Journal of Family Medicine and Primary Care

ORIGINAL ARTICLE
Year
: 2015  |  Volume : 4  |  Issue : 1  |  Page : 84--88

Correlates of overweight and obesity among urban adolescents in Bihar, India


Ayan Ghosh1, Deblina Sarkar2, Ranabir Pal2, Bijoy Mukherjee3,  
1 Department of Community Medicine, College of Medicine and Jawaharlal Nehru Memorial Hospital, Kalyani, West Bengal, India
2 Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
3 Department of Community Medicine, Katihar Medical College and Hospital, Katihar, Bihar, India

Correspondence Address:
Ayan Ghosh
Department of Community Medicine, College of Medicine and JNM Hospital, Kalyani - 741 235, West Bengal
India

Abstract

Background: For better perception of adolescent overweight and obesity as a global public health problem, systematic collection of baseline data is urgently needed in India. Objective: A community-based study was undertaken for better perception of the prevalence and correlates of obesity in an adolescent urban community in Katihar, Bihar. Materials and Methods: A cross-sectional study was conducted among urban adolescents in the eastern part of India to find out prevalence of overweight and obesity and sociodemographic correlates by interview technique followed by clinical examination with ethical consideration. Results: Out of 400 adolescent study participants, 21% were overweight or obese. The study showed that there was a significant association between less consumption of vegetable foods, fruits, meals cooked outside the home, alcohol consumption, yoga practice, socioeconomic status, and the occurrence of overweight/obesity in the adolescents. Conclusions: We attempted to find out the prevalence and risk correlates of overweight and obesity among adolescents and found it quite alarming compared to developed countries. The urban underserved population in India has difficulty to access quality healthcare and not conscious enough to seek healthcare until critically ill. Community-based studies are required to highlight the problem of obesity among urban adolescents by a comprehensive approach.



How to cite this article:
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;4:84-88


How to cite this URL:
Ghosh A, Sarkar D, Pal R, Mukherjee B. Correlates of overweight and obesity among urban adolescents in Bihar, India. J Family Med Prim Care [serial online] 2015 [cited 2019 Aug 17 ];4:84-88
Available from: http://www.jfmpc.com/text.asp?2015/4/1/84/152261


Full Text

 Introduction



Adolescents comprise about 20% of the global population of which 80% percent live in the developing countries. In India; about 230 million, which is calculated to be 23% of the total population, are adolescents. Overweight and obesity are progressively important public health problem of global significance. Obesity has reached a pandemic proportion with more than 1 billion of them have grown up as adult overweight; of them nearly 300 millionhave been noted to be clinically obese. Urbanization, modern life, altered dietary habits, and lifestyle practices among adolescents contributing to the emerging chubbiness trends predisposing to adult overweight and obesity. [1]

Adolescence, as considered by World Health Organization (WHO) as from 10 to 19 years, currently recorded a prevalence of 20% in UK and Australia, 15.8% in Saudi Arabia, 15.6% in Thailand, 10% in Japan, and 7.8% in Iran. [2]

Although the growing prevalence of overweight and obesity has received much attention in the recent years, there is a dearth of data in India, partly because of the persisting high prevalence of undernutrition. Representative national data on adolescent overnutrition is lacking even from National Family Health Survey and District Level Household and Facility Surveyfor which on this important parameter by the Government of India will be formulated.

Although the growing prevalence of overweight and obesity among adolescent population has received much attention in the recent years, there is a dearth of data in India, partly because of the persisting high prevalence of under nutrition.

In the above scenario, this community-based study was undertaken to find out the prevalence and correlates of overweight and obesity in an adolescent urban community in Katihar, Bihar.

 Materials and Methods



This cross-sectional study was conducted amongst the adolescents (10−19 years) residing in the urban community under Katihar Municipal Area in Bihar to find out prevalence of overweight and obesity with their sociodemographic correlates from October 2010 to September 2011.

Sampling method

Considering the prevalence of overweight and obesity among adolescents in the urban area as 20%, [1] the sample size was calculated to be 400 (P = 20%, L = 20% of P). By 30 clusters, study participants were sampled by probability proportional to size (PPS) method.

Study instrument

The data collection tool used for the study was an interview schedule that was developed at the institute with the assistance from the faculty members and other experts in relation to overweight and obesity in the adolescent population with the sociodemographic situation prevailing in India. This predesigned and pretested questionnaire contained questions relating to the information on family characteristics such as residence, type of family, family history of diabetes mellitus, and family history of chronic disease; income and personal characteristics such as age, sex, education, occupation, and dietary habit including salt intake physical activity and addiction. By initial translation, back-translation, retranslation followed by pilot study, the questionnaire was custom-made for the study. The pilot study was carried out at the institute among general subjects following which some of the questions from the interview schedule were modified.

Data collection procedure

Study was approved by Institutional Ethics Committee and informed verbal consent was obtained from all participants. The health workers informed and motivated the families to participate in the study along with the scope of future intervention, if necessary. All the participants were explained about the purpose of the study and were ensured strict confidentiality, and then informed consent was taken from each of them before the total procedure. The participants were given the options not to participate in the study if they wanted. Data regarding family and personal characteristics were recorded by face-to-face personal interview. The weight and height of each child were recorded.

Case definitions used in this study

Overweight and obesity

Height was measured by a WHO approved wall-mounted height measuring scale and a calibrated and standardized mechanical weighing scale was used. Overweight and obesity were defined by body mass index (BMI) for gender and age. BMI >85 th percentile of reference data were considered overweight and with a BMI >95 th percentile were considered obese. [3] The reference data used to identify the cut-off points were taken from the Centers for Disease Control and Prevention (CDC) 2000 dataset for BMI. [4],[5]

Physical activity

Those engaged in running, fast walking, cycling, biking, dancing, and playing football for at least 60 min/day on 5 or more days per week are defined as physically active. Those who failed to fulfill the following criteria are considered as insufficiently physically active. [6]

Smoking

Smoker was defined by any history of single puff of smoking by the participant in the last 30 days. [7]

Alcohol consumption

A "current drinker" was defined as one who consumed one or more drinks of any type of alcohol in the year preceding the study.

Dietary practice

Dietary practices was assessed by using semiquantitative food frequency questionnaire and the average amount and frequency of consumption of obesogenic (like fast food, cold drinks, ice cream, sweets, ghee, butter, and red meat) and protective foods (fruits and vegetables) in last week; consumption of three servings or more per week or not was calculated. [8]

Principal investigator collected the data; on an average, five to six interviews were conducted per day. Information on obesity was disseminated to participants and their caregivers in health education sessions to complement the findings of study.

Statistical analysis

The collected data were thoroughly cleaned and entered into MS Excel spreadsheets for analysis. The statistical analyses were done using Graph Pad In Stat "version 3" software. Categorical variables were presented as percentage and chi-square tests were applied to analyze epidemiological variables at alpha level of P < 0.05.

 Results



Among 400 adolescents, majority were of 15 years of age; males were 242 (60.5%); 82 (20.5%) respondents were overweight/obese and 318 (79.5%) respondents were not overweight/obese. Out of 82 overweight/obese adolescents, 68 (17%) were overweight and 14 (3.5%) were obese [Table 1].{Table 1}

Most of the participants (60.25%) were educated upto primary level, and only 32 (8%) were educated upto higher secondary level; mostly from lower middle class (39%), 129 (32.25%) were from upper lower class. Majority of them (70.5%) consumed fruit occasionally; 25 (6.25%) consumed fruit daily, 76 (19%) consumed fruit three to four times/week, and the remaining 17 (4.25%) did not consume fruit. In the majority (69.75%), percentage of weekly meals consisting of food cooked outside the home was <25%. In 102 (25.5%) of the respondents it was 25-50%, in eight (2%) of the respondents it was >50%, and remaining 11 (2.75%) respondents did not consume outside food. Out of 400 adolescents, 62 (15.5%) practiced yoga and 46 (11.5%) used tobacco [Table 2].{Table 2}

There was significant association between less consumption of vegetable and occurrence of overweight/obesity (chi-square =7.73, degrees of freedom (df) =2, P < 0.05), less consumption of fruit and overweight/obesity (chi-square=42.3, df =3, P < 0.001), consumption of meals cooked outside the home and overweight/obesity (chi-square=16.32, df =2, P < 0.002), and no yoga practicing and overweight/obesity (chi-square (Yate's corrected) =7.89, df =1, P < 0.01); alcohol consumers were 4.98 times more at risk than nonconsumers [Table 3]a.{Table 3}

There was significant association between the socioeconomic status and the occurrence of overweight/obesity (chi-square =33.81, df =3, P < 0.002) [Table 3]b.

 Discussion



In the present study, one-fifthhad over-nutrition. Hyderabad studyfoundprevalence of overweight of 6.1% among boys and 8.2% among girls; prevalence of obesity was 1.6 and 1.0%, respectively. [9] The Kerala study reported that overweight children increased from 4.94% in 2003 to 6.57% in 2005. [10] The prevalence of childhood obesity was lower than comparable studies. [11],[12],[13],[14],[15]

Vegetable consumption

A significant association between less consumption of vegetable foods and occurrence of over-nutrition was noted by us. An UK longitudinal study on parents and children noted that risk factors at 3 years of age junk foods based food habits (fizzy drinks, sweets, chocolates, chips, fried foods, and others) was associated with obesity at 7 years of age; no significant relationship with obesity for a healthy, traditional, or fussy dietary pattern was noted. [16] In contrast, Gupta et al., found 84.29% adolescent consume vegetables among rural adolescent in Bengal. [17]

Fruit consumption

There was a significant association between less consumption of fruit and the occurrence of overweight/obesity in the adolescents. Yusuf et al., showed that abnormal lipids; smoking; hypertension; diabetes; abdominal obesity; psychosocial factors; consumption of fruits, vegetables, and alcohol; and regular physical activity accounted for most risks. [18]

Meals cooked outside

The study revealed that proportion of overweight/obesity was significantly high among those consuming cooked food from outside. Tiwari and Sankhala from Rajasthan reported that higher consumption of outside food was linked with overweight in urban adolescent girls. [19]

Role of yoga and physical inactivity

This study showed that there was significant association between no yoga practicing and physical inactivity with the occurrence of overweight/obesity in the adolescents. A study observed that lack of physical activity and high consumption of junk food was found to be associated with obesity in children. [20] A Karnataka study demonstrated that overweight was twice higher among adolescents of high socioeconomic status, 21 times higher among those participating less than 2 h/week of physical activity, 7.3 times higher among television watchers and playing games on the computer for more than 4 h/day. [21] Another study from Karnataka foundhigh energy snacks and lack of physical activity as the important influencing factors. [22]

Role of alcohol consumption

We observed a significant relationship between adolescent's overweight and obesity with consumption of alcohol. However, significant relationship was not reported in the Balearic Islands comparable study. [23] Recent USA data indicated that female and male adolescents report similar rates for current drinking, 13.5 and 13.7%, respectively. [24]

Smoking

Smoking was not significantly associated with the obesity in the present study. In a review of 19 studies, Potter et al., noted a positive relationship between smoking and body weight among adolescents, [25] yet others did not find a positive association. [25],[26],[27],[28],[29],[30],[31]

Socioeconomic status

The study showeda significant association between socioeconomic status and overweight/obesity among adolescents. Wang et al., reported that the prevalence of obesity and overweight was 11.1 and 14.3% in United States; 6.0 and 10.0% in Russia; and 3.6 and 3.4% in China; respectively; relationship between obesity and socioeconomic status varied across countries. Higher socioeconomic status subjects were more likely to be obese in China and Russia, but in the USA, low socioeconomic status groups were at a higher risk. [32]

Strengths of the study

To the horizon of our knowledge, no related publication on adolescent lifestyle has been reported so far from in this part of Bihar.

Limitations of the study

We had several limitations. Firstly, a larger sample size could have provided more vital information, due to resource constraint that could not be achieved. Further, the study survey was cross-sectional with no causal inferences possible.

Future directions of the study

Any short-term solution may not help us to reach the goal of control of obesity-related diseases in a multicultural, multilingual, and geographically uneven country like India. Further, health professionals alone are unable to deal with this mammoth task. Strategic interventions to obviate the cause for noncompliance to intervention need holistic responsibility of professionals, health services, governments, and teaching institutions. For a substantial impact on this burden, unique preventive healthcare strategies need to be clearly formulated and tested. Behavior change communication supported by the screening is important for early detection to prevent complications is needed initiated by the political will.

References

1Kaur S, Kapil U, Singh P. Pattern of chronic diseases amongst adolescent obese children in developing countries. Curr Sci 2006;88:152-4.
2Arya SN, Kumar R. Obesity. Indian Acad Clin Med 2004;5:166-81.
3Chakraborty P, Dey S, Pal R, Kar S, Zaman FA, Pal S. Obesity in Kolkata children: Magnitude in relationship to hypertension. J Nat Sc Biol Med 2011;2:101-6.
4Department of Health and Human Services. Centers for Disease Control and Prevention, USA. CDC growth charts for the United States. Available from: http://www.cdc.gov/nchs/data/nhanes/growthcharts/zscore/bmiagerev.xls [Last accessed on 2013 Dec 22].
5Physical status: The use and interpretation of anthropometry. Report of a WHO Expert Committee. World Health Organ Tech Rep Ser 1995;854:1-452.
6Global School Health Survey 2007 Tobago report, Pan American Health Organization, CDC GSHS:15-6.
7Singh AK, Maheshwari A, Sharma N, Anand K. Lifestyle associated risk factors in adolescents. Indian J Pediatr 2006;73:901-6.
8Diet, physical activity and health. 2002 (documents A 55/16 and 55/16 Corr.1). WHO, Geneva.
9Laxmaiah 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.
10Raj M, Sundaram KR, Paul M, Deepa AS, Kumar RK. Obesity in Indian children: Time trends and relationship with hypertension. Natl Med J India 2007;20:288-93.
11Chhatwal 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.
12Ramachandran A, Snehalatha C, Vinitha R, Thayyil M, Kumar CK, Sheeba L, et al. Prevalence of overweight in urban Indian adolescent school children. Diabetes Res Clin Pract 2002;57:185-90.
13Marwaha RK, Tandon N, Singh Y, Aggarwal R, Grewal K, Mani K. A study of growth parameters and prevalence of overweight and obesity in school children from Delhi. Indian Pediatr 2006;43:943-52.
14Khadilkar VV, Khadilkar AV. Prevalence of obesity in affluent school boys in Pune. Indian Pediatr 2004;41:857-8.
15Kapil U, Singh P, Pathak P, Dwivedi SN, Bhasin S. Prevalence of obesity amongst affluent adolescent school children in Delhi. Indian Pediatr 2002;39:449-52.
16Reilly JJ, Armstrong J, Dorosty AR, Emmett PM, Ness A, Rogers I, et al. Avon Longitudinal Study of Parents and Children Study Team. Early life risk factors for obesity in childhood: Cohort study. BMJ 2005;330:1357.
17Gupta A, Sarker G, Das P, Shahnawaz K, Pal R. Prevalence of lifestyle associated cardiovascular risk factors among adolescent students of rural Bengal. J Integrated Health Sci 2013;1:69-75.
18Yusuf S, Hawke S, Onupuv S, Danes T, Avenue A, Lamas F, et al. INTERHEART Study Investigators. Effect of potentially modifiable risk factors associated with myocardial Infarction in 52 countries (The INTERHEART study): Case-control study. Lancet 2004;364:937-52.
19Tiwari P, Sankhala A. Prevalence of obesity, weight perception and dietary behaviour of urban college going girls. J Hum Ecol 2007;21:181-3.
20Warraich HJ, Javed F, Faraz-Ul-Haq M, Khawaja FB, Saleem S. Prevalence of obesity in school-going children of Karachi. PLoS One 2009;4:e4816.
21Kotian MS, S GK, Kotian SS. Prevalence and determinants of overweight and obesity among adolescent school children of South Karnataka, India. Indian J Community Med 2010;35:176-8.
22Kumar 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.
23Bibiloni Mdel M, Martinez E, Llull R, Juarez MD, Pons A, Tur JA. Prevalence and risk factors for obesity in Balearic Islands adolescents. Br J Nutr 2010;103:99-106.
24Substance Abuse and Mental Health Services Administration. Results from the 2010 National Survey on Drug Use and Health: Summary of National Findings, NSDUH Series H-41, HHS Publication No. (SMA) 11-4658. Rockville: Substance Abuse and Mental Health Services Administration; 2011.
25Potter BK, Pederson LL, Chan SS, Aubut JA, Koval JJ. Does a relationship exist between body weight, concerns about weight, and smoking among adolescents? An integration of the literature with an emphasis on gender. Nicotine Tob Res 2004;6:397-425.
26Al-Kloub MI, Al-Hassan MA, Froelicher ES. Predictors of obesity in school-aged Jordanian adolescents. Int J Nurs Pract 2010;16:397-405.
27Yngve A, De Bourdeaudhuij I, Wolf A, Grjibovski A, Brug J, Due P, et al. Differences in prevalence of overweight and stunting in 11-year olds across Europe: The Pro Children Study. Eur J Public Health 2008;18:126-30.
28Curry C, Gabhainn SN, Godeau E, Roberts C, Smith R, Currie D, Picket W, Richter M, Morgan A, Barnekow V, editors. Inequalities in Young People's Health: HBSC International Report from the 2005/2006 Survey. WHO Regional Office for Europe; Copenhagen, Denmark: 2008. [Last accessed on 23 December 2013].
29Hamaideh SH, Al-Khateeb RY, Al-Rawashdeh AB. Overweight and obesity and their correlates among Jordanian adolescents. J Nurs Scholarsh 2010;42:387-94.
30Puoane T, Tsolekile L, Steyn N. Perceptions about body image and sizes among Black African girls living in Cape Town. Ethn Dis 2010;20:29-34.
31Dupuy M, Godeau E, Vignes C, Ahluwalia N. Socio-demographic and lifestyle factors associated with overweight in a representative sample of 11-15 year olds in France: Results from the WHO-collaborative health behaviour in school-aged children (HBSC) cross-sectional study. BMC Public Health 2011;11:4421-42.
32Wang F, Wub S, Songa Y, Tanga X, Marshallc R, Lianga M, et al. Waist circumference, body mass index and waist to hip ratio for prediction of the metabolic syndrome in Chinese. Nutr Metab Cardiovasc Dis 2009;19:542-7.