Indan Journal of Medical Research Indan Journal of Medical Research Indan Journal of Medical Research Indan Journal of Medical Research
  Home About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Subscribe Contacts Login  
  Home Print this page Email this page Small font sizeDefault font sizeIncrease font size Users Online: 667       

   Table of Contents      
SYSTEMATIC REVIEW
Year : 2016  |  Volume : 143  |  Issue : 2  |  Page : 160-174

Epidemiology of childhood overweight & obesity in India: A systematic review


1 Madras Diabetes Research Foundation & Dr Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non Communicable Diseases Prevention & Control, IDF Centre for Education, Chennai, India
2 WHO Regional Office for South-East Asia (SEARO),New Delhi, India
3 All India Institute of Medical Sciences, WHO Collaborating Centre for Capacity Development & Research in Community based NCDPC, New Delhi, India

Date of Submission23-Jun-2014
Date of Web Publication14-Apr-2016

Correspondence Address:
Viswanathan Mohan
Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non-Communicable Diseases Prevention & Control & IDF Centre for Education, 4, Conran Smith Road, Gopalapuram, Chennai 600 086, Tamil Nadu
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-5916.180203

Rights and Permissions
   Abstract 

Background & objectives: Childhood obesity is a known precursor to obesity and other non-communicable diseases (NCDs) in adulthood. However, the magnitude of the problem among children and adolescents in India is unclear due to paucity of well-conducted nationwide studies and lack of uniformity in the cut-points used to define childhood overweight and obesity. Hence an attempt was made to review the data on trends in childhood overweight and obesity reported from India during 1981 to 2013.
Methods: Literature search was done in various scientific public domains from the last three decades using key words such as childhood and adolescent obesity, overweight, prevalence, trends, etc. Additional studies were also identified through cross-references and websites of official agencies.
Results: Prevalence data from 52 studies conducted in 16 of the 28 States in India were included in analysis. The median value for the combined prevalence of childhood and adolescent obesity showed that it was higher in north, compared to south India. The pooled data after 2010 estimated a combined prevalence of 19.3 per cent of childhood overweight and obesity which was a significant increase from the earlier prevalence of 16.3 per cent reported in 2001-2005.
Interpretation & conclusions: Our review shows that overweight and obesity rates in children and adolescents are increasing not just among the higher socio-economic groups but also in the lower income groups where underweight still remains a major concern.

Keywords: Childhood - cut-points - India - obesity - overweight - prevalence


How to cite this article:
Ranjani H, Mehreen T S, Pradeepa R, Anjana RM, Garg R, Anand K, Mohan V. Epidemiology of childhood overweight & obesity in India: A systematic review. Indian J Med Res 2016;143:160-74

How to cite this URL:
Ranjani H, Mehreen T S, Pradeepa R, Anjana RM, Garg R, Anand K, Mohan V. Epidemiology of childhood overweight & obesity in India: A systematic review. Indian J Med Res [serial online] 2016 [cited 2018 Dec 16];143:160-74. Available from: http://www.ijmr.org.in/text.asp?2016/143/2/160/180203

The term overweight refers to excess body weight for a particular height whereas the term obesity is used to define excess body fat [1] . Overweight and obesity primarily happen either due to excess calorie intake or insufficient physical activity or both. Furthermore, various genetic, behavioural, and environmental factors play a role in its pathogenesis. Childhood obesity is a forerunner of metabolic syndrome, poor physical health, mental disorders, respiratory problems and glucose intolerance, all of which can track into adulthood [2] . Developing countries like India have a unique problem of 'double burden' wherein at one end of the spectrum we have obesity in children and adolescents while at the other end we have malnutrition and underweight.

Globally, the prevalence of childhood obesity has risen in recent years. The International Association for the Study of Obesity (IASO) and International Obesity Task Force (IOTF) estimate that 200 million school children are either overweight or obese [3] . It is difficult to compare prevalence rates of childhood obesity in different countries due to several limitations: lack of nationally representative surveys of school children and paucity of serial measurements over time. Ogden et al[4] reported that the percentage of obese children in the US (6-11 yrs age group) was 7 per cent in 1980 which increased to 20 per cent by 2008. Parallely, among adolescents (age groups of 12-19 yr) obesity rates increased from 5 to 18 per cent. Recent figures from the IOTF website [3] showed prevalence rates of overweight/obesity as 40 per cent in both genders in US. Studies conducted on childhood obesity suggest that it may be plateauing off in some developed countries, while steep increases continue to occur in developing countries [5],[6] . However, these trends are not well documented.

Lower BMI (body mass index) cut-offs of 23 and 25 kg/m [2] have been suggested by the World Health Organization (WHO) and IOTF for Asian Indian adults for overweight and obesity, respectively [7],[8]but these are not applicable for children and adolescents. Over the years, there has been a lack of consensus on the various cut-points or definitions used to classify obesity and overweight in children and adolescents. This makes it difficult to interpret and compare the global or national prevalence rates [9],[10] . For children and adolescents, overweight and obesity are usually defined using age and gender specific normograms of BMI.

There is lack of national representative data on obesity in children from India with its widely varying geographical, social and cultural norms. Here we attempt to review available literature on childhood overweight and obesity from India using the various cut-points used to define childhood and adolescent obesity. We also used the published data from India from 1981 to 2013 to plot the trend in childhood obesity and to look at its key socio-demographic patterns.


   Material & Methods Top


A review of the studies published in the last three decades between 1980 and 2013 reporting on prevalence of childhood overweight and obesity (age 1-18 yr) in India was conducted using a systematic approach. As the aim was to present the current scenario in this area, we restricted our search to 1980 and beyond. Literature search was done in available scientific public domains such as Google Scholar, PubMed, IndMED and Cochrane systematic reviews using key words such as childhood and adolescent overweight, childhood obesity, epidemiology in India and globally, body mass index (BMI), trend and prevalence. A combination of MeSH terms and free texts was used for the search. Cross references from identified articles were also used to expand the coverage. Also, websites of official agencies such as IOTF, WHO and Centres for Disease Control and Prevention (CDC) were accessed for related information. The review search initially revealed 612 titles or abstracts. The first two authors critically reviewed the studies to decide if these could be included based on the criteria detailed in the flow chart indicating the review process [Figure 1]. Prevalence in the age group of 1-5 yr were obtained only from national surveys; most studies from India reported only on undernutrition in this age group. Finally, 52 studies were selected and were grouped based on the age groups studied and presented as childhood (1-12 yr), adolescent (10-18 yr) and childhood and adolescent (studies inclusive of both age groups) obesity trends in India according to the year in which that study was published. All reported prevalences were taken directly from the study and no recalculations were performed. Due to the lower obesity prevalence rates in rural or government schools, these were excluded only from the trend analysis [Figure 2] but have been reported in the Tables. Thus, to plot the figure demonstrating combined childhood and adolescent obesity trends, only urban prevalences from 42 studies (49 datasets as 7 studies reported multiple datasets in the form of repeat surveys) from 1981 to 2013 were used and the year the study was conducted in was considered for analysis; in case, this was not mentioned, the publication year was included.
Figure 1. Flow chart indicative of the review process

Click here to view
Figure 2. Box plots indicating overweight (a) , obesity (b) and combined (c) trends in Indian children and adolescents (1981-2013).
Source: Refs 9-50


Click here to view


For each time period, the median of the reported values for the individual studies was calculated along with the quartile limits. Trends for overweight, obesity and combined prevalence in children and adolescents were calculated and presented using box plots [Figure 2]. The box plot included the 25 th and 75 th percentiles and data labels plotted were median values with the minimum and maximum. When multiple cut-offs were used in the same study, only IOTF-Cole et al 2000 criteria [51] were considered to prevent duplication of study data. Also, two outliers [52],[53] were not included in this trend analysis but shown in [Table I]. We further looked at the distribution of prevalence of obesity by sex and area of residence (rural/urban).
Table I. Childhood (1-12 yr) obesity trends in India


Click here to view


Prior to 2001, prevalence studies reported more on obesity (5 studies) rather than overweight (2 studies) while post-2001, there were almost equal numbers of reported values for both (45 for obesity versus 41 for overweight). Due to this drop in the sample size and number of studies conducted, plotting separate trend graphs for children and adolescents did not show a good trend. Therefore, the results are presented for all 52 studies combined with a total count of 435162 participants. Overweight numbers were available for 43 studies comprising 353738 participants while obesity numbers were reported for 50 studies with 431262 participants. Both numbers were available for 42 studies with 351454 participants. The combined prevalence was the sum of the overweight and obesity prevalence.


   Results Top


Overall, 52 studies were included based on the defined inclusion and exclusion criteria [Figure 1]. The geographical spread of these studies is shown in [Figure 3]. The studies appear to be spread across the country with 16 of 28 States being covered by at least one survey. [Figure 3] shows the lack of prevalence data on childhood obesity from many northern and north-eastern States of India.
Figure 3. Map of India indicating prevalence (%) of childhood obesity in various States and cities. Values in parentheses are prevalence in percentages. Source: Refs 9-15, 17-49, 52, 53, 64-71

Click here to view


Cut-points used to define childhood obesity in India

The most commonly used definition for childhood overweight and obesity in India was IOTF-Cole et al[51] (28 studies) followed by WHO [61],[62] (10 studies) and CDC [63] (8 studies). Others included Gomez classification [59] , and that of Must et al[60] and Rosner et al[72] . India specific cut-points were found in the Agarwal charts 1992 [73] , 2001 [74] [used by Indian Academy of Paediatrics (IAP) for growth monitoring in children and adolescents], Eliz Health Path for Adolescents and Adults (EHPA) [75] , Pandey et al[76] cut-points for Asian Indian adolescents and the data provided by Khadilkar et al[77] . Of the 52 studies reported in this review, six studies used multiple cut-points.

Epidemiology of childhood obesity: Indian data

Studies reporting prevalence of childhood and adolescent obesity in India were included as part of [Table I] (1-12 yr), [Table II] (10-17 yr) and [Table III] (combined age group) in accordance to the year the study was published.{Table I}
Table II. Adolescent (10-18 yr)# obesity trends in India


Click here to view
Table III. Childhood & adolescent obesity trends in India (Studies inclusive of both age groups)


Click here to view


Children [Table I]: The key studies are from the National Family Health Surveys (NFHS) and National Nutrition Monitoring Bureau (NNMB) surveys [54],[55],[56],[57],[58] . These surveys covered under-five children only. In the older age groups, the study by Preetam et al[11] from Puducherry was the largest. In under-fives the prevalence of obesity was below 2 per cent in all the studies. In children above 5 yr, the prevalence of obesity varied between 2 to 8 per cent. Overweight rates were around two times higher and seem to be more in northern and eastern India than in southern India. One study from Srinagar [52] reported a high prevalence rate of 25 per cent, probably due to the smaller numbers studied and being from affluent families.

Adolescent [Table II]: The largest study in this age group was the Global School Based survey in 2007 on 8130 students. Overall, overweight prevalence varied between 3 to 24.7 per cent and obesity ranged from 1.5 to 14 per cent in these 28 studies highlighting the wide variability in their prevalence in India. In most studies, slightly higher prevalence rates were reported in boys, compared to girls. {Table II}

Combined [Table III]: A total of 17 studies reported prevalence of overweight/obesity in childhood and adolescence but were combined in such a way that we could not separate the two. The least prevalence of obesity was reported from Nagaland (2.3%) and the maximum from New Delhi (29%) and both used the IOTF-Cole et al criteria [51] . {Table III}

Some socio-demographic differentials

Sex/gender: Khadilkar et al[17] reported on affluent Indian 2 to 17 yr old children and showed that the prevalence of overweight and obesity was 18.2 per cent by the IOTF classification while it was 23.9 per cent using WHO cut-points and the prevalence was higher in boys. Chhatwal et al[18] reported overall prevalences of childhood obesity and overweight in Punjab as 11.1 and 14.2 per cent, respectively and again a higher prevalence in boys (12.4 vs 9.9%, 15.7 vs 12.9%). Sidhu and colleagues [19] from Amritsar reported overweight in 10 per cent among boys and 12 per cent among girls and obesity in 5 per cent boys and 6 per cent in girls. Kotian and co-workers [78] reported that the overall prevalences of overweight and obesity were 9.3 and 5.2 per cent, respectively among boys and 10.5 and 4.3 per cent among girls, in a semi urban city in Karnataka.

Socio-economic status (SES): Marwaha et al[20] , using IOTF classification showed that among children in the upper SES the prevalences of overweight and obesity were 17 and 5.6 per cent in boys and 19 and 5.7 per cent in girls, respectively, whereas in the lower SES the values were 2.7 and 0.4 per cent in boys and 2.1 and 0.5 per cent in girls, respectively. Goyal and colleagues [9] from Gujarat found the prevalence of obesity to be higher in upper SES group as compared to the middle SES. A recent study based on 18,955 school children in Chennai [21] , reported the prevalence of overweight to be 17 per cent while that of obesity was 4.4 per cent among private school children. Conversely, among the government school children the values were 3.1 and 0.5 per cent, respectively using the Cole cut-points. In another study from Karimnagar, Hyderabad, the prevalences of overweight and obesity were 11.9 and 2.7 per cent, respectively among 10-16 yr olds [22] . While obesity was more in higher SES, factors like family size, residence and parent's education did not contribute to obesity.

Place of residence: In a report from Kerala [23] the prevalence of overweight and obesity among children was shown to increase in urban as well as rural areas. This study reported high prevalence of obesity and overweight among boys especially in urban areas whereas underweight was more common in girls especially in rural areas. Premanath and co-workers [24] from Mysuru surveyed 43,152 school children from private and government schools using Agarwal charts [74] . They reported the prevalences of obesity, overweight and underweight to be 3.4, 8.5 and 17.2 per cent, respectively among 5-7 yr old children with higher prevalence of obesity seen in private schools. Another study from Mysuru using the WHO cut-points reported obesity prevalence among urban-rural adolescents to be 9.0 and 0.8 per cent, respectively [64] . A study from Surat, Gujarat, showed an increase in prevalence of overweight/obesity in urban males aged 14-17 yr [25] . Higher SES was found to be significant risk factor for obesity.

These data showed that in India, obesity in children was associated with affluence but the exact prevalence varied based on the definitions used. However, with the rapid epidemiological transition occurring in large metropolitan cities and peri-urban areas, recent studies have shown a steady increase in prevalence among government school children [21],[65] .

Trends in prevalence of overweight/obesity

Despite the limitations related to cut-points and definitions, when 42 prevalence studies (49 datasets) from India were plotted to observe the trends for combined overweight and obesity in Indian children and adolescents over the last decade, it was seen to be increasing [Figure 2]. The pooled data after 2010 estimated a combined prevalence of 19.3 per cent of childhood overweight and obesity which was significantly (two-sample z-test, P<0.01) higher than the earlier prevalence of 16 per cent reported in 2001[Figure 2]. However, these rates tend to vary widely (as also indicated by the length of the box plots) depending on the cut points used, the sampling frame and time period of the survey [59],[63],[72],[74],[75],[77] .

A large variation was noted for combined prevalence (overweight + obesity) values reported from different studies ranging from 4.3 to 40.9 per cent. If further stratified by the cut-offs used, looking at studies using IOTF cut-offs, the combined prevalence range was 6.98 to 40.9 per cent. Region-wise stratification was done on the basis of the region where the studies were performed, excluding studies that were done across multiple regions. The median value for the combined prevalence based on the number of studies reported from that particular region showed that the combined prevalence was higher in north (20.7%, n = 15) compared to south (15.1%, n=16). The combined obesity prevalence from east India (22.0%, n=4) and west (19.7%, n =8) could not be used to make a significant conclusion due to the smaller number of studies reported from these areas.

We also looked at studies which have been done in the same area with a time interval to assess the trends. Subramanyam et al[26]reported on obesity trends in adolescent girls in private schools in Chennai and showed that in 1981, overweight was present in 9.6 per cent and obesity in 5.9 per cent of the girls while in 1998, overweight was seen in 9.7 per cent and obesity in 6.2 per cent of the girls. A similar study from the same city in 2002 [27] showed that among children attending private schools the prevalence of overweight/obesity had almost doubled - 17.8 per cent in boys and 15.8 per cent in girls. This increase was attributed to changes in lifestyle factors [27] . Gupta et al[28] reported in girls aged 11-17 yr an unchanged trend in prevalence of overweight (10.9% in 1997, 10.5% in 2003) and obesity (5.5% in 1997, 6.7% in 2003) based on a population-based birth cohort in New Delhi. This could be attributed to tracking trends of a cohort study whereas both the studies done in Chennai were cross-sectional and in a school based setting.


   Discussion Top


India is a fast growing economy, currently undergoing major epidemiological, nutritional and demographic transitions. These transitions tend to promote obesity in all age groups. However, when one looks at the prevalence of obesity alone, there is no clear secular trend. The median values ranged from 5.5 per cent in 2001-2005 to 4.0 per cent in 2006-2010 and then rose to 4.6 per cent since 2010. This suggests that the prevalence of obesity has probably been somewhat constant over the last couple of decades. However, the overweight and combined overweight/obesity prevalence showed an increasing trend. The prevalence of overweight increased from 9.7 per cent prior to 2001 to 13.9 per cent in studies reported after 2010. The combined trend followed a similar pattern increasing from 15.9 per cent prior to 2001 to 16.3 per cent from 2001-2005. The value then increased to 17.4 per cent in the 2006-2010 period, finally reaching 19.3 per cent in studies reported after 2010. Hence, there was a trend of increase in overweight among children/adolescents in India.

The criteria used for diagnosis of obesity in children and adolescents in developing countries like India have been based on American and European BMI standards [51] . In these standards, the >85 th percentile for overweight and > 95 th percentile for obesity have been derived from the data from National Center for Health Statistics (NCHS) [60] and National Health and Nutrition Examination Survey (NHANES) [79] in USA or from studies in western European countries where BMI > 95 th percentile corresponds to >130 per cent ideal body weight and BMI of > 30 kg/m [2](Ref [8]) . The CDC growth curves have been developed from an apparently overweight population [80] . In an effort to overcome this drawback, Cole et al[51] used data from several European and Asian countries to determine childhood BMI cut-points that corresponded to adult BMI of 25 and 30 kg/m [2] . Many countries including India use the Cole (2000) criteria. This criterion has also been adopted by the IOTF. However, two studies conducted in India [66],[81] showed the IOTF reference classified participants as having a lower weight . Both the studies concluded that the Cole criteria were not suitable for Indian and South Asian children.

The WHO has been persuading paediatricians and governments all over the world to use the WHO growth charts for identifying underweight and overweight [80] . de Onis and group [82] thus came up with the WHO 2007 age and gender specific BMI cut-offs as a global standard. In children selected from across the globe it was seen that they grew at an astonishingly consistent pattern up to the age of five years, suggesting that there may not be ethnic differences in the growth pattern of babies and children [83] . However, it is likely that the WHO cut-off will result in higher overweight and or obesity rates [17],[80] .

Strengths and limitations of the review

One important limitation of this study was that the trend was plotted using reported prevalence rates which in turn were calculated using various cut-offs. To better understand and compare childhood obesity trends, we need age, gender and country or ethnic specific cut-points from age six onwards to 18 yr to uniformly define childhood overweight and obesity. Also, overweight and obesity studies from important States like Haryana, Himachal Pradesh, Uttarkhand, Bihar, Jharkand and six North-Eastern States could not be found in literature. Data from these States could have enriched the summary observations. Five studies conducted within the years 1992-2006 provided national estimates for pre-school children but many used varying cut-points for overweight and obesity. This practical issue of interpreting the various cut-points is a major obstacle in understanding secular trends in childhood obesity not just in India but also worldwide. A major strength (which may also be interpreted by some as a limitation) of this study was that we included all reported overweight/obesity prevalence studies that were accessible through our comprehensive search strategy. As we aimed to report specifically on data from India we also included reports available as conference proceedings or in Indian journals (may not be high impact and indexed). Thus, bearing in mind these limitations, the current available data on childhood overweight and obesity need to be interpreted with caution.


   Conclusions Top


The present analysis shows that overweight and obesity rates in children and adolescents are increasing not just among the higher socio-economic groups but also in the lower income groups where underweight still remains a major concern. This suggests the need for a balanced and sensitive approach addressing economic and nutrition transitions to effectively tackle this double burden paradox in India.

Conflicts of Interest: None.

 
   References Top

1.
National Institutes of Health, National Heart, Lung, and Blood Institute. Disease and Conditions Index: what are overweight and obesity? Available from: http://www.nhlbi.nih.gov/health/health-topics/topics/obe/ , accessed on December 8, 2013.   Back to cited text no. 1
    
2.
Centers for Disease Control and Prevention (CDC), Fact sheets. Available from: http://www.cdc.gov/healthyyouth/obesity/facts.htm , accessed on November 22, 2013.  Back to cited text no. 2
    
3.
International Obesity Task Force. Available from: http://www.iaso.org/iotf/obesity/obesitytheglobalepidemic /, for Saudi, Canada, South Africa, Australia and NZ estimates, accessed on November 22, 2013.  Back to cited text no. 3
    
4.
Ogden CL, Carroll MD, Curtin LR, Lamb MM, Flegal KM. Prevalence of high body mass index in US children and adolescents, 2007-2008. JAMA 2010; 303 : 242-9.  Back to cited text no. 4
    
5.
Wang Y, Lobstein T. Worldwide trends in childhood overweight and obesity. Int J Pediatr Obes 2006; 1 : 11-25.  Back to cited text no. 5
    
6.
Raj M, Krishna Kumar R. Obesity in children & adolescents. Indian J Med Res 2010; 132 : 598-607.  Back to cited text no. 6
    
7.
World Health Organization Western Pacific Region, International Association for the Study of Obesity, International Obesity Task Force. Asia Pacific perspective: Redefining obesity and its treatment. Australia: Health Communications Australia; 2000.  Back to cited text no. 7
    
8.
World Health Organization. Obesity, preventing and managing the global epidemic. Report of a WHO consultation on obesity. Geneva: WHO; 1998. Available from: http://whqlibdoc.who.int/hq/1998/WHO_NUT_NCD_98.1_(p1-158).pdf , accessed on November 22, 2013.  Back to cited text no. 8
    
9.
Goyal RK, Shah VN, Saboo BD, Phatak SR, Shah NN, Gohel MC, et al. Prevalence of overweight and obesity in Indian adolescent school going children: Its relationship with socioeconomic status and associated lifestyle factors. J Assoc Physicians India 2010; 58 : 151-8.   Back to cited text no. 9
    
10.
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. 10
    
11.
Preetam MB, Anil PJ, Zile S, Johnson C, Murugan N, Sandeep A, et al. Study of childhood obesity among school children aged 6 to 12 years in Union Territory of Puducherry. Indian J Community Med 2011; 36 : 45-50.   Back to cited text no. 11
    
12.
Monga S. Obesity among school children (7-9 years old) in India: Prevalence and related factors. The 132 nd Annual Meeting (November 6-10, 2004) of American Public Health Association (APHA).  Back to cited text no. 12
    
13.
Sidhu S, Kaur N, Kaur R. Overweight and obesity in affluent school children of Punjab. Ann Hum Biol 2006; 33 : 255-9.  Back to cited text no. 13
    
14.
Bose K, Bisai S, Mukhopadhyay A, Bhadra M. Overweight and obesity among affluent Bengalee schoolgirls of Lake Town, Kolkata, India. Matern Child Nutr 2007; 3 : 141-5.  Back to cited text no. 14
    
15.
Kumar HNH, Mohanan P, Kotian S, Sajjan BS, Kumar SG. Prevalence of overweight and obesity among preschool children in semi urban South India. Indian Pediatr 2008; 45 : 497-9.  Back to cited text no. 15
    
16.
Wang Y, Chen HJ, Shaikh S, Mathur P. Is obesity becoming a public health problem in India? Examine the shift from under- to overnutrition problems over time. Obes Rev 2009; 10 : 456-74.  Back to cited text no. 16
    
17.
Khadilkar VV, Khadilkar AV, Cole TJ, Chiplonkar SA, Pandit D. Overweight and obesity prevalence and body mass index trends in Indian children. Int J Pediatr Obes 2011; 6 : e216-24.   Back to cited text no. 17
    
18.
Chhatwal J, Verma M, Riar SK. Obesity among pre-adolescent and adolescents of a developing country (India). Asia Pac J Clin Nutr 2004; 13 : 231-5.  Back to cited text no. 18
    
19.
Sidhu S, Marwah G, Prabhjot. Prevalence of overweight and obesity among the affluent adolescent school children of Amritsar, Punjab. Coll Antropol 2005; 29 : 53-5.  Back to cited text no. 19
    
20.
Marwaha RK, Tandon N, Singh Y, Aggarwal R, Grewal K, Mani K. A study of growth parameters and prevalence of overweight and obesity in school children from Delhi. Indian Pediatr 2006; 43 : 943-52.   Back to cited text no. 20
    
21.
Sonya J, Ranjani H, Priya M, Anjana RM, Mohan V. Prevalence of over-weight and obesity among school going children and adolescents in Chennai using a national and international cut point (ORANGE-3). Indian Pediatr 2014; 51 : 544-9.  Back to cited text no. 21
    
22.
Adinatesh KV, Prashant RK. A study of prevalence of childhood obesity among school children in Karimnagar town. MRIMS J Health Sci 2013; 1 : 8-11.  Back to cited text no. 22
    
23.
Unnithan AG, Syamakumari S. Prevalence of overweight, obesity and underweight among school going children in rural and urban areas of Thiruvananthapuram Educational District, Kerala State (India). Internet J Nutr Wellness 2007; 6 : 6 pages.  Back to cited text no. 23
    
24.
Premanath M, Basavanagowdappa H, Shekar MA, Vikram SB, Narayanappa D. Mysore Childhood Obesity Study. Indian Pediatr 2010; 47 : 171-3.  Back to cited text no. 24
    
25.
Alok P, Malay P, Divyeshkumar V. Prevalence of overweight and obesity in adolescents of urban and rural area of Surat, Gujarat. Natl J Med Res 2012; 2 : 325-9.  Back to cited text no. 25
    
26.
Subramanyam V, Jayashree R, Rafi M. Prevalence of overweight and obesity in affluent adolescent girls in Chennai in 1981 and 1998, Indian Pediatr 2003; 40 : 332-6.  Back to cited text no. 26
    
27.
Ramachandran A, Snehalatha C, Vinitha R, Thayyil M, Kumar CKS, Sheeba L, et al. Prevalence of overweight in urban Indian adolescent school children. Diabetes Res Clin Pract 2002; 57 : 185-90.  Back to cited text no. 27
    
28.
Gupta R, Rastogi P, Arora S. Low obesity and high undernutrition prevalence in lower socioeconomic status school girls: A double jeopardy. Hum Ecol 2006; 14 : 120-32.  Back to cited text no. 28
    
29.
Kapil U, Singh P, Pathak, P, Dwivedi, SN, Bhasin S. Prevalence of obesity in affluent adolescent school children in Delhi. Indian Pediatr 2002; 39 : 449-52.  Back to cited text no. 29
    
30.
Mohan B, Kumar N, Aslam N, Rangbulla A, Kumbkarni S, Sood NK, et al. Prevalence of sustained hypertension and obesity in urban and rural school going children in Ludhiana. Indian Heart J 2004; 56 : 310-4.  Back to cited text no. 30
    
31.
Khadilkar VV, Khadilkar AV. Prevalence of obesity in affluent schoolboys in Pune. Indian Pediatr 2004; 41 : 857-8.  Back to cited text no. 31
    
32.
Kaneria Y, Singh P, Sharma DC. Prevalence of overweight and obesity in relation to socio-economic conditions in two different groups of school-age children of Udaipur City (Rajasthan). J Indian Acad Clin Med 2006; 7 : 133-5.  Back to cited text no. 32
    
33.
Iyer UM, Venugopal S, Gandhi HI. Obesity in school children. Magnitude and risk factor analysis. ICMR funded Project report, Department of Foods and Nutrition. WHO Collaborating Centre for Diet Related Non- Communicable Diseases and Anemia Control. Baroda: MS University of Baroda, India; 2006.  Back to cited text no. 33
    
34.
Sood A, Sundararaj P, Sharma S, Kurpad AV, Muthayya S. BMI and body fat per cent: Affluent adolescent girls in Bangalore City. Indian Pediatr 2007; 44 : 587-91.  Back to cited text no. 34
    
35.
Aggarwal T, Bhatia RC, Singh D, Sobti PC. Prevalence of obesity and overweight in affluent adolescents from Ludhiana, Punjab. Indian Pediatr 2008; 45 : 500-2.  Back to cited text no. 35
    
36.
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. 36
    
37.
Jain S, Pant B, Chopra H, Tiwari R. Obesity among adolescents of affluent public schools in Meerut. Indian J Public Health 2010; 54 : 158-60.  Back to cited text no. 37
    
38.
Gupta DK, Shah P, Misra A, Bharadwaj S, Gulati S, Gupta N, et al. Secular trends in prevalence of overweight and obesity from 2006 to 2009 in urban Asian Indian adolescents aged 14-17 years. PLoS One 2011; 6 : e17221.  Back to cited text no. 38
    
39.
Kumar KM, Prashanth K, Baby KE, Rao KR, Kumarkrishna B, Hegde K, et al. Prevalence of obesity among High School children in Dakshina Kannada and Udupi districts. Nitte Univ J Health Sci 2011; 1 : 16-20.   Back to cited text no. 39
    
40.
Kumar N, Goyal J, Parmar I, Shah V. Prevalence of overweight and obesity in affluent adolescent girls in Surat City, Western India. Int J Med Sci Public Health 2012; 1 : 2-4.   Back to cited text no. 40
    
41.
Jain G, Bharadwaj SK, Joglekar AR. To study the prevalence of overweight and obesity among school children (13-17yrs) in relation to their socioeconomic status and Eating habits. Int J Sci Res Publ 2012; 2 : 1-4.   Back to cited text no. 41
    
42.
Gupta A, Sarker G, Das P, Shahnawaz K, Pal R. Prevalence of lifestyle associated cardiovascular risk factors among adolescent students of rural Bengal. J Integr Health Sci 2013; 1 : 69-75.  Back to cited text no. 42
    
43.
Chatterjee P. India sees parallel rise in mal-nutrition and obesity. Lancet 2002; 360 : 1948.  Back to cited text no. 43
    
44.
Sharma A, Sharma K, Mathur KP. Growth pattern and prevalence of obesity in affluent schoolchildren of Delhi. Public Health Nutr 2007; 10 : 485-91.  Back to cited text no. 44
    
45.
Raj M, Sundaram KR, Paul M, Deepa AS, Kumar RK. Obesity in Indian children: Time trends and relationship with hypertension. Natl Med J India 2007; 20 : 288-93.  Back to cited text no. 45
    
46.
Kaur S, Sachdev HP, Dwivedi SN, Lakshmy R, Kapil U. Prevalence of overweight and obesity amongst school children in Delhi, India. Asia Pac J Clin Nutr 2008; 17 : 592-6.  Back to cited text no. 46
    
47.
Misra A, Shah P, Goel K, Hazra DK, Gupta R, Seth P, et al. The high burden of obesity and abdominal obesity in urban Indian schoolchildren: A multicentric study of 38,296 children. Ann Nutr Metab 2011; 58 : 203-11.   Back to cited text no. 47
    
48.
Ghosh A. Rural-urban comparison in prevalence of overweight and obesity among children and adolescents of Asian Indian origin. Asia Pac J Public Health 2011; 23 : 928-35.  Back to cited text no. 48
    
49.
Chakraborty P, Dey S, Pal R, Kar S, Zaman FA, Pal S. Obesity in Kolkata Children: Magnitude in relationship to hypertension. J Nat Sci Biol Med 2011; 2 : 101-6.  Back to cited text no. 49
    
50.
Global school based health survey. Available from: http://www.who.int/chp/gshs/2007_India_CBSE_fact_sheet.pdf , accessed on December 8, 2013.  Back to cited text no. 50
    
51.
Cole TJ, Bellizzi MC, Flegal KM, Dietz WH. Establishing a standard definition for child overweight and obesity worldwide: International survey. BMJ 2000; 320 : 1240-3.  Back to cited text no. 51
    
52.
Dhingra R, Sharma A, Azad AM. Vulnerability for life style disorders among affluent primary school children of Srinagar, Jammu and Kashmir, India. Stud Home Com Sci 2011; 5 : 147-55.  Back to cited text no. 52
    
53.
Patnaik S, Patnaik L, Patnaik S, Hussain M. Prevalence of overweight and obesity in a private school of Orissa, India. Internet J Epidemiol 2010; 10 : (1).  Back to cited text no. 53
    
54.
International Institute for Population Sciences (IIPS). National family health survey (MCH and Family Planning), India 1992-93. Mumbai: IIPS; 1995.  Back to cited text no. 54
    
55.
International Institute for Population Sciences IIPS and ORC Macro. National family health survey (NFHS-2), 1998-99: India. Mumbai: IIPS; 2000.  Back to cited text no. 55
    
56.
International Institute for Population Sciences. (IIPS) and Macro International. National family health survey (NFHS-3), 2005-06: India. Mumbai: IIPS; 2007.  Back to cited text no. 56
    
57.
National Nutrition Monitoring Bureau (NNMB). Diet and nutritional status of rural population. NNMB Technical Report No: 21. 2002. Available from: http://nnmbindia.org/NNMBREPORT2001-web.pdf , accessed on November 22, 2013.  Back to cited text no. 57
    
58.
National Nutrition Monitoring Bureau (NNMB). Diet and nutritional status of population and prevalence of hypertension amongst adults in rural areas. NNMB Technical Report No: 24. Hyderabad: NNMB; 2007.  Back to cited text no. 58
    
59.
Gomez F, Galvan R, Frank S, Cravioto J, Chavez R, Vasquiz J. Mortality in Second and Third Degree Malnutrition, 1956. Bull World Health Organ 2000; 78 : 1275-80.  Back to cited text no. 59
    
60.
Must A, Dallal GE, Dietz WH. Reference data for obesity. 85 th and 95 th percentiles of Body Mass Index (BMI) and Triceps skinfold thickness. Am J Clin Nutr 1991; 53 : 839-46.  Back to cited text no. 60
    
61.
World Health Organization (WHO). Report of a WHO Committee. Physical status: the use and interpretation of anthropometry. Technical Report Series no. 854. Geneva, Switzerland: WHO; 1995.  Back to cited text no. 61
    
62.
WHO Multicentre Growth Reference Study Group. WMGRS. WHO Child Growth Standards: Length/height-for-age, Weight-for-age, Weight-for-length, Weight-for height and Body Mass Index-for-Age: Methods and Development. World Health Organization: Geneva, Acta Paediatr 2006; 450 : 76-85.  Back to cited text no. 62
    
63.
Using the BMI-for-Age Growth Charts. Available from: http://www.cdc.gov/nccdphp/dnpa/growthcharts/training/modules/module1/text/module1print.pdf , accessed on November 22, 2013.  Back to cited text no. 63
    
64.
Saraswathi YS, Najafi M, Gangadhar MR, Malini SS. Prevalence of childhood obesity in school children from rural and urban areas in Mysore, Karnataka, India. J Life Sci 2011; 3 : 51-5.   Back to cited text no. 64
    
65.
Singh AK, Maheshwari A, Sharma N, Anand K. Lifestyle associated risk factors in adolescents. Indian J Pediatr 2006; 73 : 901-6.  Back to cited text no. 65
    
66.
Gupta R, Goyle A, Kashyap S, Agarwal M, Consul R, Jain BK. Prevalence of atherosclerosis risk factors in adolescent school children. Indian Heart J 1998, 50 : 511-5.  Back to cited text no. 66
    
67.
Rao S, Kanade A, Kelkar R. Blood pressure among overweight adolescents from urban school children in Pune, India. Eur J Clin Nutr 2007; 61 : 633-41.  Back to cited text no. 67
    
68.
Gupta AK, Ahmad AJ. Childhood obesity and hypertension. Indian Pediatr 1990; 27 : 333-7.  Back to cited text no. 68
    
69.
Singh MS, Devi RKN. Nutritional status among the urban Meitei children and adolescents of Manipur, Northeast India. J Anthropol 2013; 2013 : 1-5.   Back to cited text no. 69
    
70.
Longkumer T. Physical growth and nutritional status among Ao Naga children of Nagaland, Northeast India. J Anthropol 2013; 2013 : 1-6.  Back to cited text no. 70
    
71.
Siddiqui NI, Bose S. Prevalence and trends of obesity in Indian school children of different socioeconomic class. Indian J Basic Appl Med Res 2012; 5 : 393-8.  Back to cited text no. 71
    
72.
Rosner B, Prineas R. Loggie J, Daniels SR. Percentiles for body mass index in US children 5- 17 years of age. J Pediatr 1998; 132 : 211-22.  Back to cited text no. 72
    
73.
Agarwal DK, Agarwal KN, Upadhyay SK, Mittal R, Prakash R, Rai S. Physical and sexual growth pattern of affluent Indian children from 6-18 years of age. Indian Pediatr 1992; 29 : 1203-82.  Back to cited text no. 73
    
74.
Agarwal KN, Saxena A, Bansal AK, Agarwal DK. Physical growth assessment in adolescence. Indian Pediatr 2001; 38 : 1217-35.  Back to cited text no. 74
    
75.
Elizabeth KE. A novel growth assessment chart for adolescent. Indian Pediatr 2001; 38 : 1061-4.   Back to cited text no. 75
    
76.
Pandey RM, Madhavan M, Misra A, Kalaivani M, Vikram NK, Dhingra V. Centiles of anthropometric measures of adiposity for 14- to 18-year-old urban Asian Indian adolescents. Metab Syndr Relat Disord 2009; 7 : 133-42.  Back to cited text no. 76
    
77.
Khadilkar VV, Khadilkar AV, Borade AB, Chiplonkar SA. Body mass index cut-offs for screening for childhood overweight and obesity in Indian Children. Indian Pediatr 2012; 49 : 29-34.  Back to cited text no. 77
    
78.
Kotian MS, Kumar GS, Kotian SS. Prevalence and determinants of overweight and obesity among adolescent school children of South Karnataka, India. Indian J Community Med 2010; 35 : 176-8.   Back to cited text no. 78
    
79.
Ogden CL, Flegal KM, Carroll MD, Johnson CL. Prevalence and trends in overweight among US children and adolescents, 1999-2000. JAMA 2002; 288 : 1728-32.  Back to cited text no. 79
    
80.
James WPT. The challenge of childhood obesity. Int J Pediatr Obes 2006; 1 : 7-10.  Back to cited text no. 80
    
81.
Stigler MH, Arora M, Dhavan P, Tripathy V, Shrivastav R, Reddy KS, et al. Measuring obesity among school-aged youth in India: A comparison of three growth references. Indian Pediatr 2011; 48 : 105-10.  Back to cited text no. 81
    
82.
de Onis M, Onyango AW, Borghi E, Siyam A, Nishida C, Siekmann J. Development of a WHO growth reference for school-aged children and adolescents. Bull World Health Organ 2007; 85 : 660-7.  Back to cited text no. 82
    
83.
Bhandari N, Bahl R, Taneja S, de Onis M, Bhan MK. Growth performance of affluent Indian children is similar to that in developed countries. Bull World Health Organ 2002; 80 : 189-95.  Back to cited text no. 83
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
    Tables

  [Table I], [Table II], [Table III]


This article has been cited by
1 The role of Indian school canteens in nutrition promotion
Neha Rathi,Lynn Riddell,Anthony Worsley
British Food Journal. 2018; 120(1): 196
[Pubmed] | [DOI]
2 Body Composition Percentiles in Urban South Indian Children and Adolescents
Rebecca Kuriyan,Sumithra Selvan,Tinku Thomas,Jayakumar Jayakumar,Deepa P. Lokesh,Mamatha P. Phillip,Jini V. Aravind,Anura V. Kurpad
Obesity. 2018; 26(10): 1629
[Pubmed] | [DOI]
3 Barriers to Nutrition Promotion in Private Secondary Schools in Kolkata, India: Perspectives of Parents and Teachers
Neha Rathi,Lynn Riddell,Anthony Worsley
International Journal of Environmental Research and Public Health. 2018; 15(6): 1139
[Pubmed] | [DOI]
4 Dietary Patterns of Children and Adolescents from High, Medium and Low Human Development Countries and Associated Socioeconomic Factors: A Systematic Review
Patrícia Hinnig,Jordanna Monteiro,Maria de Assis,Renata Levy,Marco Peres,Fernanda Perazi,André Porporatti,Graziela Canto
Nutrients. 2018; 10(4): 436
[Pubmed] | [DOI]
5 Obesity Prevention Behaviors in Asian Indian Adolescent Girls: A Pilot Study
Annie Thomas,Linda Janusek
Journal of Pediatric Nursing. 2018; 42: 9
[Pubmed] | [DOI]
6 Indian adolescents’ perceptions of the home food environment
Neha Rathi,Lynn Riddell,Anthony Worsley
BMC Public Health. 2018; 18(1)
[Pubmed] | [DOI]
7 Physical Activity Among Adolescents in India: A Qualitative Study of Barriers and Enablers
Ambika Satija,Neha Khandpur,Shivani Satija,Shivani Mathur Gaiha,Dorairaj Prabhakaran,K. Srinath Reddy,Monika Arora,K. M. Venkat Narayan
Health Education & Behavior. 2018; 45(6): 926
[Pubmed] | [DOI]
8 Genetics of obesity and its measures in India
Simmi Saini,Gagandeep Kaur Walia,Mohinder Pal Sachdeva,Vipin Gupta
Journal of Genetics. 2018;
[Pubmed] | [DOI]
9 The relationship between sensory integration challenges and the dietary intake and nutritional status of children with Autism Spectrum Disorders in Mumbai, India
Pujitha S. Padmanabhan,Hemal Shroff
International Journal of Developmental Disabilities. 2018; : 1
[Pubmed] | [DOI]
10 Relationship of body mass index to job stress and eating behaviour in health care professionals-an observational study
Jorida Fernandes,Veena Vasant Shinde
Obesity Medicine. 2018;
[Pubmed] | [DOI]
11 Parents’ and Teachers’ Views of Food Environments and Policies in Indian Private Secondary Schools
Neha Rathi,Lynn Riddell,Anthony Worsley
International Journal of Environmental Research and Public Health. 2018; 15(7): 1532
[Pubmed] | [DOI]
12 Contribution of Different Anthropometric Measures to BMI towards Assessing Overweight and Obesity of (6-10Year) Children in Kolkata, India
Manoranjan Pal,Premananda Bharati,Susmita Bharati
Journal of Life Sciences. 2017; 9(2): 88
[Pubmed] | [DOI]
13 Detrimental effects of atherogenic and high fat diet on bone and aortic calcification rescued by an isoflavonoid Caviunin ß- d - g lucopyranoside
Dharmendra Choudhary,Sulekha Adhikary,Jyoti Gautam,Preeti Maurya,Naseer Ahmad,Priyanka Kushwaha,Mohd Parvez Khan,Avinash Kumar,Manoj Barthwal,Rakesh Maurya,Ritu Trivedi
Biomedicine & Pharmacotherapy. 2017; 92: 757
[Pubmed] | [DOI]
14 Antilipase activity guided fractionation of Vinca major
Sukhdev Singh,Singh Shamsher Kanwar,Indu Kumari
Journal of King Saud University - Science. 2017;
[Pubmed] | [DOI]
15 Asthma, GERD and Obesity: Triangle of Inflammation
Samriti Gupta,Rakesh Lodha,S. K. Kabra
The Indian Journal of Pediatrics. 2017;
[Pubmed] | [DOI]
16 The Long Road from Obesity to Atherosclerosis via the Liver
Swastik Agrawal
Journal of Clinical and Experimental Hepatology. 2016;
[Pubmed] | [DOI]
17 Food environment and policies in private schools in Kolkata, India: Table 1:
Neha Rathi,Lynn Riddell,Anthony Worsley
Health Promotion International. 2016; : daw053
[Pubmed] | [DOI]
18 Prevalence of overweight and malnutrition among ethnic minority children and adolescents in China, 1991–2010
Sifan Guo,Chunhua Zhao,Qinghua Ma,Hong-peng Sun,Chen-wei Pan
Scientific Reports. 2016; 6: 37491
[Pubmed] | [DOI]



 

Top
 
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
    Abstract
   Material & Methods
   Results
   Discussion
   Conclusions
    References
    Article Figures
    Article Tables

 Article Access Statistics
    Viewed5513    
    Printed20    
    Emailed0    
    PDF Downloaded1156    
    Comments [Add]    
    Cited by others 18    

Recommend this journal