Keywords
prevalence - adolescents - obesity - overweight - urban
Introduction
Adolescence is a Latin word “adolescentia” from “adolescere” meaning “to grow up.”[1]
[2] One in every five people is an adolescent.[2] Today, 1.2 billion adolescents stand between the period of childhood and adulthood.[3] Out of 7.5 billion world population, 243 million adolescents' live in India.[1]
[4] Adolescent age is commonly thought of as a period of optimum health. However, now
adolescents are considered vulnerable to their neighborhood environments.[5] Globally and nationally, adolescents suffer from various health problems like communicable
and noncommunicable diseases (NCDs).[6] The global flow of NCDs has swept across all age groups, including children and
adolescents. However, the younger age group affected by NCDs is often under recognized.[7] Global status report on NCDs-2014 by the World Health Organization (WHO) shows that
NCDs are responsible for approximately 1.2 million deaths worldwide each year in the
age group below 20 years, and around 60% of deaths happen in India due to NCDs.[8]
Globally, the magnitude of overweight and obesity and its impact have increased.[2] An unhealthy lifestyle can contribute to the development of risk factors for NCDs.[9] Currently, lifestyle of the adolescents is a major issue; lifestyle choices adopted
during adolescent time continue into adulthood.[10] The WHO estimates 2 million deaths/year are caused by physical inactivity and unhealthy
eating habits.[11] Lifestyle has long been associated with the development of many chronic diseases
and NCDs.[10] Obesity is an important risk factor for NCDs.[11] Many studies in India have reported that hypertension caused cardiovascular diseases
beginning in the age group of children and adolescents.[8] A study results showed that prevalence of hypertension was 11% among school children
in the age group of 13 to 19 years in the five schools of Udaipur city of Rajasthan.[8]
[9] In India, approximately 18.3% of female adolescents aged between 2 and 17 years
are either in the category of overweight or obese.[11]
[12] According to the 2015–2016 National Family Health Survey (NFHS-4), the prevalence
of obesity among women was 20.6%, and for men it was 18.9% of the 15 to 49-year age
group, which is slightly higher than the NFHS-3 study (2005–2006).[12]
[13] Morbidity from cardiovascular disease, diabetes, cancers, and arthritis because
of obesity was 50 to 100% higher among obese individuals suffering from childhood
or teenage obesity.[14] Childhood obesity can profoundly affect children's physical health, social, and
emotional well-being, and self-esteem.[15] It is also associated with poor academic performance and a lower quality of life
experienced by the child.[16] Early identification of overweight and obesity in early life is very important due
to its short- and long-term association with morbid outcomes and its influence on
young people's psychosocial development.[15] The current upward trend in overweight and obesity among adolescents' populations
is a consequence of inadequate lifestyle habits.[17] Declining physical activity, excess screen time, availability of junk food, and
varying parenting styles are the major reasons for adolescent overweight and obesity.[18]
[19] Therefore, the identification and monitoring of overweight or obese children and
adolescents are major concerns in public health. Moreover, a research gap also was
identified that research studies have been not conducted on the prevalence of overweight
and obesity among adolescents in Mangalore, India Thus, this study was undertaken
to identify the magnitude of overweight and obesity among adolescents in selected
urban high schools at Mangaluru, Dakshina Kannada, India.
Materials and Methods
A descriptive cross-sectional study was conducted among adolescents at selected urban
high schools of Mangaluru, Dakshina Kannada, India. Samples of the study were in the
age group of 13 to 15 years and who were enrolled in 8th standard to 9th standards
for the academic year of 2021 to 2022. In the screening phase, a total of 10 schools
were selected through a cluster random sampling technique. A demographic proforma
with nine items including self-reported home-measured height and weight measurements
tool was used to gather data. (weight in kg and height in cm). Experts in the field
did the tool validation. Pre-testing and reliability were done with 12 samples through
online mode and found that the tool was understandable and simple. The instrument
was reliable enough to use as a body mass index (BMI) identification screening tool.
Respondents could measure height and weight with the help of instructions given in
the Google Forms, which were confirmed through telephonic communication by the researcher.
Administrative permission was obtained from school authorities priorly after explaining
the aims and objectives of this study. From each school, information on the number
of sections for each class and the number of students in each division was collected.
Ethical clearance was obtained from the institutional ethical committee. An informed
written consent was obtained from the parents and assent from adolescents. The participants
were assured of the confidentiality of their responses. Demographic proforma including
self-reported home-measured (parents/guardians assisted) height and weight measurements
were collected through Google Forms. BMI based on self-reported weight and height
data is a quick, cheap, and easy-to-implement measure to identify overweight and obesity,
even though such studies are not much conducted in Indian setup. Many studies have
been undertaken at the international level to discuss the accuracy and validity of
its measurements. Literature supported that self-reported and measured BMI was good
measurements for identifying adolescents with overweight or obesity with some caution.[20] Instructions to measure height and weight were provided in the Google Forms and
notified not to respond to the Google Forms if they do not have tools like measuring
tape and weight machine to measure height and weight. The Google Forms link was shared
with the students by school headteachers/headmasters. A total of 1,100 adolescents
responded to the screening phase through Google Forms. BMI was computed by using the
formula, BMI = weight (kg)/height (m2). The categorization of the adolescents was done based on the WHO-revised consensus
guidelines for BMI classification for the Asian population; adolescents were classified
as underweight, normal weight, overweight, and obese.[1]
[2]
Sample Size Estimation
The minimum sample size was determined based on available literature indicating that
overweight or obesity affects approximately 17.7% of adolescents Mangaluru, Dakshina
Kannada.[2] Assuming a population proportion of z for a 95% confidence level is 1.96 and a margin
of error of 3%, the estimated sample size was 1,077 adolescents and rounded off with
1,100 subjects.
Statistical Analysis
The statistical calculations were performed using computer-based statistical software
Statistical Package for the Social Sciences (SPSS) version 21. The data were analyzed
in terms of objectives of the study using both descriptive and inferential statistics.
Results
Section 1: Description of Demographic Characteristics of Adolescents
[Table 1] shows that most (910; 82.7%) of the subjects were in the age group of 13 years with
mean age of 13.94 with ± 1.02 standard deviation (SD); highest percentage (770; 70%)
of subjects were females; more than half of the subjects (632; 57.4%) belonged to
the nuclear family; maximum percentage of the adolescents (1,083; 98.5%) were not
having family history of overweight and obesity; most 1088 (99%) of the subjects consumed
mixed diet; more than half 737 (67%) of the subjects had regularly junk foods. Majority
(973; 88.4%) adolescents spend screen time more than 2 hours per day; more than half
710 (64.5%) of the adolescents do physical exercise only sometimes; and the majority
1,079 (98.1%) of the subjects stayed at their home.
Table 1
Distribution of baseline characteristics of adolescents, n = 1100
|
SI. No.
|
Demographic variables
|
Mean ± SD
|
Frequency (f)
|
Percentage (%)
|
|
1.
|
Age (years)
a. 13
b. 14
c. 15
|
13.95 ± 1.02
|
910
157
33
|
82.7
14.3
3
|
|
2.
|
Gender
a. Male
b. Female
|
|
330
770
|
30
70
|
|
3.
|
Type of family
a. Nuclear
b. Joint
c. Extended
|
|
632
465
3
|
57.5
42.2
0.3
|
|
4.
|
Family history of overweight /obesity
a. Yes
b. No
|
|
17
1083
|
1.5
98.5
|
|
5.
|
Dietary habits
a. Vegetarian
b. Mixed (both veg and nonvegetarian)
|
|
12
1088
|
1
99
|
|
6.
|
Regular junk food intake
a. Yes
b. No
|
|
737
363
|
67
33
|
|
7.
|
Screen time per day
a. <2 hours
b. >2 hours
|
|
127
973
|
11.6
88.4
|
|
8.
|
Physical exercise
a. Regularly
b. Sometimes
c. Never
|
|
318
710
72
|
30
64.5
6.5
|
|
9.
|
Place of stay
a. Home
b. Hostel
c.PG
d. Relative's house
|
|
1079
6
5
10
|
98.1
0.55
0.45
0.90
|
The data presented is frequency (n) with percentage in parenthesis (%). Continuous variables presented in mean and (SD)
standard deviations.
Section 2: Prevalence of Overweight and Obesity among Urban Adolescents
[Table 2] depicts that magnitude of overweight and obesity among 1,100 adolescents. One-hundred
twenty-six (11.5%) of adolescents were overweight and 111 (10.1%) of them were obese
according to their BMI status. Unfortunately, the prevalence of underweight was also
recognized (377; 34.3%).
Table 2
Categorization of urban adolescents based on the BMI according to World Health Organization
scale, n = 1,100
|
SI. No.
|
BMI kg/m2
|
Categories
|
Frequency (f)
|
Percentage (%)
|
|
1.
|
<18.5
|
Under weight
|
377
|
34.3
|
|
2.
|
18.5–22.9
|
Normal weight/lean
|
486
|
44.2
|
|
3.
|
23 to 24.9
|
Over weight
|
126
|
11.5
|
|
4.
|
> 25
|
Obese
|
111
|
10.1
|
Abbreviation: BMI, body mass index.
Section 3: Association of Overweight and Obesity among Adolescents with Selected Demographic
Variables
Hypothesis testing:
The following null hypothesis stated
H0: There is no significant association of BMI scores of adolescents with selected demographic
variables.
[Table 3] reveals that there was a significant association found among adolescents with age,
family history of overweight and obesity, and screen time more than 2 hours per day
with a p-value less than 0.044, 0.002, and 0.004, respectively.
Table 3
Association of overweight and obesity among adolescents with selected demographic
variables, n = 1,100
|
SI. no.
|
Variables
|
X2
|
p-Value
|
|
1.
|
Age (years)
a. 13
b. 14
c. 15
|
12.96
|
0.044*
|
|
2.
|
Gender
a. Male
b. Female
|
6.39
|
0.09
|
|
3.
|
Type of family
a. Nuclear
b. Joint
c. Extended
|
8.46
|
0.06
|
|
4.
|
Family history of overweight /obesity
a. Yes
b. No
|
6.126
|
0.002*
|
|
5.
|
Dietary habits
a. Vegetarian
b. Mixed (both veg & nonvegetarian)
|
5.627
|
0.08
|
|
6.
|
Regular junk food intake
a. Yes
b. No
|
1.414
|
0.238
|
|
7.
|
Screen time per day
a. <2 hours
b. >2 hours
|
4.464
|
0.004*
|
|
8.
|
Physical exercise
a. Regularly
b. Sometimes
c. Never
|
3.43
|
0.615
|
|
9.
|
Place of stay
a. Home
b. Hostel
c.PG
d. Relative's house
|
4.64
|
0.591
|
* significant p < 0.05.
Discussion(s)
This cross-sectional study conducted in high schools situated in an urban area of
Mangaluru City Corporation Limit, Dakshina Kannada, India, regarding overweight and
obesity among adolescents, had given current status. Of the total 1,100 adolescents,
82.2% of the total adolescents were in the age group of 13 years with a mean age of
13.95 ± 1.02 SD, and most 70% of them were females. This study result was consistent
with a similar study result that showed that approximately 52.7% of children belonged
to the age group of 13 to 15 years. Another study results also depicted that nearly
half of the participants (47.5%) were 14 years old and their mean age was 13.9 years.[6]
In case of prevalence of overweight and obesity among adolescents, this study revealed
the magnitude as 237 (21.6%). According to their BMI status, 11.5% of adolescents
were overweight and 10.1% of them were obese. A similar study results show that prevalence
of obesity among boys was 9.3% higher than among girls (3.5%). The prevalence for
boys was consistently higher than that for girls at each age and across years. The
prevalence of overweight and obesity was highest at 11 years: 37.3% for boys and 19.8%
for girls.[18] A similar study showed that based on the IOTF/WHO criteria, the overall prevalence
of weight categories among young adolescents in low- and middle-income countries was
13.4%/4.7% for underweight, 15.4%/17.3 overweight, and 5.6%/8.6% for obesity.[21] Another similar study results showed that the overall prevalence of overweight and
obesity was 13.4 (14.2% for girls and 12% for boys; p = 0.02) and 18.2% (18% for girls and 18.4% for boys; p = 0.73), respectively. When compared with the WHO-based national prevalence rate
of obesity reported in 2004 (∼9.3%), the obesity rate has doubled over a 10-year period.
There was a significantly higher prevalence of obesity in adolescents (>11 years)
than in children (20.2 vs. 15.7%; p < 0.01).[22]
In this study, there was a significant association found adolescents overweight and
obesity with age, family history of overweight and obesity, and screen time more than
2 hours per day with p-value less than 0.044, 0.002, 0.004, respectively. A similar study showed a significant
association of gender, socioeconomic status, dietary habits, chocolate eating habits,
mode of transportation to school, sports participants, physical activity, and screen
time. The teens who watched more than 2 hour of screen time were more obese.[6] Similar study results indicate that the screen time ranged between 2.6 and 2.9 hours
per day.[18] Another study results demonstrated that associations between screen time, sleep
duration, and physical activity level with health-related quality of life in children
and adolescents.[23] In India, National Health Policy 2017, whose major focus area is school health programs,
laid emphasis on the health challenges faced by the adolescents.[24]
Conclusion(s)
There is plenty of prevalence of overweight and obesity studies conducted worldwide
among adolescents irrespective of developed or developing or underdeveloped countries.
All such study results showed that overweight and obesity became a global challenge
and alarmingly increasing. Still, its burden can be preventable by providing a healthful
school environment with a live intervention program. Health promotion activities need
to be planned, and there is a need to identify the challenges of implementing such
activities. Irrespective of all the barriers, it is the responsibility of all stakeholders
to help our adolescents to adopt a healthy lifestyle in all aspects to have a healthier
nation. Health promotion strategies need to be initiated by the school or government
because in a day the majority of the time an adolescent spends their time is at school.
Ensure students have access to healthier food and beverages like school breakfast
and lunch programs. A local school wellness policy with nutrition and physical activity
goals for all schools needs to be implemented. Weight reduction strategies need to
be supported by parents, school authorities, physical educators, peer groups, and
a dietitian post can be created under school health policy. A self-reported anthropometric
measurement in adolescents can be used to calculate BMI for weight classification
and reach out to the target population.
Limitation of the Study
This study has limitations. First, data are based on self-reported information, including
body weight and height. This policy was implemented to avoid the difficulties of persuading
adolescents to participate in weight measurements and to reach out to the target population.
And accuracy of self-reported data was only ensured in terms of parent assisted/guardian-assisted
measurements. Moreover, machine calibration was not ensured directly by the researcher.
