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Brief Reports

Indian Pediatrics 2002; 39:449-452 

Prevalence of Obesity Amongst Affluent Adolescent School Children in Delhi

Umesh Kapil 
Preeti Singh
Priyali Pathak
Sada Nand Dwivedi
Sanjiv Bhasin

From the Departments of Human Nutrition and Bio-statistics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110 029, India.

Correspondence to: Dr. Umesh Kapil, Additional Professor, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110 029, India.

E-mail: ukapil@medinst.ernet.in

Manuscript received: April 11, 2001;

Initial review completed: May 21, 2001;

Revision accepted: August 24, 2001.

Adolescence is a period of transition between childhood and adulthood. It occupies a crucial position in the life of human beings characterized by an exceptionally rapid rate of growth(1). During the past 20 years, prevalence of obesity among children and adolescents have doubled in America(2). The United States National Center for Health Statistics suggests that nearly 15% adolescents are overweight or obese(2,3). Obesity in childhood is associated with an increased incidence of hypertension, diabetes, coronary artery disease, osteoarthritis and overall increase in morbidity and mortality during adult life(2). There is evidence that children and adolescents of affluent families are overweight than in the past possibly because of decreased physical activities, sedentary lifestyles, altered eating patterns and increased fat content of the diet(2,4).

A study conducted in 1990 amongst 3,861 school children reported the prevalence of obesity as 7.5%(4). Limited data is available from India on this nutritional disorder and hence, the present study was conducted to study the prevalence of obesity amongst affluent adolescent children in Delhi.

Subjects and Methods

The study was a cross sectional study conducted in one public school of Delhi catering to the affluent segment of population. The school tuition fees was more than Rs. 2000/- per month. The school was selected by using purposive sampling procedure keeping in view the operational feasibility.

The sample size was calculated keeping in view an expected prevalence of obesity as 6% in well-to-do adolescent children. The exact age of the children was verified from the school records. A semi-structured pre-tested questionnaire was administered to each child to collect data on socio-demographic profile (age, sex, socio-economic status), dietary pattern, and nutrient intake. Anthropometric measurements of weight, standing height, mid-arm circumference (MUAC) and triceps skin fold thickness (TSFT) were measured by utilizing standard methodology(5). Weight was measured using SECA electronic weighing scale to the nearest 100 g, for height shorr’s board was used and measurement was done to nearest 0.1 cm. Harpendon’s calipers were used for measuring TSFT and it was measured upto an accuracy of 0.2 mm. The MUAC was measured with the help of a non stretchable fibre glass tape to the nearest 0.1 cm.

The international cut off points for body mass index were used for classifying children as overweight and obese. According to this classification (i) if BMI analogue for age and sex is 25 kg/m2 and more but less than 30 kg/m2, then the child is overweight and (ii) if BMI analogue for age and sex is 30 kg/m2 and more, then the child is obese(6).

Nutrient intake was assessed amongst 25% of the study subjects, utilizing the 24 hours dietary recall methodology. The quantity of cooked food consumed by each subject was inquired and the raw amount of food consumed by subject was calculated. Subsequently, the intake of different nutrients by subject was calculated by utilizing data on the Nutritive Value of Indian Foods(7).

Results

A total of 870 school children were included in the study, out of which 64.5% were boys. Sixty five per cent of the children belonged to nuclear families.

The overall prevalence of obesity according to international cut off points (BMI criteria) was found to be 7.4%. About 8% of the boys and 6% of the girls were obese (Table 1). The centiles for overweight and obesity corresponding to a body mass index of 25 and 30 kg/m2 were calculated by sex. It was found that BMI 30 kg/m2 was at 98.4 centile for males and 98.0 centile for females. Similarly, it was found that BMI 25 kg/m2 for males and females subjects was at 86.7 and 86.9 centile, respectively.

Table I-Prevalence of Obesity by Body Mass Index (BMI)
Nutritional status
Age(years) n Normal Overweight Obese Prevalence of obesity
Boys
10 35 15 (42.9) 14(40.0) 6(17.1) 6(17.1)
11 82 55 (67.1) 17(20.7) 10(12.2) 10(12.2)
12 108 70 (64.8) 30(27.8) 8(7.4) 8(7.4)
13 95 69 (72.6) 19(20.0) 7(7.4) 7(7.4)
14 97 66 (68.0) 26(26.8) 5(5.2) 5(5.2)
15 89 66 (74.2) 15(16.8) 8(9.0) 8(9.0)
16 57 45 (78.9) 9(15.8) 3(5.3) 3(5.3)
Total 563 386 (68.6) 130(23.1) 47(8.3) 47(8.3)
Girls
10 34 18 (52.9) 12(35.3) 4(11.8) 4(11.8)
11 52 36 (69.3) 14(26.9) 2(3.8) 2(3.8)
12 55 38 (69.1) 14(25.5) 3(5.4) 3(5.4)
13 41 27 (65.9) 11(26.8) 3(7.3) 3(7.3)
14 38 26 (68.5) 10(26.3) 2(5.3) 2(5.3)
15 46 26 (56.5) 18(39.2) 2(4.3) 2(4.3)
16 41 34 (82.9) 6(14.7) 1(2.4) 1(2.4)
Total 307 205 (66.8) 85(27.7) 17(5.5) 17(5.5)
Grand Total 870 591 (67.9) 215(24.7) 64(7.4) 64(7.4)
Figures in parentheses denote percentages.

It was found that 17.0% of all adolescent boys and girls had their energy intake 100 per cent or more as compared to their RDA. It was found that both obese boys and girls had higher anthropometric measurements as compared to non-obese boys and girls, and this difference was statistically significant (Table II).

Discussion

The prevalence of obesity in affluent adolescent school children in Delhi according to BMI criteria was found to be 7.4%. An earlier study on school children had reported a similar prevalence rate of obesity as 7.5%(4). In the present study, the overall prevalence of obesity was higher in male than female children. The maximum prevalence of obesity was found during the pubertal period, between 10-12 years. This may be associated with the increase in adipose tissue and overall weight gain during the pubertal growth spurt(8). The present study has highlighted that obesity is an emerging health problem in adolescent children belonging to affluent families in Delhi.

Table II-Comparison of Anthropometric Measurements of Obese and Non-obese Subjects$
Body measurements Boys (mean ± SD) Test of significance Girls (mean ± SD) Test of significance
  Obese (n = 47) Non-obese
(n = 516)
t p Obese (n = 17) Non-obese (n = 290) t p
Weight (kg) 72.1±13.32 48.6±12.44 12.29 0.000* 66.3±11.68 47.9±10.49 6.96 0.000*
Height (cm) 157.9±10.39 156.5±13.79 0.64 0.5 150.6±11.72 152.9±8.32 1.09 0.27
Mid upper arm circumference (cm) 29.4±3.65 23.6±3.56 10.69 0.000* 28.9±2.65 23.4±3.06 7.26 0.000*
Skin fold thickness (mm) 23.6±5.22 13.3±5.97 11.42 0.000* 25.6±3.95 16.2±5.66 6.71 0.000*
$ Obesity was calculated by using BMI criterion. * Significant at 95% level.

 

Acknowledgements

We would like to thank Mr. M.I. Hussain, Principal and Dr. S.Pathak, Vice Principal, Delhi Public School, Mathura Road for the help extended during the study. We would like to thank Dr. R.S. Murgan and all the paramedical staff members for their most valuable support and guidance in implementation of the study. We would like to thank teachers and students for their kind co-operation in the data collection. We are grateful to the Director, All India Institute of Medical Sciences for providing infrastructural facilities for conducting the survey.

Contributors: UK coordinated the study, participated in data collection and drafted the paper; he will act as the guarantor for the manuscript. PS and PP participated in data collection and data analysis. SB participated in data collection. SND helped in statistical analysis.

Funding: All India Institute of Medical Sciences, Ansari Nagar, New Delhi.

Competing interests: None stated.

 

 

Key Messages

• Prevalence of obesity is higher in male than female children.

• Obesity is an emerging health problem amongst affluent adolescent children.


 References


1. Tanner JM. Fetus into Man: Physcial Growth from Conception to Maturity. New York, Wells, Open Book Publishing Limited, 1978; pp 22-36.

2. International Life Sciences Institute. Preventing Childhood Obesity is a Current Research Focus: Initiatives Cooperate to Share Information and Stem Epidemic. The PAN Report: Physical Activity and Nutrition, USA, International Life Sciences Institute, 2000; 2: p 5.

3. Onis de M, Habicht JP. Anthropometric reference data for international use: Recom-mendations from a World Health Organization Expert Committee. Am J Clin Nutr 1996; 64: 650-658.

4. Gupta AK, Ahmed AJ. Childhood obesity and hypertension. Indian Pediatr 1990; 27: 333-337.

5. Jelliffe BD. The Assessment of the Nutritional Status of the Community. Geneva, World Health Organization, 1966; pp 63-78.

6. Cole JT, Bellizzi CM, Flegal MK, Dietz HW. Establishing a standard definition for child overweight and obesity worldwide: Inter-national survey. BMJ 2000; 320: 1240-1243.

7. Gopalan C, Rama Sastri VB, Balasubramanian CS. Nutritive Value of Indian Foods: National Institute of Nutrition, Indian Council of Medical Research, Hyderabad Siddamsetty Press, 1991; pp 29-36.

8. Kasmini K, Idris MN, Fatimah A, Hanafiah S, Iran H, Asmah MN. Prevalence of overweight and obese school children aged between 7 to 16 years amongst the major 3 ethinic groups in Kuala Lumpur, Malaysia. Asia Pacific J Clin Nutr 1997; 6: 172-174.

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