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Author |
Year |
Place |
Age |
Prevalence of Obesity |
Settings |
SupreetKaurMD et al[3] |
2006 |
Delhi |
5-18 yrs |
2.45% |
School |
Preetam B Mahajan et al[2] |
2007 |
Pondicherry |
6-12 yrs |
2.12%. |
School |
Pediatric Oncall Journal[1] |
2012 |
Patiala Punjab |
6-15 yrs |
7.6% |
School |
Nora El-Said Badawi et al[5] |
2012 |
Egypt |
6-12 yrs |
13.5% |
School |
Alice T Cherian et al[6] |
2012 |
Kochi, Kerala |
6-15 yrs |
3.0% - boys 5.3% - Girls |
School |
Premnath M et al[7] |
2010 |
Mysore |
5-16 yrs |
3.4 % |
School |
Age distribution and obesity:
In our study BMI increases with age and with no gender variation, but there is no statistical difference in the prevalence of obesity related to increase in age (p value is 0.303). Studies done by Preetam B Mahajan et al[2] in Pondicherry among school children aged 6-12 years, studies in Egypt by Nora-El-Said[5] and Shiji K Jacob in Ernakulum, Kerala[8] also inferred that no increase in obesity noted in school age and obesity increases only during the pubertal age.
Effect of gender on prevalence of Obesity:
In our study prevalence of obesity among boys and girls were 9.7% (n=141) and 8.0% (n=93) respectively. P value was 0.354 and statistically insignificant. This delineate that comparing the obesity status between the genders in the age group of 6 to 12 years, does not show any relationship with obesity. Studies by Cynthia L. Ogden et al [9] in Maryland USA, and Helen et al[10] study also had the same views.
Association of obesity with place of residence.
In this study prevalence of obesity in urban and rural schools were 12% and 4.3% respectively. This result was statistically highly significant with p value <0.001. Parekh Alok et al [11] reported in 2009 obesity to be less in rural school than in urban schools. Similar result was note by Unnithan et al [12] as urban children showing 6.73% and rural children with 2.93% obesity rates in Trivandrum educational district. A study by Preetam B Mahajan et al [2] in the union territory of Pondicherry and by shashidhar et al [13] in south Karnataka also has similar.
Association between sedentary life styles and obesity:
Our study showed significant association between obesity and sedentary health behaviors with p value being < 0.001 and statistically highly significant.Irrespective of the gender and place of residence, obesityhas strong association with sedentary lifestyles. Studies done by Ann Smith et al [14] in Texas and Aggarwal et al [15] in Punjabhave also proved the relation between sedentary lifestyle and obesity.
Sleep deprivation and obesity:
Our study also shows positive correlation between sleep deprivation and obesity (p value was <0.0001) and statistically significant. Studies one on semi-urban south Indian children by Kuriyan R et al [16] and study published in bmj by Philippa J Carter and the Nixon GM, Thompson et al [17] have confirmed this hypothesis. In study by Beccuti et al [18]laboratory evidence have confirmed the association between sleep loss and increased risk of obesity.
Influence of parental obesity on childhood Obesity:
In this study Parental obesity was not found to have any significant association (P value=0.239). Whitaker et al [19] study says parental obesity is not a stronger predictor in older children, but the child’s obesity is the most important predictor of adult life obesity.
Birth weight and child’s obesity:
In our study prevalence of obesity increases as the birth weight increases (p value of 0.021) which is significant. Meta-analysis done by Yu ZB, Han SP et al [20] has inferred same results. Similarly studies by Barry Caerphilly et al[21] concluded with similar results stating that as there is a statistical significant increase in obesity as the birth weight increases.
Logistic Regression Analysis:
This logistic regression analysis has analyzed that children, watching TV and playing video games for more than3 hours and sleeping less than 10 hours are having statistical significant risk of being obese. These variables showed adjusted OR of >1 and p value <0.05 relating the variable to be a risk factor for obesity.Children with preferred foods being vegetables or fruits, long hours of outdoor play and occasional restaurant visits are identified as protective factors with statistical significance. The logistic regression table calculated was with adjusted OR <1 and p value <0.05. This states that these variables are the protective factors noted against obesity.
Strength of the study is BMI analyzed with IAP BMI Chart 2015 for Indian standards as per the recommendations of Indian Academy of Pediatrics, so that under diagnosing obese children in native region is averted.
Limitations of the study include fine detail errors in the sleep pattern, food habits and recollecting the birth weight might be possible because of poor parental recollection and a moderate sample size.
CONCLUSION:
The Prevalence of Obesity among school children in Madurai is 9.3%. Comparing previous studies in Tamil Nadu it is on the rise. Prevalence of overweight among school children is 16.8%. The prevalence of obesity has strong association with the place of residence and socio-economic status. No correlation was noted between age and gender in relation to obesity, but there is an increase in Mean and Standard deviation of BMI as the age increases. Risk factors identified were sedentary lifestyle; unhealthy food patterns, sleep deprivation and birth weight and most of these factors are modifiable. Protective factors identified were to prefer fruits and vegetables for healthy diet, adequate physical activity and outdoor play and visiting restaurants rarely. Parental obesity showed no correlation to the prevalence of obesity in their children.
RECOMMENDATIONS:
1) Screening for obesity among school children is needed on a regular basis, so as to identify and intervene early.
2) Early diagnosis and life style modification has to be started in the childhood to prevent the epidemic of morbid obesity in adult life.
3) This study adds that prevalence of obesity among school children is 9.3% and overweight is 16.8% in Madurai, and modifiable factors are the commonest causative factor, hence early life style modification is of utmost importance to the native community.
Acknowledgement:
We express our sincere thanks to The Inspector of Matriculation services, Madurai and the Principles of the schools for their support. Authors acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript. The authors are also grateful to authors/ editors/ publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed.
Source of funding: NIL
Conflict of Interest: NIL
References:
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