|Year : 2016 | Volume
| Issue : 2 | Page : 125-130
The study of obesity among children aged 5-18 years in Jaipur, Rajasthan
Anjali Jain1, Ashish Jain2, JP Pankaj1, BN Sharma1, A Paliwal1
1 PSM Department, Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India
2 Cardiac Anaesthesia, Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India
|Date of Web Publication||30-Jun-2016|
B-13, Near Jain Temple, Kirti Nagar, Tonk Road, Jaipur - 302 018, Rajasthan
Source of Support: None, Conflict of Interest: None
Background: Prevalence of TV and computers in today's times has also driven the regular outdoor activities of children out from their lives. An increased calorie intake along with a decreased physical activity level has a great bearing on the level of obesity found in children. The present study was done with the objective to study the obesity among children of aged 5-18 years in Jaipur, Rajasthan. Methods: A Cross sectional study was undertaken on children of 5-18 years of urban field practice area, Mahatma Gandhi Medical College and Hospital, Jaipur. Simple random sampling was done. A semi-structured questionnaire was developed, pilot study was carried out to draw the necessary questionnaire which was tested and retested for necessary modifications. Body Mass Index (BMI) 10 was derived by dividing the subject's mass by the square of his or her height, Statistical test was applied in our study accordingly. Results: 12.5% children were overweight having percentage between 85 to 95, while only 5.6% children were obese having percentage equal or greater than 95. Out of 564 boys 101 (17.9%) were obese or over-weight and out of 436 boys 69 (15.9%) were obese or over-weight. Among 783 vegetarian children, 14.8% were obese and overweight. Conclusions: Children eating more frequent junk foods were more obese and overweight as comparative eating them in low frequency. Children with lesser physical activity were more obese.
Keywords: Children of 5-18 years, dietary pattern, obesity, physical activity
|How to cite this article:|
Jain A, Jain A, Pankaj J P, Sharma B N, Paliwal A. The study of obesity among children aged 5-18 years in Jaipur, Rajasthan. Muller J Med Sci Res 2016;7:125-30
|How to cite this URL:|
Jain A, Jain A, Pankaj J P, Sharma B N, Paliwal A. The study of obesity among children aged 5-18 years in Jaipur, Rajasthan. Muller J Med Sci Res [serial online] 2016 [cited 2019 Nov 17];7:125-30. Available from: http://www.mjmsr.net/text.asp?2016/7/2/125/185013
| Introduction|| |
Obesity was considered a problem of the affluent countries. Today the problem has started appearing even in developing countries. Many studies have shown that the prevalence of overweight among adolescents varies between 10% and 30%.  Prevalence varies within the country because of differences in the lifestyle, mainly in the dietary pattern and physical activities. 
Among obese children, 50-80% continue as obese adults.  An increase in the prevalence of childhood obesity is associated with potential medical complications of obesity noted in adolescence and especially in adulthood such as hypertension, coronary artery diseases, diabetes mellitus, dyslipidimia, cholecystitis, pancreatitis, sleep apnea, osteoarthritis, and even cancer. Complications of adulthood obesity are made worse if the obesity begins in childhood.
There are a few studies supporting the prevalence of childhood obesity and adolescent obesity and overweight from different parts of India (Punjab, Maharashtra, Delhi, South India) that ranges from 3% to 29% and also indicate that the prevalence is higher in urban than in rural areas.  However, there is no published data on a representative sample from Jaipur, Rajasthan, India on the prevalence of obesity in children aged 5-18 years.
An important factor concerning childhood obesity is also shown to be the education level of the mother in terms of literacy vis a vis higher education. It plays a significant role in determining the food habits of the children in both rural and urban areas.
The prevalence of TV and computers in today's times has also driven out the regular outdoor activities of children from their lives. Children today have a sedentary lifestyle compared to the children even 10-15 years back. An increased calorie intake, along with a decreased physical activity level, has a great bearing on the level of obesity found in children. 
The present study was conducted with the objective of studying obesity among children aged 5-18 years residing in the urban field practice area of Mahatma Gandhi Medical College in Jaipur, Rajasthan, India.
| Materials and Methods|| |
A cross-sectional study was undertaken on children aged 5-18 years in the urban field practice area, Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India. Our urban field practice area catered to a population of around 9-10,000, out of which approximately 18.5% were in the age group of 5-18 years. We obtained sample size of 900 assuming 10% of prevalence (of obesity among school children of Karnataka), 20% of prevalence was considered to allow for margin of error. But for the sake of convenience and keeping in mind the dropouts, the sample size was increased and rounded off to 1,000.  Purposive sampling was done. The urban field area was divided into 10 sectors and 100 children from every sector were selected. The first child from every sector was selected randomly with the help of the last digit of currency note and then every child was selected till the target was achieved. Mothers were inquired about each child separately. Interviews were taken in accordance with the questionnaire and the data of the sample population were collected.
- Children who were 5-18 years of age.
- Children whose respondent was the mother/father.
- Children of less than 5 years and more than 18 years of age.
- Children with any acute disease such as diarrhea/acute respiratory infection/or any severe accident.
- Children whose mother or father was not present at the time of interview.
The mothers of selected children were explained about the purpose and methods of the study and an appropriate consent was taken before starting the interview.
A two-part questionnaire was administered. The first part of the pro forma dealt with general sociodemographic information about the children including age, sex, religion, and socioeconomic status. The second part of the pro forma was used to record the height (cm) and weight (kg) of the child, exercise duration, TV-watching hours, computer-watching hours, diet preferences, and physical activity duration.
In our study, the anthropometric measurements of 5-18-year-old children were recorded using standardized procedures. The weight of children was recorded using a weighing machine, with every time the mark of zero checked before taking weight. The weight was measured to the nearest 500 g. For measuring height, the subject was made to stand erect looking straight on a level surface with heels together and toes apart, without shoes. The height was measured in centimeters from the highest point on the head to the heel, with the help of a measuring tape.
Body mass index (BMI) was derived by dividing the subject's mass by the square of his or her height, typically expressed in metric units: 
BMI = Weight (in kilograms)/height 2 (in meters) 2
We applied the cutoff points standardized by the Centers for Disease Control and Prevention (CDC) growth chart in identifying the age- and gender-specific cutoff points for the BMI with the age ranging from 5 years to 18 years for the labeling of overweight and obesity among the included subjects.  Children with ≥85 percentile were considered overweight, those with ≥95 percentile were obese while those between 5-85 percentile were considered desirable or normal, and <5 percentile were categorized as lean.  The interpersonal communication technique was used for deriving the unbiased information maintaining full confidentiality. Statistical test were applied accordingly.
As the percentage of obese children emerged to be small and overweight children were at risk of developing obesity, National Family Health Survey (NFHS)-3 gives us combined data of overweight and obese children and their dietary patterns were also found to be much similar; so being obese and overweight were merged in the tables.
| Results|| |
[Table 1] depicts the physical parameters of children by evaluating their BMI and their percentile. It shows that most of the children were healthy and normal (62.6%), having the percentile between 5 to 85; 20.3% were underweight having the percentile less than 5; 12.5% children were overweight having the percentile between 85 and 95 while only 5.6% children were obese having the percentile equal or greater than 95.The difference between normal and obese and overweight children was found to be highly significant.
[Table 2] shows the prevalence of obesity and overweight according to the sex of the respondents. It was found that out of 564 boys, 101 (17.9%) were obese or overweight and out of 436 boys, 69 (15.9%) were obese or overweight. The difference between the sexes of children with regard to obesity was found to be not significant. Regarding the prevalence of obesity and overweight according to income per capita per month, it was found that out of 542 children whose family per capita income was `≥5,000, 110 children were obese or overweight while 432 were nonobese and 60 children were obese or overweight while 398 were nonobese out of 458 children whose family per capita income was `2,000-5,000. The difference between income per capita per month and obesity was found to be significant.
|Table 2: Prevalence of obesity by sex, income of family, occupation of mother, and family history of obesity|
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[Table 2] also shows the prevalence of obesity and overweight according to the occupation of the mother. It was found that out of 357 children whose mothers were working, 102 (28.6%) were obese and overweight while 255 (71.4%) were nonobese; also, out of 643 children whose mothers were housewives, 68 (10.6%) children were obese and overweight while 574 (89.4%) were nonobese. The difference between obesity and overweight and occupation of the mother was found to be highly significant.
[Table 2] also shows family history (maternal or paternal) of the respondents. It was found that out of 1,000 families, only 56 obese children had obese parents while 14.5% obese children had normal, healthy parents. The difference associated with family history of obesity was found to be very highly significant.
[Table 3] depicts dietary habits of the respondents. It was found that out of 1,000 children, 78.3% were vegetarian and 21.7% were on a mixed diet. Among 783 vegetarian children, 14.8% were obese and overweight. Regarding the frequency of taking a nonvegetarian diet, 16.7% of the children took nonvegetarian food ≤1 time/week, 4.2% took nonvegetarian food 2-4 times/week, and 8 children took nonvegetarian food 5-6 times/week. The proportion of children who consumed a more nonvegetarian diet was more obese than children who consumed nonvegetarian food less frequently. (≤1 or 2-4 times/week). Of the children, 2.9% ate outside their homes almost daily and among them nearly half (41.4%) were obese and overweight. Of the children who ate outside their homes ≤2 times/week, >80% were not obese (i.e. 82.9%).
Consumption of milk and other dairy products was 5-6 times/day in 80%, 2-4 times/week in 15.3%, and ≤1 time/week in 4.6% of the children. Again, 10.9%, 20.3%, and 6.7% were obese and overweight who consumed milk and other dairy products ≤1, 2-4, and 5-6 times/week, respectively. Children who consumed more vegetables/fruits were less obese, i.e., 58.6%, 25.2%, and 16.9% were obese and overweight who consumed fruits/vegetables ≤1, 2-4, and 5-6 times/week, respectively. Nearly three-fourth (75.6%) children were consumed pizza and other junk food ≤1 times/week and among those, 16.7% were obese and overweight. 19.3% and 5.1% consumed pizza and other junk food 2-4 and 5-6 times/week, respectively.
[Table 4] shows the relation of physical activity between children who were obese and children who were overweight. Only 30.11% of the children did some sort of exercise daily. Among those doing daily exercise, 20.2% were obese and overweight.
|Table 4: Relation of Physical exertion with obese and overweight children|
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It was found that a majority (84%) of the children played some form of outdoor game such as football, cricket, basketball, pakdam padkai, etc. A lesser proportion of children (11.6%) were obese among those who played any outdoor game daily compared to children who played weekly (19.8%). A majority (80.7%) of the children had auto/car/bus as the means of transport to school, 19.3% went to school on foot or by cycling. Few children (8.3%) who went to school on foot or by cycling were obese and overweight. Nearly three-fourth (71.4%) children watched TV while eating, and among them obesity was present in 19.7% of the children. 10.1% of the children were obese and overweight among 286 children did not watch TV while eating.
| Discussion|| |
Our study was planned to assess the occurrence of obesity among children aged 5-18 years of urban area in Jaipur, Rajasthan. 12.5% children were overweight having the percentile between 85 and 95 while only 5.6% children were obese having the percentile equal or greater than 95. This is supported by the studies on schoolchildren by Kapil et al. in 2002 in Delhi, India where the overall prevalence of obesity according to the international cutoff points (BMI criteria) was found to be 7.4%.  About 8% of the boys and 6% of the girls were obese.
As the percentage of obese children emerged to be small and overweight children were at risk of developing obesity, NFHS-3 gives us the combined data of children who were overweight and obese and their dietary pattern were also found to be much similar; so being obese and overweight were merged in the tables.
In our study it was found that the prevalence of obesity/overweight was more in boys than girls, which was similar to the study of Goyal et al.  in Surat, Gujarat. Kumar et al.  in 2007 in Davangere (Karnataka) studied that obesity was 4.10% in boys and 8.82% in girls. , Goyal et al. in 2010 in Ahemdabad studied that overweight is 14.3% in boys and 9.2% in girls.  Gupta and Kochar  in 2009 in Kurukshetra, Haryana, India studied and showed that obesity and being overweight was more prevalent in women than men. 
In our study, obesity and being overweight were more prevalent in the high income group than in the low income group. Goyal et al. in 2010 in Ahmedabad, Gujarat, India studied that 14.3% of boys and 9.2% of girls were overweight and 2.9% of boys and 1.9% of girls were obese.  Being overweight is high in the middle socioeconomic status (SES) than the high middle socioeconomic status while obesity is higher in the high middle socioeconomic status than the mid middle socioeconomic status. Junk food, chocolate, and eating outside home increases the chances of being overweight and obese while exercise and outdoor game decreases these in both the mid and high middle socioeconomic status.
Children who ate junk food more frequently were more obese and overweight as compared to those who ate such food in low frequency. Goyal et al. in 2011 in Surat, Gujarat, India studied that children who consumed carbonated drink daily and more than three times per week were at 19.7 times and 6.9 times more risk of being overweight and obese.  Similarly, children who daily consumed snacks outside their home were at 4.19 times more risk of being overweight and obese and those who consumed such more than three times per week were at 1.97 times more risk of being overweight and obese. More than two servings per week outside the home increased the risk of being overweight and obese by 7.97 times. The risk of being overweight and obese was twice as much when the child consumed junk food more than once daily. The overall prevalence of obesity and overweight was 6.55% and 13.9%.
Keerthan et al. in 2011 in their study in Dakshina Kannada and Udupi districts, both in Karnataka, India also found that the overall prevalence of obesity was higher in males, those who studied in private schools, stayed in nuclear families, consumed fried foods and aerated drinks regularly, and in those who did not exercise regularly. 
In our study, 89.5% of the children were found to consume carbonated soft drinks <1 time/week. A lesser percentage of children was obese and overweight among those who drank carbonated soft drinks <1 time/week (11.4%) than among those who drank ≥1 time/week (57.1%). Similarly, with regard to the consumption of sweets/candies/chewing gums/chocolates and potato chips/popcorns/packed food items among children, 14.2% and 11.8% were obese and overweight among those who ate sweets/candies/chewing gums/chocolates and potato chips/popcorns/packed food items <1 time/week, respectively, compared to 20.5% and 28.5% who were obese and overweight who consumed sweets/candies/chewing gums/chocolates and potato chips/popcorns/packed food items ≥1 time/week, respectively. The difference between them was found to be very highly significant. Goyal et al., Gupta N and Kochar, and Kumar S et al. also found findings similar to our study. ,,
Kumar et al. and Goyal et al. also found that obesity was higher in children with low physical activity. , Gupta and Kochar in 2009 in Kurukshetra found that obesity and overweight were more prevalent in sedentary work than exercise and outdoor games.  Keerthan et al. in 2011 in Dakshina Kannada and Udupi districts, both in Karnataka, India in their study also found that the overall prevalence of obesity and overweight was be higher in those who did not exercise regularly.  Goyal et al. in their study in 2011 in Surat, Ahmedabad, India found that if child did not play any outdoor game or played games only weekly, the risk of being overweight and obese increased by 4.29 times.  Transport to school by bus or auto rickshaw was also associated with 2.81 times increase in the risk of being overweight and obese. 
A majority (80.6%) of the children did <1 h of exercise. No child who did >2 h exercise daily was obese and overweight. A significant association was found between eating while watching TV, doing exercise, and playing outdoor games on the one hand and being obese and overweight on the other hand, in our study. The children who watched more TV tended to become obese as was also found by Goyal et al., which showed that eating while watching TV was associated with the risk of being overweight and obese 1.81 times while watching TV or playing computer games for 1-3 h and more than 3 h increased the risk of being overweight and obese 1.84 and 5.4 times, respectively. 
The current study of obesity among children gives a prelude to a new set of medical, social, and economic problems that could arise if a timely initiative in this direction is not taken by program managers and policymakers. There is a need to highlight the medical and socioeconomic problems faced by such children and these need to be explored. The study highlights the need to support the compulsory physical exercise session in schools (state/central), which can be an asset to the youth of India.
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Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4]