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ORIGINAL ARTICLE
Year : 2020  |  Volume : 10  |  Issue : 2  |  Page : 29-34

Study of Prevalence and Lifestyle Related Correlates of Overweight and Obesity Among Rural Adolescents of Western Maharashtra


Department of Community Medicine, Krishna Institute of Medical Sciences Deemed to be University, Karad, Maharashtra, India

Date of Submission20-Nov-2019
Date of Decision19-Jan-2020
Date of Acceptance30-Jan-2020
Date of Web Publication10-Apr-2020

Correspondence Address:
D.G.O, M.D, Ph.D. Supriya S Patil
Associate Professor and Dean Academics, “Jaisriram”- Plot No 3, RS No. 2, Near Water Tank, Koyna Vasahat, Karad, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijnpnd.ijnpnd_75_19

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   Abstract 


Context: India is in a nutritional transitional phase; hence overweight and obesity is also on the rise. Nutritional assessment should begin right from adolescence as it is the transition between childhood and adulthood, hence focusing on this age group would not only prevent disease emergence but also promote a healthy life style in them. Aim: To determine the prevalence of overweight, obesity and the risk factors associated with it. Methods: A school-based, cross-sectional study was conducted between May to July 2018 in randomly selected schools of Karad Taluka. 300 adolescents, 12–15 years of age were interviewed using a pretested and semi-structured proforma. Height, weight and Body mass index (BMI) were measured using standard methodology. The prevalence of overweight and obesity was determined using Indian Association of Pediatrics (IAP) age and gender-specific BMI standards and the risk factors were assessed. Statistical analysis used: Data was analyzed using SPSS version 20. Chi-square, mean, standard deviation and odds ratio were applied. A P-value less than 0.05 was statistically significant. Results: The prevalence of overweight was 27(9%) and obesity was 15(5%). Overweight was more in females 13(48.14%) while obesity in males 12(80%). Frequent consumption of fast food, carbonated drinks, snacks and spending 1hr or more daily on television were found to be a significant risk factors for overweight and obesity. Conclusion: The prevalence of adolescent overweight and obesity is on a rise even in rural areas. Education and awareness on healthy eating along with physical activity and lifestyle modifications if made in this age will be easily accepted and followed thus bringing significant differences.

Keywords: Adolescence, obesity, odds, overweight, prevalence


How to cite this article:
Viswanathan VT, Patil SS, Durgawale P, Kakade S. Study of Prevalence and Lifestyle Related Correlates of Overweight and Obesity Among Rural Adolescents of Western Maharashtra. Int J Nutr Pharmacol Neurol Dis 2020;10:29-34

How to cite this URL:
Viswanathan VT, Patil SS, Durgawale P, Kakade S. Study of Prevalence and Lifestyle Related Correlates of Overweight and Obesity Among Rural Adolescents of Western Maharashtra. Int J Nutr Pharmacol Neurol Dis [serial online] 2020 [cited 2020 May 29];10:29-34. Available from: http://www.ijnpnd.com/text.asp?2020/10/2/29/282289




   Introduction Top


Adolescent obesity is rising at an alarming state. About 21% of Indian population is adolescents (about 243 million) which is the largest in the world.[1] The level of overweight and obesity has been increasing rapidly with 1 in 10 individuals of age 5–17 years being overweight or obese globally.[2] The prevalence of overweight and obesity among children and adolescents (aged 5–19) has risen dramatically from 4% in 1975 to just over 18% in 2016,[3] thus prompting the World Health Organization to designate obesity as a global epidemic.[4]

With a proportion that equals to one-fourth of the total population of India, there is a need to emphasis on a balanced nutrition in this age group. Adolescence is characterized by rapid growth spurt that overlaps with rapid physical, mental, socio-psychological and sexual growth. The pubertal growth is a complex process regulated and modified by hormonal and genetic factors. Nutritional status and heavy exercise training are only two of the major influences on the linear growth of children.[5] Up to 80% of adolescents may remain overweight as they mature, particularly if severely overweight or if they have an obese parent.[6] Obesity is also a major risk factor for Non-Communicable Diseases (NCDs) such as Non-Insulin-Dependent Diabetes Mellitus (NIDDM), Cardiovascular\Disease (CVD) and cancer. In many industrialized countries, it is associated with various psychological problems also. Overweight and obesity in the adolescence attributes to the increase in sedentary life style, unhealthy food habits, poor diet, lack of physical activity, and also to the overuse of gadgets. Lack of awareness is also a determining factor when it comes to obesity in this age group.

There has been a shift to double and triple burden of malnutrition in most of the developing countries. With a wide range of health initiatives that focus on curbing undernutrition, it is a high time that a shift is made to obesity too. This study was hence conducted to determine the prevalence of overweight and obesity among school going adolescents, and to assess the risk factors associated with it. A reliable data on the adolescent nutritional status if obtained, can help plan the governmental strategies required to improve adolescent health and wellbeing. [7]


   Materials and Methods Top


This cross-sectional study was conducted during March 2018 to October 2018, among school going adolescents of Karad Taluka. Sample size was estimated using the formula, n=4pq/L2, using a prevalence of 5.62% for obesity and 9.99% for overweight from a Pune-based study in 2015,[8] allowable error of 3 as 234. A total of 300 adolescents, 12–15 years of age were included in this study. An updated list of schools obtained from Karad Taluka was used as the sampling frame. Three schools were selected randomly, 100 students from each of the three schools were included from randomly selected classes. Ethical clearance was obtained from Institutional ethical committee, and permission to conduct the study was obtained from the principals of the respective Schools. Informed consent from parents and assent from the participants was obtained prior to data collection.

A pretested and semi-structured proforma was used for data collection. Information pertaining to socio-demographic profile, housing, eating habits, and lifestyle of each student was asked individually. Detailed dietary history comprising of diet preference, number of meals consumed, fast-food consumption, consumption of soft-drinks, snacks between meals were obtained. Lifestyle pattern including hours of physical activity, hours spend on television, hours spend on mobile phones and gadgets were also asked. Occasional consumption of fast-food and soft drinks were defined to be less than once per week, one or more times every week was used to define frequent consumption. Snacks were defined as any food or drink consumed in between meals, daily consumption was defined as frequent consumption and less than daily to be occasional. Anthropometric measurements like height and weight of each student was measured. Height was measured with the child standing bare foot, head in Frankfurt plane, arms by the side, head, heels and back touching the wall. A thin, wooden scale was placed above the head perpendicular to the ruler and parallel to the ground, measurements were calibrated to the nearest 0.1cm. Weight was measured to the nearest 0.1 kilogram using a portable weighing machine, with the child standing barefoot, head in Frankfurt plane, empty pockets while standing on the weighing machine. The weighing machine was calibrated to zero prior to each measurement.[9]

The prevalence of overweight and obesity was determined using the IAP standard for BMI, 2015.[10] The adult equivalent of 23 and 27 BMI cut-off lines as presented in the IAP BMI charts were used to define overweight and obesity.[10] A comparison of the prevalence was done using the WHO reference 2007,[11] and Regional BMI standard.[12] As per recommendations of WHO and regional BMI standard, the 85th and 95th age and gender specific percentiles were used to classify as overweight and obesity. The regional BMI standards were developed in the Department of Community Medicine, KIMSDU following a study conducted on 2025 adolescents aged 10–15 years from eight Tahsils of Satara district, Maharashtra and was recommended for use in the Satara district.[12]

Data was analyzed using SPSS version 20 (licensed). Statistical tests like mean, standard deviation, chi square, odds ratio, percentages were used.


   Results Top


300 adolescents of 12–15 years were included in this study, where maximum adolescents belonged to 14 years 129(43%) and minimum to 12 years 25(8.3%) with a mean age of 13.84±0.8 years. In this study, Males 170(56%) were more than the females 130(43.3%), but there was no significant difference in the gender-wise distribution of adolescents p>0.05. The mean height, weight and BMI of the adolescents were 159±7.5cm, 43±10kg, and 17.6±3.5 respectively.

The prevalence of obesity was 15(5%), while overweight was 27(9%). Both overweight and obesity were found to be more towards the mid and late adolescence with maximum obesity in 14 years 7 (46.66%) while overweight was maximum in 13 years 11(40.7%). The prevalence of obesity was higher amongst males 12 (80%), while overweight was increasing amongst the females 13(48.14%) [Table 1].
Table 1 Age-wise prevalence of overweight and obesity

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The prevalence of overnutrition was compared using the three standards namely WHO 2005 reference, IAP standard 2015, and Regional standard of BMI. It was found that the prevalence of obesity was 15(5%) with both WHO reference and IAP standard, while it was slightly higher with the regional standard 17(5.7%). The prevalence of obesity was higher in males when compared to females according to all the three standards. The prevalence of overweight was lower with WHO reference 7 (2.3%), while it was higher with the IAP standard 27(9%) and the regional standard 31(10.3%) [Table 2].
Table 2 Gender-wise prevalence of overweight and obesity—A comparison of WHO 2007 and Regional BMI Standard

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On assessing the socio-demographic and lifestyle related risk factors it was found that the prevalence of overweight and obesity was higher in upper class 7(20.6%). Majority of the overweight and obese adolescents had fathers educated above high school 37 (14.2%) and mothers educated below high school 7(15.2%) respectively. A higher prevalence was found in adolescents whose mothers were housewives 34(14.1%), and fathers employed between skilled to professional occupation 36(14.6%). However, there was no significant association between socioeconomic status, education and occupational status of the parents and presence of overweight and obesity.

When the lifestyle-related risk factors for overweight and obesity was assessed it was observed that there was a higher prevalence of overweight and obesity in adolescents who followed a mixed diet 32(12.9%) and those who skipped meals 7(14.3%). Frequent consumption of fast food, snacks, and soft-drinks had a statistically significant association with overweight and obesity 25(26.3%), 19(25.3%), and 18(28.6%) respectively. 33(17.2%) of the overweight and obese adolescents watched television for >/=1hr/day, which was statistically significant. Also, maximum overweight and obese adolescents did not do any form of exercise 22(16.9%) [Table 3].
Table 3 Lifestyle-related risk factors associated with overweight and obesity.

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A stepwise multivariate logistic regression analysis [Table 4] was carried out using dietary, lifestyle and sociodemographic risk factors as the independent variable and BMI as the dependent variable. It was found that consumption of fast food, snacks, soft-drinks and watching television were significant risk factors for development of overweight and obesity in the aged 12-15 years. Frequent consumption of fast food had a 5.9 times increased chance of developing overweight and obesity, snacks consumption had a 3.8 times increased chance and consumption of soft drinks had a 4.5 times increased chance of developing overweight and obesity. Watching television for 1hr or more per day had a 5.8 times increased chance of developing overweight and obesity. Occasional consumption of fast food, snacks and soft-drinks also had an increased odd of developing overweight and obesity, however it was found be lesser than when consumed frequently. This model of analysis also showed that a probability cut-off value of 0.5 had a predictive value of 14(33.3%) overweight −obese and 252(97.7%) normal. The prediction of overweight-obese increased to 24(57.1%) and 217(84.1%) for normal with a probability cut-off value of 0.25.
Table 4 Multivariate analysis to assess the risk factors of overweight and obesity amongst adolescents

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   Discussion Top


The present study was carried out on 300 adolescents aged 12–15 years, studying between 7th to 9th standard. The prevalence of overweight and obesity, and the associated sociodemographic and lifestyle related risk factors were determined. Our study showed the prevalence of obesity 15(5%), while overweight was 27(9%). In the United States, the percentage of children and adolescents affected by obesity has more than tripled since the 1970s. [13] A combined prevalence of 29.8% overweight and obese was found according to a nationwide study conducted in 2015.[14] A study from Egypt also found a higher proportion of overweight (20%) and obese (10.7%). [15] This variation in the prevalence could be due to the difference in the reference standards and also the geographical locations for each study. However similar to our study a lower proportion of overweight and obesity was found in studies carried out in Rajasthan,[16] and Pondicherry.[17]

Our study showed maximum obesity in 14 years 7 (46.66%) and Overweight in 13 years 11(40.7%). A study by Khadilkar et al found that the prevalence of overweight increased from preschool years to 14 years, after which it declined, while the prevalence of obesity increased from preschool years to 17 year.[14] The Age-wise prevalence according to various studies showed maximum prevalence in age group of 13 to 16 years.[16],[18] This was in consistence to the findings in our study. Hence overweight and obesity showed an increase towards the mid adolescence and beyond which could be due to the pubertal changes and also the increased access to unhealthy diet and sedentary lifestyle. There have been discrepancies in the gender-wise prevalence of overnutrition. A gender-based comparison found that similar to our study males were more obese than females in studies conducted in Prasad et al.,[17] Tapnikar et al.[19] and Kotian et al.[20] However, in studies by sadhu Charan Panda et al,[21] females were found to be more obese. This increase of prevalence in males in our study could be because males have more access to go out than the girls, as it is a rural based study. Also, in this study the lifestyle associated risk factors like consumption of fast-food, soft-drinks and snacks between meals were also higher amongst males.

When the prevalence of overweight and obesity was compared using the WHO reference,[11] IAP standard [10] and Regional standards,[12] there was an under detection of overweight-obesity and over detection of undernutrition that was observed with the international (WHO reference) and the national reference standards (IAP Reference). This comparison between different standards was detrimental as it focusses on the need for development of regional standards. India being a country with diversity in traditions and various practices, rather than a nation-wide standard, developing standards that are comparable with the different regions of the country could provide a more accurate diagnosis of nutritional status.

When the socio-demographic risk factors were assessed, our study showed a higher prevalence in upper class 7(20.6%). A study by Kotian et al.[20] found that the risk of overweight was two times higher among the adolescents of high SES. Higher social economic status was found to have a positive correlation with the development of overweight and obesity. Our study showed a higher prevalence in adolescents whose mothers were housewives 34(14.1%), and fathers employed between skilled to professional occupation 36(14.6%). A study by Ahmad et al.[22] found that majority of the overweight and obese adolescents had their parent’s educated to middle school and above and majority mothers were house wives. This could attribute to majority of the parents educated above middle school and mothers being housewives.

Our study showed a significant association between consumption of fast-food, soft drinks, snacks and watching television for 1 hr. or more daily and development of overweight and obesity. Refined carbohydrates, snack foods, processed foods and fried foods have been found to be replacing the traditional foods like unrefined whole grains, fruit, vegetables and nuts.[23] A study from Morocco found that frequent consumption of soda and soft drinks three or more times a week (OR = 1.42, P = 0.04) was correlated with an increased risk for overweight and obesity. a higher incidence of overweight and obesity among adolescents who consumed fast-food and carbonated drinks. Similar findings were observed in studies conducted by in Karnataka by Mithra et al.[24] a study in Rajasthan by Sharma et al.[25] and Ahmed et al. There has been an increased adaptation to sedentary lifestyle patterns in the adolescents too. With urbanization and internet era that has emerged there has been various lifestyle related changes that has influenced even the adolescents and children. There has been a shift from the outdoor activity and games to increased time being spend indoor on television, videogames, computers or other gadgets. Multiple studies also found that lack of physical activity had a significant association with overweight and obesity.[24],[25],[22]. A study from Bangladesh found that engaging in sedentary activities for >4 hours a day (OR = 2.0, P = 0.02) were independent risk factors for overweight and/or obesity while exercising ≥ 30 minutes a day at home was a protective factor (OR = 0.4, P = 0.02).[26] Thus there is a proven increase in sedentary lifestyle, lack of physical activity and unhealthy eating pattern that is prevailing in the adolescents. The pubertal hormonal changes combined with such a lifestyle has led to the increase in overweight and obesity in this age group.


   Conclusion and Recommendations Top


The prevalence of adolescent obesity and overweight was 5% and 2.3% respectively in this study. Fast food consumption, consumption of soft-drinks, lack of exercise, consumption of snacks, increased hours of watching television were the factors significantly associated with overweight and obesity. Significant variations were observed in the prevalence of overweight and obesity using the WHO reference values, IAP and regional standards thus emphasizing the need for development of regional standards. Education and awareness on healthy eating along with physical activity and lifestyle modifications if made in this age will be easily accepted and followed thus bringing significant differences. Also, there is always a scope for further research in this area where a longitudinal study could further establish a causal relationship.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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