|Year : 2015 | Volume
| Issue : 2 | Page : 84-88
Identification of Family Risk Factors of Obesity in Urban Adolescents of North India
Manish Taneja, Baljeet Maini, Mohinder Singh, Surya Kant Mathur
Department of Pediatrics, MMIMSR, Mullana, Ambala, Haryana, India
|Date of Submission||08-Sep-2014|
|Date of Decision||22-Nov-2014|
|Date of Acceptance||27-Nov-2014|
|Date of Web Publication||7-May-2015|
Department of Pediatrics, MMIMSR, Mullana, Ambala, Haryana
Source of Support: None, Conflict of Interest: None
Background: Obesity in rising in the adolescent population of India. The third National Family Health Survey (NFHS-3) national family health survey (NFHS-3) of India revealed increasing obesity in north Indian states more than other parts of the country. Family plays a key role in shaping young adolescents. There is a paucity of literature regarding family risk factors for adolescent obesity in the north Indian population. Study Design: Cross-sectional survey type study. Methodology: A total sample of 5993 school going adolescents (10-19 years of age) was taken into the study from urban area of Ambala district, Haryana, India. The data were collected using self reporting questionnaires. Various questions were used to evaluate the parental demographic factors: parents' education, parents' occupation, family income and obesity in the family. Anthropometric measurements such as height and weight of each student were measured and documented. Statistical evaluation was done by Chi-square (χ2) test to analyze the differences between proportions. P < 0.05 was considered statistically significant. Results: Overall prevalence of obesity was 2.4%. Prevalence of obesity was highest in the 16-19 yrs age group (4.4%). Parental obesity, high literacy and high income of parents were significantly associated with adolescent obesity. Conclusions: Adolescent obesity is influenced by parental obesity, socioeconomic status of family and increase in age.
Keywords: Adolescents, family, North India, obesity
|How to cite this article:|
Taneja M, Maini B, Singh M, Mathur SK. Identification of Family Risk Factors of Obesity in Urban Adolescents of North India. J Obes Metab Res 2015;2:84-8
|How to cite this URL:|
Taneja M, Maini B, Singh M, Mathur SK. Identification of Family Risk Factors of Obesity in Urban Adolescents of North India. J Obes Metab Res [serial online] 2015 [cited 2021 Mar 1];2:84-8. Available from: https://www.jomrjournal.org/text.asp?2015/2/2/84/151756
| Introduction|| |
Obesity is rising in the adolescent population of India.  While the trend of obesity has stabilized in western developed nations,  it continues to rise in developing countries like India who are in final stages of nutritional stabilization. With a large proportion of adolescents in the Indian demography now, obesity with its attendant health risks, poses a very big threat to the future health of the Indian society. The third National Family Health Survey (NFHS-3) of India revealed increasing obesity in north Indian states more than other parts of the country.  Family plays a key role in shaping young adolescents. There is a paucity of literature regarding family risk factors for adolescent obesity in the north Indian population. It is important in today's scenario to assess the family risk factors in North India for adolescent obesity so that timely interventions can be implemented.
| Methodology|| |
A total sample of 5993 school going adolescents (10-19 years of age) was taken into the study from the urban area of Ambala district, Haryana, India. Using Probability Proportionate to Size ratio of 3:5, six government and ten private schools were included for the desired sample size. Schools were chosen by systematic sampling technique taking every 5 th school. In this manner, the proportionality between public and private schools was obtained. Also, the sample was representative of the whole population, therefore, subjects from all socio-economic classes were included. The Institutional Ethics Committee reviewed and approved the study. Informed consent was obtained from all guardians and school directors. The following inclusion and exclusion criteria were employed for the purpose of this study:
- School going adolescents
- Urban area of Ambala district, Haryana, India
- Only completely filled questionnaires after discussion with parents
- Data of the subjects whose parents volunteered for the subject and themselves were included in the study.
- The physically challenged subjects
- Subjects who did not provide complete information
- Any chronic medical disease or hospitalisation in last 3 months.
The data were collected using self-reporting questionnaires. A bilingual questionnaire (Hindi/English) was administered to the adolescents from each of the selected class. The questionnaires were explained to the subjects, and necessary clarifications were provided live in the classroom sessions. Various questions were used to evaluate the parental demographic factors: Parents' education, parents' occupation, family income, and obesity in the family. Parents' highest education was classified as illiterate, under matriculate, and above matriculation. The family income was used to define the economic class and was stratified into 4 categories viz., category I: Monthly income of ≤ 12,000 rupees, category II: Rs 12,001-60,000, category III: Rs. 60,001-1, 20, 000 and Category IV: >Rs 1, 20, 000. Anthropometric measurements such as height and weight of each of the students were measured and documented. Standard calibrated scales and stadiometers were used to determine the height, weight, and body mass index (BMI) of all participants. Assessment of parental obesity was based on their height and weight as reported by them in the questionnaire. The students were requested to answer the questionnaire at home with the help of parents (a special home visit was arranged for students with both illiterate parents). International Obesity Task Force cutoff points for BMI (25 and 30 kg/m 2 for overweight and obesity, respectively) were used as recommended by WHO.  BMI was calculated as per the formula. BMI = Weight (kg)/Height (m) 2 .
Statistical evaluation was done by Chi-square test to analyze the differences between proportions, and a multivariate logistic regression model was used. P < 0.05 was considered statistically significant. The students found to be obese/overweight were counseled for detailed medical checkup.
| Results|| |
The overall distribution of students is shown in [Table 1]. The overall prevalence of overweight and obesity was 9.5% (n = 567) and 2.4% (n = 145), respectively. Females (73 [2.8%]) were more affected as compared to males (72 [2.1%]), however, there was no significant difference between two sexes. Increase in the prevalence of obesity was seen with increasing age. The prevalence of obesity in different age groups were 41 (1.7%) who were obese in 10-12 years, 37 (1.8%) in 13-15 years and 67 (4.4%) in 16-19 years age group [Table 2].
Socioeconomic status and obesity
Educational status of parents
The prevalence of obesity increased significantly (P = 0.005) with the better educational status of the both parents. Eleven students (2.5%) were obese in the category whose parents were illiterate, 52 (1.8%) in the category of under matric and 82 (3.0%) in the category of those who were above matric [Table 3].
|Table 3: Prevalence of obesity according to the education status of the parents|
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Occupation of parents
As depicted in [Table 4], parents' occupation did not have a significant relationship with adolescents' obesity.
|Table 4: Prevalence of obesity according to the occupational status of parents|
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Relation with family income
The prevalence of obesity among students was significantly higher among the students who had better economic conditions (in terms of family income in rupees per month [P < 0.001]. Obese adolescents were 2 (0.4%) in < Rs. 12,000 (category I), 63 (2.4%) in Rs. 12,001-60,000 (category II), 36 (2.3%) in Rs. 60,001-120,000 (category III) and 44 (3.4%) in >Rs. 120,000 (category IV) [Table 5].
|Table 5: Prevalence of obesity according to the monthly family income (rupees/month)|
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Parental obesity was significantly associated with the prevalence of obesity among adolescents. 85 (6.5%) students were obese who had obese parent(s) as compared to 60 (1.3%) obese who did not have obese parents (P < 0.001) [Table 6].
|Table 6: Prevalence of obesity among student according to family history of obesity|
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| Discussion|| |
Health impact of the increasing prevalence of overweight and obesity among adolescents is a matter of serious worldwide concern. While the obesity rates have leveled off in developed nations,  India and other developing countries are still in final transition phases of the nutrition stabilization. With changing demographic features of developing countries worldwide, it is notable that there is a well-recognized drift in lifestyle with more energy dense food and leisurely sedentary entertainment. , Rise in prevalence of obesity in late adolescent age was depicted by findings of some recent Indian studies. ,, In this study also, obesity rates were found increased in the later adolescent phase. Obesity rates in 16-19 years age group was highest than younger students, a finding similar to other Indian studies. ,,, In a recent study on obesity trends in adolescents, in Delhi, obesity rates were higher in 14-17 years age group.  Change (decrease) in physical activity (especially among girls), changes in body structure due to hormones etc., may play a role in an increase of BMI in the later adolescent age group. These factors can further compound the overall problem of obesity.
There is a very complex interplay of various factors which leads to fatty adolescents. The role of family is central in adolescent obesity as it reflects the role of heredity and also, it shapes the adolescent personality and behavior. Family dietary patterns, parenting practices etc., play a very important role in weight patterns of adolescents.  This in turn is affected by income and educational status of the family. Due to easy availability and affordability, "junk food," is getting preferred over expensive fruits and vegetables in individual households, quite commonly. North Indian states were found to have high obesity prevalence rates in NFHS-3 survey.  This study thus addressed the important issue of finding the prevalence of obesity in the entire 10-19 years adolescent age group and evaluating the role of family factors responsible for north Indian adolescents' obesity.
Literacy, occupation, and family income are an indirect measure of socioeconomic status. The study clearly revealed that better educational status of both parents and increasing household income lead to an increased prevalence of obesity. Previous studies from India had similar finding. ,,,,, On the other hand in developed countries, Wang et al.  (Australia) and Babey et al.  (USA) found obesity prevalence significantly increased among lower-income adolescents. The relationship between obesity and socioeconomic condition is complex. In lower socioeconomic strata of developed countries like USA, there is an increased risk of obesity. This is mainly attributed to other factors like lack of awareness, peculiar dietary patterns with more energy dense foods, different parenting conditions, etc., On the other hand, reduced physical activity at work due to mechanization, improved motorized transport, and preferences for sedentary entertainment to outdoor games, have resulted in positive energy balance in affluent sections of most of the Asian countries. ,, We thus can assume that because of the difference of parenting patterns and food consumption, there is a difference in obesity trends of affluent sections of developing and developed nations. Also, in north Indian population "plump is healthy" is being recognized as an important contributing cultural risk factor. 
Familial prevalence of obesity has been reported in different population. Polymorphisms in various genes controlling appetite and metabolism predispose individuals to obesity differently.  Parental obesity has been found to influence childhood and adolescent obesity. , In a study from south India, parental obesity was found to be an important risk factor. 
Our adolescents were from the north Indian region, where adult obesity is more prevalent than other regions of the country.  Excessive weight in adolescents was significantly associated with parents' obesity in our study. To directly attribute this to genes would be an over-simplification of a very complex issue of family influence on obesity. In a recent review of studies on family factors influencing obesity, the author outlines that the family system, with its various subsystems, plays a very important role in deciding the energy intake and spending behavior of adolescents.  The obese parents in the west may be more active in preventing their children getting obese. In developing countries like ours, this factor is probably non operative mainly due to lack of awareness of health hazards of obesity.  Hence, cultural factors may be acting in concert with possible genetic predisposition and elevated socioeconomic parameters. In a single center, cross-sectional survey-based study like ours; it is probably not possible to outline the heredity and other factors separately for a group of children.
Whether obese parents reflect the genetic aspect or the socioeconomic-cultural aspect of feeding and exercising behavior in a given society, demands larger, longitudinal studies taking ethnicity, and other important features into main consideration. These studies will also be important in identifying the possible areas of primary and secondary prevention.
| Conclusion|| |
We conclude that better socio-economic conditions lead to increased adolescent obesity prevalence in the urban north Indian population. Positive association of parental obesity in the obese adolescents also suggests the possible role of genes as well as socio-economic factors. This is an important aspect for further scientific exploration. There is a need of a larger multicentric, multiethnic study looking at genetics, nutritional, and other factors of obesity in our country. Our study results also suggest taking measures to introduce healthier eating and energy spending behaviors before the onset of adolescence.
Strength of study
To the best of our knowledge, till date, this is the only study on the role of family factors influencing adolescent obesity in Haryana state, with such a large sample size.
Limitations of the study
This study having been conducted in urban areas does not describe the status of obesity in rural adolescent population which is also a large part of the adolescent population. It would have been ideal to include questions to test awareness of obesity-related health risks, but to prevent bias while answering the rest of the questions; we did not put such questions. As it is with all questionnaire based studies, a chance prevails, that responses to some questions may be different from the reality. We also acknowledge the fact that self-reporting of height and weight by parents has various limitations.
What this study adds
Urban areas of Haryana face the risk of increasing obesity in adolescents, especially in economically "well to do" families.
| References|| |
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
Ogden CL, Carroll MD, Curtin LR, Lamb MM, Flegal KM. Prevalence of high body mass index in US children and adolescents, 2007-2008. JAMA 2010;303:242-9.
Cole TJ, Bellizzi MC, Flegal KM, Dietz WH. Establishing a standard definition for child overweight and obesity worldwide: International survey. BMJ 2000;320:1240-3.
Epstein LH, Saelens BE. Behavioral economics of obesity: Food intake and energy expenditure. In: Bickel WK, Vuchinich RE, editors. Reframing Health Behavior Change with Behavioral Economics. Mahwah, NJ: Lawrence Erlbaum Associates; 2000. p. 293-312.
Janssen I, Katzmarzyk PT, Boyce WF, Vereecken C, Mulvihill C, Roberts C, et al. Comparison of overweight and obesity prevalence in school-aged youth from 34 countries and their relationships with physical activity and dietary patterns. Obes Rev 2005;6:123-32.
Sharma A, Sharma K, Mathur KP. Growth pattern and prevalence of obesity in affluent schoolchildren of Delhi. Public Health Nutr 2007;10:485-91.
Mohan B, Kumar N, Aslam N, Rangbulla A, Kumbkarni S, Sood NK, et al. Prevalence of sustained hypertension and obesity in urban and rural school going children in Ludhiana. Indian Heart J 2004;56:310-4.
Remesh A. Prevalence of adolescent obesity among high school students of Kerala, South India. Arch Pharm Pract 2012;3:289-92.
Gupta DK, Shah P, Misra A, Bharadwaj S, Gulati S, Gupta N, et al. Secular trends in prevalence of overweight and obesity from 2006 to 2009 in urban Asian Indian adolescents aged 14-17 years. PLoS One 2011;6:e17221.
Berge JM. A review of familial correlates of child and adolescent obesity: What has the 21 st
century taught us so far? Int J Adolesc Med Health 2009;21:457-83.
Tharkar S, Viswanathan V. Impact of socioeconomic status on prevalence of overweight and obesity among children and adolescents in Urban India. Open Obes J 2009;1:9-14.
Kaur S, Sachdev HP, Dwivedi SN, Lakshmy R, Kapil U. Prevalence of overweight and obesity amongst school children in Delhi, India. Asia Pac J Clin Nutr 2008;17:592-6.
Goyal RK, Shah VN, Saboo BD, Phatak SR, Shah NN, Gohel MC, et al. Prevalence of overweight and obesity in Indian adolescent school going children: Its relationship with socioeconomic status and associated lifestyle factors. J Assoc Physicians India 2010;58:151-8.
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.
Bharati DR, Deshmukh PR, Garg BS. Correlates of overweight and obesity among school going children of Wardha city, Central India. Indian J Med Res 2008;127:539-43.
Wang Z, Patterson CM, Hills AP. Association between overweight or obesity and household income and parental body mass index in Australian youth: Analysis of the Australian National Nutrition Survey, 1995. Asia Pac J Clin Nutr 2002;11:200-5.
Babey SH, Hastert TA, Wolstein J, Diamant AL. Income disparities in obesity trends Among California Adolescents. Approaches Obes Prev 2010;100:2149-55.
Gerald LB, Anderson A, Johnson GD, Hoff C, Trimm RF. Social class, social support and obesity risk in children. Child Care Health Dev 1994;20:145-63.
Qazi IA, Charoo BA, Sheikh MA. Childhood obesity. Indian J Endocrinol Metab 2010;14:19-25.
Reilly JJ, Armstrong J, Dorosty AR, Emmett PM, Ness A, Rogers I, et al. Early life risk factors for obesity in childhood: Cohort study. BMJ 2005;330:1357.
Whitaker RC, Wright JA, Pepe MS, Seidel KD, Dietz WH. Predicting obesity in young adulthood from childhood and parental obesity. N Engl J Med 1997;337:869-73.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]