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ORIGINAL ARTICLE
Year : 2014  |  Volume : 5  |  Issue : 1  |  Page : 11-14

Augmenting body mass index and waist-height ratio for establishing more efficient obesity percentiles among school-going children by using body mass index, waist to hip ratio and waist to height ratio


Department of Community Medicine, Government Medical College, Aurangabad, Maharashtra, India

Date of Web Publication15-Mar-2014

Correspondence Address:
Subhash Shahaji Dhole
Department of Community Medicine, Government Medical College, Aurangabad - 431 001, Maharashtra
India
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0975-9727.128934

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  Abstract 

Background: Traditionally, a fat child is considered as an "attractive" child and is often referred to as a "healthy" child, one who is likely to survive the rigors of undernourishment and infection. The obesity has been defined as a condition of abnormal or excessive fat accumulation in adipose tissue, to the extent that health may be impaired. Obesity can be seen as the first wave of a defined cluster of non-communicable diseases called "New World Syndrome" creating an enormous socio-economic and public health burden in poorer countries. Objective: Augmenting body mass index (BMI) and waist-height ratio for establishing more efficient obesity percentiles among school-going children by using BMI, waist to hip ratio and waist to height ratio. Materials and Methods: The present cross-sectional study was carried out in the municipal corporation area among school going children during the period of 1 st September 2009-31 st August 2010. We prepared the list of children roll number wise from selected school. From the list of children by systematic random sampling method, we selected 10% children, i.e., 286 government's school children, 114 private schools children and total 400 school children were selected for study. First we selected 10 th roll number and then every 10 th roll number children was included in the study. Those children who were absent on the day of a survey, they were not included. Results and Conclusion: The study conducted among a sample of 400 school children of the municipal corporation area revealed that 30 (7.5%) of the children were overweight, 25 (6.3%) were obese and 345 (86.3%) of them were normal. Out of a total of 400 children screened, 206 (51.5%) were girls and 194 (48.5%) were boys. Among the total girls, 10.2% were overweight and 6.3% were obese, 83.5% were normal. Similarly among total boys 4.6% were overweight and 6.25% were obese, 89.2% were normal. The prevalence of overweight and obesity were higher in girls than boys. Difference in the distribution of children according to sex was not statistically significant. Maximum prevalence of overweight (18%) was found in the 13-14 years age group and prevalence of obesity (9%) was in the same age group.

Keywords: Body mass index, diabetes mellitus, ischemic heart disease, non-communicable diseases


How to cite this article:
Dhole SS, Mundada VD. Augmenting body mass index and waist-height ratio for establishing more efficient obesity percentiles among school-going children by using body mass index, waist to hip ratio and waist to height ratio. Muller J Med Sci Res 2014;5:11-4

How to cite this URL:
Dhole SS, Mundada VD. Augmenting body mass index and waist-height ratio for establishing more efficient obesity percentiles among school-going children by using body mass index, waist to hip ratio and waist to height ratio. Muller J Med Sci Res [serial online] 2014 [cited 2020 Apr 8];5:11-4. Available from: http://www.mjmsr.net/text.asp?2014/5/1/11/128934


  Introduction Top


Traditionally, a fat child is considered as an "attractive" child and is often referred to as a "healthy" child, one who is likely to survive the rigors of undernourishment and infection. The obesity has been defined as a condition of abnormal or excessive fat accumulation in adipose tissue, to the extent that health may be impaired. [1] The terms "obese" and "overweight" often are used interchangeably. Technically, "obesity" is the upper end of "overweight". Obesity is clinically diagnosed as body mass index (BMI) greater than 25 and overweight in between 23 and 25 in children. [2] At least 30% of obesity begins in childhood. 50-80% of obese children will continue as obese adult [3] and fall into risk group of diabetes, hypertension, coronary heart disease (CHD) and many more obesity related diseases. Complication of adult obesity are made worse if the obesity begins in childhood. Obesity is harder to treat in adults than in children. [4] Effective prevention of adult obesity will require the prevention and management of childhood obesity. Obesity can be seen as the first wave of a defined cluster of non-communicable diseases called "New World Syndrome" creating an enormous socio-economic and public health burden in poorer countries. With the increase in obesity prevalence there is a parallel increase in obesity associated chronic diseases and their clinical onset at ever younger ages. The obesity has reached an epidemic proportion in urban Indian population. If we allow this epidemic to continue we will top the world in diabetes and CHD earlier than estimated. The cost of treating diabetes mellitus and associated disorders alone will consume a major chunk of our national resources, which we cannot afford. Only community-based approaches can address such large numbers of affected children.


  Materials and Methods Top


The present cross-sectional study was carried out in the municipal corporation area among school going children during the period of 1 st September 2009-31 st August 2010.


  Sample Size Top


The prevalence of childhood obesity in India was 7.6% 74 in previously published study. By considering, 7.6-8% as the prevalence, sample size was calculated with the help of practical manual for sample size determination by Lwanga and Lemeshow [5] as follows:

  • Anticipated prevalence 8%
  • Confidence level 95%
  • Absolute precision 5%.


The resultant sample size was 114 children. However we had concluded 400 children from 57 schools in the study.

Selection of Schools

For the selection of schools, the list of all schools (577) belonging to different categories (262 government school and 315 private school) was obtained from the school authorities of the local government. From the list of school by systematic random sampling method, we selected 10% schools i.e., 26 government's school, 31 private schools and total 57 schools were selected for study. First we selected 10 th number school and then every 10 th school was included in the study.

Selection of Subjects

As the standards of the school are divided into primary schools, middle school and secondary schools, we conducted our study on children of middle school i.e., 5 th -7 th standard.

Inclusion Criteria

  1. Children studying in 5 th -7 th standards.
  2. School from the municipal corporation area.


Exclusion Criteria

  1. Children below 5 th and above 7 th standards.
  2. Schools outside municipal corporation area.


We prepared the list of children roll number wise from selected school. From the list of children by systematic random sampling method, we selected 10% children, i.e., 286 government's school children, 114 private schools children and total 400 school children were selected for study. First we selected 10 th roll number and then every 10 th roll number children was included in the study. Those children who were absent on the day of the survey, they were not included.

Data on weight and height were collected for each through direct physical examinations. Height and weight were measured using standard procedure and BMI (kg/m 2 ) was calculated.

Data Analysis

Analysis was performed with Statistical Package for Social Sciences version 18.0. (SPSS Inc. 233 South Wacker Drive, 11 th Floor, Chicago, IL, USA).


  Discussion Top


Out of 400 children, 345 (86.3%) children had normal BMI, 30 (7.5%) children were overweight and 25 (6.3%) children were obese.

In the 9-10 years age group, all 36 (100%) children had normal BMI. In the 11-12 years age group, out of 264 (66%), 236 (89.4) children had normal BMI, 12 (4.5%) children were overweight and 16 (6.1%) children were obese [Table 1]. In the 13-14 years age group, out of 100 (25%), 73 (73%) children had normal BMI, 18 (18%) children were overweight and 9 (9%) children were obese. The maximum number of prevalence of obesity (18.1%) were found in the age group of 13-14 and overweight were (9%). The proportion of overweight/obesity was higher (18%) in the age group of 13-14 years than in 9-10 years and 11-12 years.
Table 1: Distribution of children BMI according to age-group among school going children of Aurangabad, India

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Laxmaiah et al. [6] in their study at Hyderabad found that the prevalence of overweight among girls tended to increase from 6.2% at 12 years to 10.8% at the age of 15 years and gradually decreased at 17 years (9.2%), whereas in boys, it was the highest at the age of 14 years (9.2%) and decreased to 5.3% at the age of 17 years.

Bharati et al. [7] in their study at Wardha, central part of India found that the overall, 79 (3.1%) children were overweight while 32 (1.2%) were obese. The proportion of overweight/obesity was higher (5.0%) in late adolescence (>15 year of age) than in early adolescence (<15 year of age). However, the difference was not statistically significant.

Out of 400 children, 345 (86.3%) children had normal BMI, 30 (7.5%) children were overweight and 25 (6.3%) children were obese.

In the male, out of the 194 (48.5%), 173 (89.2%) children had normal BMI, 9 (4.6%) were overweight and 12 (6.2%) were obese. In the female, out of 206 (51.5%), 172 (83.5%) children had normal BMI, 21 (10.2%) children were overweight and 13 (6.3%) children were obese. The prevalence of overweight and obesity were higher in girls than boys. The difference found between sex was not statistically significant (P > 0.05) [Table 2].
Table 2: Distribution of children according to sex among school going children of Aurangabad, India

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Kumar et al. [8] in their study also observed that a total of 1496 children studied (975 boys, 521 girls). Prevalence of obesity was 5.74%. Prevalence of obesity was more in girls (8.82%) than boys (4.10%). The difference observed in prevalence of obesity between boys and girls was highly significant.

Bharati et al. [7] in their study observed that, the proportion of overweight/obesity was 4.4 and 4.3 per cent among boys and girls respectively.

Patnaik et al. [9] in their study observed that, out of total 468 school children, 41.9% were boys and 58.1% were girls Out of 468 students examined for the study, 28.68% were either overweight or obese. Overweight and obesity was 33.65% in boys and 25.73% in girls.

Out of 400 children, 276 (69%) children had normal waist to hip ratio and 124 (31%) children were obese.

In the boys out of the 194 (48.5%), 168 (86.6%) children had normal waist to hip ratio and 26 (13.4%) were obese. In the girls, out of 206 (51.5%), 174 (84.5%) children had had normal waist to hip ratio and 32 (15.5%) children were obese [Table 3].
Table 3: Distribution of children according to their waist to hip ratio among school going children of Aurangabad, India

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The higher obesity was found in the girls than boys when we compared with waist to hip ratio. The difference found between waist to hip ratio was not statistically significant (P > 0.05).

Mohanty [10] the study results revealed that the among urban subjects 12.3% of boys are overweight/obese according to waist to hip ratio, whereas in girls subjects 77.1% are overweight and 19.4% are obese. In rural subjects, 93.6% of boys have normal waist to hip while 54.7% of girls are overweight and 19.3% of girls are obese.

Out of 400 children, 346 (86.5%) children had normal waist to height ratio and 54 (13.5%) children were obese.

In the boys out of the 194 (48.5%), 174 (89.69%) children had normal waist to height ratio and 20 (10.3%) were obese. In the girls, out of 206 (51.5%), 172 (83.49%) children had normal waist to height ratio and 34 (16.5%) children were obese [Table 4].
Table 4: Distribution of children according to their waist to height ratio among school going children of Aurangabad, India

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The higher obesity was found in the girls than boys when we compared with waist to height ratio. The difference found between waist to height ratio was not statistically significant (P > 0.05).

Panjikkaran and Kumari [11] from their study reported that the only 3.2% of the children were found to be obese using BMI percentiles based methodology whereas 8% of the children were found to be overweight. Augmenting BMI and waist-to-height ratio is more accurate with a prevalence of 3.6% and 6.2% of obese and overweight school children, respectively.


  Conclusions Top


  1. The study conducted among a sample of 400 school children of municipal corporation area revealed that 30 (7.5%) of the children were overweight, 25 (6.3%) were obese and 345 (86.3%) of them were normal by using BMI.
  2. According to the waist to hip ratio, out of the 194 boys children 168 (86.6%) were normal, 26 (13.4%) were obese and out of the 206 girls children 174 (84.5%) were normal, 32 (15.5%) were obese.
  3. According to the waist to height ratio, out of the 400 children 174 (89.69%) boys were normal, 20 (10.3%) boys were found obese and 172 (83.49%) girls were normal, 34 (16.5%) girls were found obese.



  Recommendations Top


Healthy society is a wealthy society and children are the important components of the society. The teachers and parents are the equal partners in delivering this message and fulfilling the agenda for the society.

  1. There should be regular class hours on healthy food habits, nutritive values of different food items, life-style and behavioral modification.
  2. Every student should take part in outdoor games and sports.
  3. Each student should monitor his/her anthropometric parameters in their health dairy, at least once in a month.


 
  References Top

1.Obesity: Preventing and Managing the Global Epidemic. Report of a WHO Consultation. Geneva: World Health Organization; 2000. (WHO Technical Report Series, No. 894).  Back to cited text no. 1
    
2.Anuurad E, Shiwaku K, Nogi A, Kitajima K, Enkhmaa B, Shimono K, et al. The new BMI criteria for Asians by the Regional Office for the western pacific region of WHO are suitable for screening of overweight to prevent metabolic syndrome in elder Japanese workers. J Occup Health 2003;45:335-43.  Back to cited text no. 2
    
3.Styne DM. Childhood and adolescent obesity. Prevalence and significance. Pediatr Clin North Am 2001;48:823-54, vii.  Back to cited text no. 3
[PUBMED]    
4.Park K. Park's Textbook of Preventive and Social Medicine. 18 th ed. Jabalpur, India. Banarsidas Bhahot Publisher; 2005. p. 316-9.  Back to cited text no. 4
    
5.Lwanga SK, Lemeshow S. Sample Size Determination in Health Studies: A Practical Manual. Geneva: World Health Organization; 1966. p. 132.  Back to cited text no. 5
    
6.Laxmaiah A, Nagalla B, Vijayaraghavan K, Nair M. Factors affecting prevalence of overweight among 12- to 17-year-old urban adolescents in Hyderabad, India. Obesity (Silver Spring) 2007;15:1384-90.  Back to cited text no. 6
    
7.Bharati DR, Deshmukh PR, Garg BS. Correlates of overweight & obesity among school going children of Wardha city, Central India. Indian J Med Res 2008;127:539-43.  Back to cited text no. 7
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8.Kumar S, Mahabalaraju DK, Anuroopa MS. Prevalence of obesity and its influencing factor among affluent school children of Davangere city. Indian J Community Med 2007;32:15-7.  Back to cited text no. 8
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9.Patnaik S, Patnaik L, Patnaik S, Hussain M. A prevalence of overweight and obesity in a private school of Orissa, India. Internet J Epidemiol 2011;10:1540-2614.  Back to cited text no. 9
    
10.Mohanty B. The prevalence of overweight and obesity in school going children of Pondicherry. Aarupadai Veedu Medical College and Hospital, Pondicherry; Indian J Physiol Pharmacol 2008;52 (3):307-310  Back to cited text no. 10
    
11.Panjikkaran ST, Kumari K. Augmenting BMI and waist-height ratio for establishing more efficient obesity percentiles among school-going children. Indian J Community Med 2009;34:135-9.  Back to cited text no. 11
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