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Year : 2013 | Volume : 1 | Issue : 1 | Page : 8 - 11  


Original Articles
A Study of Prevalence of Childhood Obesity among School Children in Karimnagar Town

Adinatesh Katta V.1, Prashant R. Kokiwar2

1 Medical Officer, Primary Health Centre, Parigi, Ananntapuram Dist. 2Professor and Head, Department of Community Medicine, Malla Reddy Institute of Medical Sciences, Suraram, Hyderabad

Abstract:

Background: The problem of obesity is confined not only in adults but also among the children and adolescents. The most significant long term consequence of childhood obesity is its persistence into adulthood along with its attendant risks. The surveys on childhood obesity in under surveyed areas help to identify risk factors. Objectives: 1.To study the prevalence of obesity among school children of Karimnagar town. 2. To study the factors associated with obesity. Methods: A cross sectional study was conducted in schools of Karimnagar town. A total of 892 students were randomly selected belonging to 6th to 10th standard in randomly selected schools. Data was collected in a predesigned questionnaire. The cut off points for age and gender specific BMI recommended by Agarwal et al were used. Statistical analysis: The data was analyzed using chi square test. P value of less than 0.05 was considered as significant. Results: The mean age of study subjects was 13.03+1.52 years. The overall prevalence of overweight and obesity was 11.99% and 2.69% respectively and 14.68% combined together. Out of the factors studied, children belonging to open category (caste), upper social class were found to be significantly associated with obesity (p < 0.05). Other factors were not associated with obesity. Conclusion: The overall prevalence of obesity in the present study is high it is significantly associated with caste and upper social class. There is a need to increase awareness on physical fitness, regular exercise and appropriate dietary habits among children through schools.

Key words: Obesity, Overweight, Prevalence

Corresponding Author: Dr. Katta V. Adinatesh, Medical Officer, Primary Health Centre, Parigi, Ananntapuram Dist., Andhra Pradesh. Email: adinatesh69@gmail.com


Introduction:

Today as standards of living continue to rise, weight gain and obesity are posing a growing threat to health of the world. Obesity is a chronic disease, prevalent in both developed and developing counties. [1] In many developing countries including India it co exists with under nutrition. This constitutes a double burden for these countries. [2] The problem of obesity is confined not only in adults but also among the children and adolescents. [4]

Data from National Health and Nutrition Examination Survey (NHANES) showed that 17% of children in the age group of 12-19 years are overweight or obese. [5] Similar trends were observed in Japan, [6] Thailand. [7]

In India, the data which is available from urban school children in cities like New Delhi, Chennai, Hyderabad etc. where prevalence of obesity was found to be between 6-8% and overweight between 9-12%. [5]

Obesity is strongly associated risk factor for many known diseases and is also linked to underachievement in school, to lower self esteem and has negative consequences on cognitive and social development. The most significant long term consequence of childhood obesity is its persistence into adulthood along with its attendant risks. [8]

Prevention efforts are always directed by findings from studies. The surveys on childhood obesity in under surveyed areas help to identify further risk factors. Based on which preventive efforts can be undertaken. There is lack of data in India especially in the setting like Karimnagar which is rapidly growing in terms of modern life styles, where adverse influences of urbanization exist.

With this background, present study has been undertaken to study the prevalence of overweight and obesity among school children of Karimnagar town and factors associated with it.

Material and methods:

Study design: Cross sectional study.

Place of study: Schools of Karimnagar town.

Study period: May 2010 to September 2011.

Reference population: Total number of schools having 6th to 10th standard was 87 and a total of 29845 children in these schools.

Sample size:

Sample size was calculated based on the findings of pilot study conducted among 100 randomly selected students from 6th to 10th standard in two randomly selected schools. The prevalence of overweight and obesity was 17%. Based upon this prevalence, with 95% confidence interval and 15% allowable error, the sample size was 870.

Sampling technique:

Permission from District Education Officer (DEO) of Karimnagar District was obtained and subsequently a list of schools in Karimnagar was obtained from the office of DEO. From this a list of schools having 6th to 10th standard was prepared. Total number of such schools was 87 and total students were 29845. As sample size was 870, by taking 50 students from each school we could cover 18 schools (i.e. > 20% of schools) and these 18 schools were selected by using simple random sampling technique. These 18 schools were having 5835 school children.

There were five classes from 6th to 10th standard in each school, so it was decided to ten students from each class. In the schools where there was more than one section in a class, a list of students from each class with all sections was prepared. A serial number was then given as per their roll number. The required ten students from each standard were selected by using systematic random sampling technique. In this way it was expected to cover 900 students (i.e. 50 from 18 schools). But in the final data analysis eight students were excluded due to some missing information in their data.

Methodology:

Present study was approved by ethical committee of Chalmeda Anand Rao Institute of Medical Sciences, Karimnagar.

A predesigned, pretested, semi-structured questionnaire was administered to each pupil. If any selected child was absent on the day of the study, he/she was interviewed on subsequent visits to the school and data was collected. Information on socio demographic profile, anthropometric measurements was collected and recorded. The information on certain parameters was collected from the parents. A general physical examination of the child was also performed. Any child found having morbidity during examination was treated or referred. At the end, health education session was conducted by including all children of the school.

Age was confirmed from school records. Modified Prasad’s scale was used to classify the study subject into categories of socio economic status. [9] Height and weight were measured as per standard guidelines recommended by WHO. [10] Body Mass Index (BMI) was calculated as body weight in kg/height in meters in squares. [1] The cut off points for age and gender specific BMI recommended by Agarwal et al [3] were used.

Statistical analysis:

The data was analyzed using chi square test. P value of less than 0.05 was considered as significant.

Results:

In the present study, a total of 892 children from the schools of Karimnagar town were studied. The mean age of study subjects was 13.03+1.52 years (boys 13.08+1.51 years and girls 12.99+1.53 years). Majority of children were Hindu (85.99%). About 46.41% belonged to backward community. Of the total, 81.16% were from urban area. Few parents were illiterates i.e. 6.5% of fathers and 1.88% of mothers. Nearly two third (67.26%) of the children belonged to small family i.e. family size of four or less. Maximum i.e. 35.65% of children belonged to upper social class.

Table 1 shows that of the total children surveyed 50.33% were boys and 49.6% were girls. It was observed that in each age group there was almost equal proportion of boys and girls. This may be due to the fact that most of the schools were having separate sections for boys and girls with almost equal number of children and also children of same age group were present in each class.

Table 2 shows age and sex specific prevalence of overweight and obesity combined. The overall prevalence of overweight and obesity was 11.99% and 2.69% respectively and 14.68% combined together. The overall mean body mass index (BMI) was higher among girls (18.49 + 3.17) compared to boys (17.77 + 3.13) and the difference was statistically significant (Z = 3.4133; p = 0.0006708). The mean BMI increased as the age increased.

Out of the factors listed in the table, belonging to open category (caste) and belonging to upper social class were found to be significantly associated with overweight and obesity combined (p < 0.05). Other factors like family size, residence and parent’s education status were not associated with overweight and obesity.

Table 1: Age wise distribution of study subjects

Age

(years)

Boys

Girls

Total

N

%

N

%

N

%

10

15

3.3

19

4.3

34

3.81

11

67

15.1

75

16.9

142

15.92

12

79

17.6

73

16.5

152

17.04

13

102

22.7

97

21.9

199

22.31

14

89

19.8

96

21.7

185

20.74

15

83

18.5

69

15.6

152

17.04

16

14

3.1

14

3.2

28

3.14

Total

449

50.33

443

49.67

892

100

N* = Total Number

 

Table 2: Age and sex specific prevalence of obesity

Age

(years)

Boys

Girls

Total

N*

Obese#

N

Obese

N

Obese

10

10 (66.66)

05 (33.34)

16 (84.21)

03 (15.79)

26 (76.57)

08 (23.53)

11

59 (88.05)

08 (11.95)

57 (76.0)

18 (24.0)

116 (81.7)

26 (18.3)

12

62 (78.48)

17 (21.52)

67 (91.78)

06 (08.22)

129 (84.86)

23 (15.14)

13

84 (82.35)

18 (17.65)

89 (91.75)

08 (08.25)

173 (87.0)

26 (13.0)

14

78 (87.65)

11 (12.35)

83 (86.46)

13 (13.54)

161 (87.0)

24 (13.0)

15

74 (89.15)

09 (10.85)

63 (91.3)

06 (08.7)

137 (90.13)

15 (9.87)

16

10 (71.42)

04 (28.58)

09 (64.28)

05 (35.72)

19 (67.86)

09 (32.48)

Total

377 (83.97)

72 (16.03)

384 (86.68)

59 (13.32)

761 (85.32)

131 (14.68)

Mean BMI (boys) = 17.77+3.13; Mean BMI (girls) = 18.49+3.17

N* = Non overweight and obese;

Obese# = include overweight as well as obese

*Figures in the parentheses indicate percentages

 

Discussion:

In the present study, the overall prevalence of overweight and obesity was 11.99% and 2.69% respectively and 14.68% combined together. These findings are consistent with the findings from studies in India. [11, 12] However a very low prevalence was reported by Bharathi et al. [13]

A higher rate of prevalence of overweight and obesity was also reported from other developing countries like in Pakistan [14] and Saudi Arabia. [15] In India, studies done by Khadilkar et al [16] and Kapil et al [4] in Delhi reported a very high prevalence of overweight and obesity.

In the present study, the prevalence of overweight and obesity was more among boys than girls but it was statistically not significant. (X2 = 1.314; df = 1; p = 0.2524). Similar findings were also reported from other studies done in India. [11, 12] This was not the same in the studies done by Kumar et al [17] where the prevalence was more among girls rather than boys. But study by Supreet Kaur et al, [3] the prevalence was nearly equal in both boys and girls.

These differences in prevalence among various studies as well as among boys and girls may be due to the varying influences of social, cultural and dietary practices in different area. But newer studies are definitely documenting the higher prevalence.

When the association between caste and obesity was studied, it was found that the prevalence of overweight and obesity was more in the open category subjects (18.91%) as compared to backward community and SC; ST (12.56% and 8.33%) respectively. This difference was statistically significant. (X2 = 10.26; df = 2; p = 0.005908). From the literature search of studies on obesity among children it was clear that no study has reported this significant association between caste and overweight and obesity. Possibly this was the first study to examine this relationship. It means that the children belonging to open category are more prone to develop overweight and obesity possibly due to better nutrition, higher levels of income and higher standards of living, availability of facilities like computer, videogames, vehicles for transportation etc.

When the association between residence and childhood obesity was studied, we found that prevalence of overweight and obesity was high among urban residents than their rural counterparts. However, the difference was not significant. Similar finding was also reported by R K Lafta et al [18] who conducted study in Iraq. Other studies done in India found that the prevalence was significantly more among urban residents. [13, 19] However in a secondary analysis of data from National Survey of child health (NSCH) in U.S. among 5-18 years children observed that children living in rural areas in US are about 25% more likely to be overweight or obese than their metropolitan counterparts, suggesting that rural residency is an independent childhood risk factor for being overweight or obese (OR = 1.252; C.I. = 1.248 – 1.256). [104] This non significant difference in the present study may due to the fact that these 22 (13.17%) children from rural areas are actually very nearer to Karimnagar town and probably they are under the influence of urban environment.

The association between parent’s education and childhood obesity was statistically not significant in this study. Study by Bharathi D et al [13] showed a positive association between parental literacy status and childhood obesity. Whereas Lafta RK et al [18] reported that the prevalence of obesity is more in the children of parents with lower education levels. Tareek et al [15] observed a significant association between low maternal education and obesity among children.

A non significant association was found between family size and childhood obesity in the present study. But Tareek et al [15] found that the prevalence was more among children with small family size.

We found that prevalence of childhood obesity was significantly higher among children who belonged to upper social class compared to children who belonged to middle or lower classes. Similar findings were also reported by other studies [11, 13] and also studies from other developing countries like Thailand. [14]

But our study findings were contradictory to the studies done in developed countries where prevalence of overweight and obesity is significantly higher in lower social classes. [21, 22] This may be due to adaptation and awareness of healthy lifestyles in upper classes in the developed countries. The lower classes in these countries may be in the transition phase of development.

Thus it is concluded that the overall prevalence of overweight and obesity combined together in the present study shows a trend towards an emerging epidemic of obesity among children and this childhood obesity was significantly associated with caste and upper social class.

There is a need to increase awareness on physical fitness, regular exercise and appropriate dietary habits among children through schools.

 

Table 3: Association of various factors with obesity (overweight + obesity)

 
 

Factor

Obese#

Total (%)

N*

Total (%)

Total

Total (%)

Chi square

p value

Caste

Open category

BC

SC & ST

 

70 (18.91)

52 (12.56)

09 (08.33)

 

300 (81.09)

362 (87.44)

099 (91.66)

 

600 (41.48)

414 (46.41)

108 (12.11)

 

 

10.26

 

 

0.005908

Residence

Urban

Rural

 

109 (15.03)

022 (13.17)

 

616 (84.96)

247 (86.63)

 

725 (81.28)

167 (18.72)

 

0.3751

 

0.5401

Parent’s education

Literate

Illiterate

 

 

244 (15.09)

018 (10.97)

 

 

1372 (84.91)

0146 (89.03)

 

 

1616 (91.70)

0164 (09.30)

 

 

2.017

 

 

0.1557

Family size

< four

> four

 

086 (14.33)

045 (15.4)

 

 

514 (85.67)

247 (84.57)

 

600 (67.26)

292 (32.74)

 

 

0.182

 

 

0.6696

SES

Upper

Middle

Lower

 

065 (20.44)

060 (12.22)

006 (07.23)

 

253 (79.56)

431 (87.78)

077 (92.77)

 

318 (35.65)

491 (55.05)

083 (09.31)

 

 

14.47

 

 

0.0007206

N* = Non overweight and obese; Obese# = include overweight as well as obese

BC = Backward Community, SES = Socio Economic Status

 

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