the hypothalamic mechanisms that regulate appetite and energy expenditure.
It was observed from the [Table 6] that, an increasing form of obesity has manifested from middle to lower and then upper socioeconomic class. In this study, a statistically significant link (χ2 = 34.24, P &< 0.0001) was found between obesity in adolescents and the social class. One possible account for the different socioeconomic status-obesity relationship in developing countries such as India is that the influence of socioeconomic status on people's lifestyle such as diet and public services such as health care and transportation and physical activity may differ.
| Conclusion|| |
On the basis of the results obtained, we concluded that the prevalence of childhood obesity in U.T. of D.N.T. is not as high as the incidence reported by other studies. However, the prevalence of underweight is higher as reported by other studies. That shows children in rural areas are malnourished and prone to deficiency disorders. Special attention has to be given for their overall nutrition. The major determination drawn from the study is that higher sedentary activity and low degrees of physical activity, watching TV, having high-calorie food, less sleep duration, and middle socioeconomic status are related with a high prevalence of obesity and overweight.
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Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]