|Year : 2022 | Volume
| Issue : 3 | Page : 235-240
|Secular trends in prevalence of overweight and obesity over a decade in urban and rural South Indian children integrated with geographic information system
HP Chanchala1, B Madhu2, Manjunatha S Nagaraja3, Raghavendra Shanbhog4
1 Department of Pediatric and Preventive Dentistry, JSS Dental College and Hospital, JSS Academy of Higher Education and Research, Mysore, Karnataka, India
2 Department of Community Medicine, JSS Academy of Higher Education and Research, Mysore, Karnataka, India
3 Department of Community Medicine, Mysore Medical College and Research Institute, Mysore, Karnataka, India
4 Department of Pediatric and Preventive Dentistry, JSS Academy of Higher Education and Research, Mysore, Karnataka, India
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|Date of Submission||24-Sep-2021|
|Date of Decision||06-Sep-2022|
|Date of Acceptance||09-Sep-2022|
|Date of Web Publication||17-Jan-2023|
| Abstract|| |
Context: The globalization in the process most of the rural sectors are also upgrading technically with digitalization with more availability of smart phones and gaming along with the refined food influences on the present-day children is causing a trend of overweight among the children. Aims: To arrive at the prevalence of overweight and obesity considering the Indian Academy of Pediatrics (IAP) cut-offs for growth standards among children aged 12 years from the rural and urban areas of Mysuru District. Methods and Material: The present program was the third large scale community intervention project carried out including the 7 talukas of Mysuru District which focused on the measurement of the Body mass index (BMI). In this phase between the year 2019 and 2020 anthropometric measurements were undertaken in 1602 urban and rural children aged 12 years from government-funded and privately-funded schools of Mysuru District. Statistical Analysis Used: The results were analysed statistically using SPSS for Windows (version 23.0) and the t-test, Chi-square test and proportion tests, P value were reported. Results: As per the IAP reference ranges the prevalence of obesity was 5.5% and overweight was 7.1% among children of Mysuru District. Conclusions: We report that this increase was significantly higher in girls than boys. There was an increasing trend in rural sectors; however, the obese children were more predominantly distributed among the urban sectors. This calls for a precise preventive measure to fulfil the goal of the World Health Organization (WHO) to control prevalence of childhood obesity by the year 2022.
Keywords: Indian children, obesity, overweight, rural, urban
|How to cite this article:|
Chanchala H P, Madhu B, Nagaraja MS, Shanbhog R. Secular trends in prevalence of overweight and obesity over a decade in urban and rural South Indian children integrated with geographic information system. Indian J Dent Res 2022;33:235-40
|How to cite this URL:|
Chanchala H P, Madhu B, Nagaraja MS, Shanbhog R. Secular trends in prevalence of overweight and obesity over a decade in urban and rural South Indian children integrated with geographic information system. Indian J Dent Res [serial online] 2022 [cited 2023 Feb 3];33:235-40. Available from: https://www.ijdr.in/text.asp?2022/33/3/235/367892
| Introduction|| |
Childhood obesity and obesity in adolescence has been one of the most critical challenges in the 21st century on the community health. It is now affecting developing and underdeveloped countries to a greater degree. In the year 2010, the prevalence of overweight children was over 42 million and close to 35 million of them were from the developing countries. This trend is also gradually increasing in India.
The member states of the World Health Organization (WHO) in view of the emergency posed by increase weight in children initiated and endorsed 'no increase in childhood overweight by 2025' as one of the six global nutrition targets in the 'Comprehensive Implementation Plan for Maternal, Infant and Young Child Nutrition'. This was consistent with the same target for obesity and diabetes between 2010 and 2025 in the 'WHO Global Action Plan for the Prevention and Control of Non-communicable Diseases 2013–2020'.
Short term effects of this include psychological comorbidities such as low self-esteem, depression, anxiety, emotional and behavioural disorders, asthma, low-grade systemic inflammation, liver complications, musculoskeletal problem and also prone to metabolic and cardiovascular systems. Long term effects often result in reduced average lifespan. Therefore, it highlights the need to seriously monitor and prevent overweight/obesity at the earliest possible stage to aid in better quality of life.
The global prevalence of childhood obesity/overweight has doubled in the duration of 1990 and 2015. The rate of increase in childhood obesity is markedly higher compared to adults. As per the statistics approximately 10% children between age 5 and 17 are either obese/overweight. The distribution varies from 30% in The USA to 2% in African Sub-Saharan region. In about three decades, the statistics of children and adolescents with obesity had spiked up by 10-folds, from 11 million to 124 million. The International Association for the Study of Obesity (IASO) and International Obesity Task Force (IOTF) reckon that 200 million school children across the globe were either overweight or obese. While the prevalence of childhood obesity was plateauing among the developed countries, there was a steep rise noticed in the countries of Asia and Africa. Within Asia, China had the highest statistics of 15 million followed by India with 14 million children being affected. Certain subgroups like children of migrants and indigenous populations were at greater risk of obesity.
The NCD Risk Factor Collaboration (NCD-RisC) study compiled the data for 2416 population-based studies and they included the data of 31.5 million children and adolescents aged 5–19 years. As per the reports, the mean BMI in 1975 was 17.2 kg/m2 for girls and 16.8 kg/m2 for boys. It was lowest in South-East Asia and East Africa and highest in Polynesia, Micronesia and English-speaking regions. During 1975 to 2016, the age-specific mean BMI for children and adolescents increased globally. The increase was 0.32 kg/m2 and 0.40 kg/m2 per decade for girls and boys. The mean BMI for girls and boys in 2016 was 18.6 kg/m2 and 18.5 kg/m2, respectively. The mean BMI in 2016 was still lowest in South-East Asia and east Africa and highest in Polynesia and Micronesia. It was 16.9 and 17.9 kg/m2 for girls and boys of South-East Asia and Africa and 23.1 and 22.4 kg/m2 for girls and boys, respectively, in Polynesia and Micronesia. The regions with the largest numbers of children with obesity were East Asia, the Middle-East, North Africa, South Asia. It was predicted that if post 2000 the same trend continues then by the year 2022 the number of obese children will outstrip those with moderate and severe underweight. So, as we are approaching the year 2022 along with the pandemic lockdowns the prevalence of overweight and obesity may be witnessed earlier than 2022.
Peltzer reported that the prevalence of overweight/obesity in school children aged 13–15 years in seven Asian countries. Brunei Darussalam (36.1%) reported the highest prevalence of overweight/obesity followed by Malaysia (23.7%). Recorded lowest in Myanmar (3.4%) and Cambodia (3.7%). Pengpid and Peltzer studied on prevalence and the factors leading to childhood obesity in six Pacific Island countries of Oceania. A total of 10,424 children in the age group of 13–16 years with a prevalence of overweight and obesity as 24.3% and 6.1%, respectively.
The situation in India is a nutrition paradox. As per a study report, the prevalence of overweight/obesity among adolescent Indian children rose from 9.8% in 2006 to 11.7% in 2009. Lobstein and Jackson-Leach computed that there will be 17 million obese children in India by 2025 all over India, both in urban and rural areas. In a study conducted in Delhi, prevalence of overweight/obesity had increased from 16% in 2002 to 24% in 2006. Reports from a south Indian study, Udupi, reported that the prevalence of overweight and obesity was 10.8% and 6.2%, respectively. Another study from Central India evaluated children between 10 to 17 years, reported 3.1% to be overweight and 1.2% to be obese and overall 4.3%. Reports from a West Indian study, Gamit et al. reported the prevalence of overweight and obesity to be 10.2% and 6%. In Kanpur, the prevalence of overweight and obesity were 4% and 2%, respectively. A study by Gupta et al., reported that prevalence of overweight ranged between 6.1 and 25.2% among 5–19 years, while that of obesity ranged between 3.6 and 11.7% Khadilkar et al., reported the prevalence of overweight and obesity to be 19.6%. Among adolescence the percentage was 22.3 as per IOTF cut off and 29.8% as per WHO cut off, and these age groups should be considered most vulnerable for adiposity with an overview of the significance of adhering to country specific growth chart cut off for better adaptability. It is important to adopt standard criteria of measurement to obtain consistent results. The Indian Academy of Pediatrics (IAP) cut-offs for growth standards has been applied to bring a uniformity for better evaluation and follow up during the comparative evaluation studies. Thus, the study aimed at arriving at the prevalence of overweight and obesity considering the IAP cut-offs for growth standards among children aged 12 years from the rural and urban areas of Mysuru District.
| Methods|| |
This cross-sectional study was conducted to assess the prevalence of different BMI types among 12 years old children of Mysuru District. Examination and data collection were performed from June 2019 to March 2020. This research was approved by the Deputy Director Public Instructions (DDPI- D3/65888/07/2018-19) and from the concerned school authorities. The survey protocol was reviewed and approved by the Institutional ethical Review Board (JSS/DCH/ETHICAL/PhD-04/2017-18) and was performed according to the Declaration of Helsinki. All patients provided written consent for participation.
Sample size was determined using sample size formula for prevalence study. The prevalence rate was fixed at 40% and relative precision was 0.12 thus obtained 1602 as sample size. School children aged 12 years from Government and Private school of seven taluks of Mysuru district were the target population. Children were selected based on the following Inclusion criteria: 12-year-old school children who provided both informed consent and informed assent to participate in the study. Exclusion criteria: History of any longstanding medical treatment, any other craniofacial anomalies and syndromes or any other contributing medical history.
Body Mass Index (BMI) is a simple index of weight-for-height that is commonly used to classify underweight/thinness, overweight and obesity in adults.
The anthropometric measurements were recorded by the teachers under supervision of co-investigators. Height to the nearest mm and weight to the nearest 100th gram were measured using standard techniques. Standard charts for BMI for age and sex were used as reference standards. Children with BMI above 95th percentile were considered as obese, those between 85th and 95th percentile as overweight, and those with BMI below the 5th percentile were considered as underweight.
Modified Kuppuswamy's SES scale was used to evaluate the Socioeconomic status of the population. The obtained data from every taluka was associated with the coordinates like the latitude and the longitudes to be converted in the form of a map using geographic information system software called GIS Arc software. (Arc GIS 10.0 Environmental Systems Research Institute [ESRI], Redlands, California, United States).
The results were analysed statistically using SPSS for Windows (version 23.0) and the t-test, Chi-square test and proportion tests, P value were reported. The level of significance was set at p<0.05.
| Results|| |
A total of 1602 children aged 12 years participated in this study. The study subjects distribution among the government and private school is detailed in [Table 1].
|Table 1: Classification of the subjects based on type of school from various taluks of Mysuru district|
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The prevalence of obesity/overweight is shown in [Table 2]. 3.8% are overweight among the private schools and 3.2% among the government school children. 3.7% obese among private school and 1.8% among government school. Therefore, private school children had higher percentage of overweight/obese children.
|Table 2: Gender wise distribution of different body mass index categories as per IAP growth reference chart|
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The distribution of boys was 38.6% and girls were 61.4%. Prevalence of overweight (4.9%) and obesity (4.0%) among girls was higher compared to boys. An overall percentage of overweight was 7.1% and obesity was 5.5% [Table 3].
|Table 3: Distribution of subjects based on different body mass index as per IAP growth reference chart among the type of school|
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The prevalence of overweight (55.8%) is greater among the below poverty line (BPL) subjects compared to above poverty line (APL) (44.2%). Whereas, obesity is more prevalent among the APL subjects (54.5%) in comparison to BPL subjects [Table 4].
|Table 4: Association of different categories of BMI to Socioeconomic status - IAP growth reference|
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The taluka wise data along with the latitude and longitude for the GIS map creation is presented in [Table 5].
|Table 5: Taluka wise prevalence of overweight and obesity categories as per IAP growth reference chart and the latitude and longitude for the GIS Map creation|
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[Map 1] and [Map 2] present the GIS mapping of Prevalence of overweight and obesity among the children of Mysuru District. The colour coding depicts the concentration of the subjects in the specific areas.
| Discussion and Conclusion|| |
Evaluation of children for overweight/obesity provides an opportunity to identify the problem early and prevent disease progression. Most of the earlier studies had evaluated for small sample sizes those including only adolescents from affluent schools and hence the prevalence of obesity and overweight is high compared to our study, which has a large sample size of children from both private and government schools.
The present study demonstrated the prevalence of overweight and obesity in Mysuru district urban and rural children aged 12 years. Further, we report that the increase was significantly higher in girls than boys and the children from rural sector were on increasing front towards overweight. However, the obese children were predominantly distributed among the urban sectors.
Considering the previous studies conducted in Mysuru district in the year 2005 and 2006 by M Premanath et al. Children from private schools were significantly overweight in comparison to those from government schools (9.1% vs 5.9%; P < 0.05) while prevalence of obesity was not different between the two groups (3.6% vs 2.1%).
Prevalence of obesity was higher in boys than girls (P < 0.05) and displayed decreasing trend of obesity in boys and increasing trend of obesity in girls as the age advanced, respectively.
An overall percentage of overweight and obesity at 12 years was 7.1% and 1.5%, respectively.
In a study by Saraswathi et al. (2008–2009), prevalence of overweight/obesity was recorded as 8.75% and 0.8% in urban and rural area, respectively. Further, higher frequency of overweight and obesity was recorded in urban (10.36%) and rural girls (1.02%) compared to boys (7.67%) in urban and (0.5%) in rural areas.
Interesting finding of this study was when outdoor activities of the children were compared with their BMI status, there was significantly higher prevalence of overweight in children with only indoor activities such as television viewing, computer and videogame, indoor games, sleeping and long school hours as it is an inevitable situation due to the pandemic. There would have been breaks in between the class like physical education, assembly or some movement within the class like lab classes, etc. The logistic regression analysis including all combinations to establish specific relation of physical activity and overweight and obesity, the results were statistically significant which supports the strong influence of physical inactivity on overweight.
In the present study, similar inferences were obtained in terms of prevalence of overweight and obesity as it was reported that the prevalence was higher in the private schools than the government schools. The present study related the socioeconomic status to the prevalence of the overweight and obesity which suggests that overweight is more predominant in the BPL in comparison to the APL where there is predominance of obesity. Through this we can relate that the lower SES children are transforming from thinness predominant to overweight predominance which could be due to the digitalization to the rural sectors leading to more sedentary lifestyles unlike the previous eras.
The prevalence of overweight and obesity among the girls was higher is both the studies and our study is in consensus with the previous studies quoted. This might be due to physiological changes such as hormonal variations with respect to their age which coincides with the Menarche/growth spurt and as per the Indian culture there are certain rituals, high calorie nutritive food given to the girls around that age could be a contributing factor to the increased prevalence overweigh and obesity among the girls than the boys. However, in the same study by Suttur Malini suggested that it is related to the physical activity than the diet and inference has concluded the correlation of sedentary lifestyles and weight gain.
Previously, under-nutrition in children had been the major public health concern in India over the past decades, little attention was paid to childhood overweight/obesity until recently. The emerging evidence suggests an increase in over-nutrition status among children as well as adults. However, limited literature availability on the trends of prevalence of childhood obesity in Indian and also one-time cross-sectional studies do provide a good overview and snapshot of burden of obesity, these studies do not however give detailed insight into the patterns and dynamics of this burgeoning problem. Studying trends of prevalence of overweight/obesity in children is important as it allows the researchers and policy makers to design specific and targeted programs aimed at checking the problem of obesity. The aim of our study was to determine the secular trends in childhood overweight and obesity among urban and rural adolescents aged 12 years and notice if a trend similar to developed countries also exists in southern India.
It is not possible to know how many of these children will continue to have high BMI as they age in future. So, a prospective comparative study during a particular time period will help in better understanding and authentic reports.
Dr. Srilatha KT, Former Head of the Department and Guide for her constant support and guidance.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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Dr. H P Chanchala
Assistant Professor, Department of Pediatric and Preventive Dentistry, JSS Dental College and Hospital, JSS Academy of Higher Education and Research, Mysore, Karnataka
Source of Support: None, Conflict of Interest: None
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]
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