Kar and Behera: Study on prevalence of obesity in urban and rural adolescents in Odisha: Implications for public health strategies


Introduction

Obesity is a serious public health problem, with about 2.8 million people dyeing each year due to overweight or being obese (WHO).1, 2 The consequences can range from depression, low self-esteem, and lack of enthusiasm to impaired memory and cognition. Due to the consumption of energy dense food (i.e unhealthy food habits), sedentary life style, lack of health care services and financial support, the developing countries are facing high risk of obesity and their adverse consequences on public health status including non-communicable diseases. The prevalence of obesity in India varies due to age, gender, geographical environment, socio-economic status etc. Various studies have shown that the prevalence of obesity among women were significantly higher as compared to men.1

Childhood obesity is a substantial public health problem with burden of ill-health worldwide. Increasing rate of overweight and obesity has reached epidemic proportions in developed countries and is rapidly increasing in many middle-income and less-developed countries.3 In 2016, India had 3.7% obese boys, 2.6% obese girls in the age group of 5 to 9 years. There were 1.8% obese boys and 1.1 obese girls in the age bracket of 10 to 19. Overall obesity rates have doubled between National Health Survey 4 and National Health Survey 5. As per National Family Health Survey (NFHS) - 4 (2015-16) Odisha had 32% and 13.2 % obese women in the age group of 15-49 years in urban and rural area respectively .Men in the same age bracket had 32.4% (urban area) and 13.3 % (rural area) were obese. In total 16.5% women and 17.2% men in the same age bracket were obese. From survey it was revealed that 34% of women and 32.4% men (15-49 years) in urban area of Khorda district were obese, whereas it was 17.1% and 8% in rural area of Jajpur district. In total 30.2% of women and 27% of men in the same age bracket of Khorda district were obese against 17.5% of women and 9.4% men in Jajpur district in Odisha. Overweight and obesity are the fifth leading risk of global deaths than underweight, particularly in urban settings. Worldwide obesity has nearly tripled between 1975 and 2016. In 2016 more than 19 billion adults, 18 years and older, were overweight. Of these 650 million were obese. Over 340 million children and adolescents aged 5-19 were overweight or obese. Childhood obesity increases the risk of adult obesity as well as chronic health problems such as type II diabetes, hypertension and cardiovascular disease. In addition, 44% of diabetes burden, 23% of ischemic heart disease burden and 7-41% of certain cancer burdens are attributable to overweight and obesity. Obesity is an abnormal growth of the adipose tissue due to enlargement of fat cell size (hypertrophic obesity) or an increase in fat cell number (hyperplasic obesity) or a combination of both. It is often expressed in terms of body mass index (BMI). Overweight is usually due to obesity but can arise from other causes such as abnormal muscle development or fluid retention. However obese individuals differ not only in the amount of excess fat that they store, but also in the regional distribution of fat within the body.4

For industrialized societies, even in those countries, it has been suggested that such increase in body weight have been caused primarily due to sedentary lifestyles and reduced levels of physical activity, rather than by changes in food intake or by other factors. Diet and lifestyle are ostensibly major contributors to weight gain. Overweight and obesity are strongly associated with certain type of diets, such as those include large amounts of fats, animal-based foods and processed foodstuffs.5, 6, 1 Keeping an eye on the global problem, the present study was undertaken to study whether the prevalence of overweight and obesity among adolescents is restricted by their habitat (urban versus rural) or not.

Materials and Methods

Primary data was collected through a pre-tested and validated questionnaire distributed to 240 adolescents belonging to the age group of 13 to 18 years by applying random sampling technique. 240 samples comprising of 120 boys and 120 girls from both urban and rural areas were taken for the study. The investigation was undertaken in Bhubaneswar city (urban area) of Khorda district and Dharmasala block of Jajpur district (rural area) in the state of Odisha. In Bhubaneswar city 3 areas namely Sisupal garh, Palaspalli and New Forest Park and 3 Gram Panchayats namely Kamagarh, Madhupur Garh and Mahisara of Dharmasala block in Jajpur district were selected. Adolescents of various socio-economic backgrounds were selected to make a comparative cross-sectional study.

Information on age, height, weight, was collected from adolescent boys and girls. Weighing machine was used to record the weight in kg. of the respondents without footwear. Height was measured in cm. using a metric stadiometer taking care so that the back of the head, shoulder blades, buttocks and heels touches the stadiometer.7, 8 Body Mass Index (BMI) was calculated after measuring height and weight. Thereafter adolescents were categorized as normal, overweight and obese using the formula weight/height2 (kg/ m2) based on the revised consensus guidelines for India.

The adolescents of both area were enquired about their participation in sports, physical activity, food habit and family history of obesity. The collected data was analyzed with the help of statistical tools such as mean, percentage, standard deviation, F- Test etc.

Results and Discussion

Mean values of age, height (cm.) and weight (kg.) of both adolescent boys and girls area wise i.e. urban area & rural area and total area were presented in Table 1. The observation showed that the height and weight were higher in case of boys than girls both in urban and rural area.

Table 1

Demographic information of the respondents

Area

Gender

N

Age (Years)

Height (Cm.)

Weight (Kg.)

Sd. Deviation

Height

Weight

Rural

Boys

60

15.27

162.53

50.61

11.304

14.135

Girls

60

15.33

152.18

43.57

6.365

11.122

Total

120

15.30

157.36

47.09

10.509

13.150

Urban

Boys

60

15.75

168.73

64.20

8.714

15.237

Girls

60

15.32

157.17

51.98

5.597

10.502

Total

120

15.53

162.95

58.09

9.322

14.402

Total

Boys

120

15.51

165.63

57.41

10.521

16.146

Girls

120

15.33

154.68

47.78

6.471

11.570

Total

240

15.42

160.15

52.59

10.301

14.824

The mean height of boys and girls in rural area with ± SD are 162.53+ 11.304 and 152.18+ 6.365 observed between 137-182 cm. and 137-168 cm. respectively. Similarly the mean height of boys and girls in urban area with ± SD are 168.73 ± 8.714 and 157.17 ± 5.597 observed between 154-189 cm. and145-171 cm. respectively. Hence it can be inferred that the mean height of both boys and girls of urban area is greater than that of rural area.

The mean weight of boys and girls in rural area with ± SD are 50.61 ± 14.135 and 43.57 ± 11.122 observed between 26-85 and 29-76 kg. respectively. Similarly the mean weight of boys and girls in urban area with ±SD are 64.2 ±15.237 and 51.98 ± 10.502 observed between 39-120 and 37-83 kg. respectively. From the table it can be concluded that the mean weight of both boys and girls in urban area is greater than that of rural area.

In Table 2, the mean BMI of boys and girls in rural area with ± SD are 18.82 ± 3.78 and 18.65 ± 3.87 observed between 11.57-28.69 and 14.28-31.20 respectively. This shows the mean BMI of both boys and girls of rural area are close enough and may not be treated as different in reference to F-value shown in Table 5 also. In a similar fashion, the mean BMI of boys and girls in urban area with ± SD are 22.45 ± 4.87 and 21.16 ± 4.12 observed between 14.50-37.04 and 14.27-33.33 respectively. This shows the mean BMI of both boys and girls of urban area are close enough and may not be treated as different in reference to F-value shown in Table 5 also. But the mean BMI of rural and urban area are 18.73 and 21.81 are significantly different in reference to F-value (Table 3). Accordingly, the BMI of urban area students are better than that of rural area. For further study, the data has been classified as normal, over weight and obese where BMI is <=24, 25-29 and >=30 respectively based on the revised consensus guidelines for India.

Table 2

Mean BMI of adolescents of rural and urban area

Area

Gender

N

Mean

Std. Dev.

Minimum

Maximum

Rural

Boys

60

18.82

3.78

11.57

28.69

Girls

60

18.65

3.87

14.28

31.20

Total

120

18.73

3.81

11.57

31.20

Urban

Boys

60

22.45

4.87

14.50

37.04

Girls

60

21.16

4.12

14.27

33.33

Total

120

21.81

4.54

14.27

37.04

Total

Boys

120

20.64

4.71

11.57

37.04

Girls

120

19.90

4.18

14.27

33.33

Total

240

20.27

4.46

11.57

37.04

Table 3

Analysis of variance on BMI of adolescents of rural and urban area

Source of Variation

Sum of Squares

Degrees of freedom

Mean Square

F

Area

567.116

1

567.116

32.425*

Gender

32.154

1

32.154

1.838NS

Pooled over Area &Gender

18.821

1

18.831

1.077NS

Error

4127.640

236

17.490

Total

4745.740

239

From Table 3, it is observed that the calculated F-value shown against area (32.425) is significant where as those against gender (1.838) and pooled area & gender (1.077) is not significant at 5% level. Hence, the variation in BMI due to area i.e. between urban & rural is acceptable and in other two cases the variation in BMI due to gender and pooled over area & gender (area - gender interaction) may not be acceptable.

Table 4

Chi-square test between BMI of adolescents and area of residence

Obesity Category

Area

Total

Rural

Urban

Normal

N

111

93

204

%

92.5%

77.5%

85.0%

Overweight

N

8

21

29

%

6.7%

17.5%

12.1%

Obese

N

1

6

7

%

0.8%

5.0%

2.9%

Total

N

120

120

240

Table 4 shows the cross tabulation of obesity category (normal, over weight and obese) with area of residence (rural, urban). The calculated Chi-square value 10.299 found to be not significant at 5% level shows the association between obesity category and residence is acceptable. Although more students are found to be normal in both rural (92.5%) and urban (77.5%) area, overweight (17.5%) and obese (5.0%) students are more from urban area in comparisons to rural area. Hence, the students of urban area are found to be more obese than those of rural area.

Table 5

Prevalence of overweight and obese and its relationships with participation in sports, physical exercise, food habit and family history

Characteristics

Rural

Urban

Normal 111

Overweight 08

Obese 01

Normal 93

Overweight 21

Obese 06

Participation in sports

Yes

59 (53.15)

04 (50.00)

0 (0.00)

55 (59.14)

09 (42.86)

02 (33.34)

No

52 (46.85)

04 (50.00)

01(100.00)

38 (40.86)

12 (57.14)

04 (66.66)

Physical exercise

Yes

58 (52.25)

03 (37.50)

0 (0.00)

35 (37.63)

08 (38.10)

01 (16.67)

No

53 (47.75)

05 (62.50)

01(100.00)

58 (62.37)

13 (61.90)

05 (83.33)

Food habit

Vegetarian

04 (3.60)

04 (50.00)

01(100.00)

05 (5.37)

02 (9.52)

01 (16.67)

Non.Veg (Mixed diet)

107(96.40)

04 (50.00)

0 (0.00)

88 (94.63)

19 (90.48)

05 (83.33)

Family history of diabetes

Yes

29 (26.13)

03(37.50)

01(100.00)

21 (22.58)

07 (33.34)

03 (50.00)

No

82 (73.87)

05 (62.50)

0 (0.00)

72(77.42)

14 (66.66)

03 (50.00)

Figures in parentheses indicate percentage.

The overall prevalence of overweight and obese and its relationship with participation in sports, physical exercise, food habit and family history of obesity are presented in Table 5. It is also found that overweight and obese of rural and urban adolescents participation in sports, do physical exercise less often than normal weight participants. The result revealed that physical activities did influence changes in BMI. The result with regards to vegetarian or non-vegetarian (mixed diet) food habit did not have any significant effect on prevalence of normal, overweight and obesity among adolescents. The result also revealed that BMI has a strong independent association with family history of obesity both in rural and urban adolescents. Adolescents having family history of obesity were more likely to gain weight easily and to become overweight and obese.

Research Findings

It is observed that the average height and weight, physical growth of adolescents of urban area is greater than that of rural area irrespective of their gender. The BMI of urban adolescents are more than their counterparts in rural area, but the mean BMI of rural and urban adolescents are significantly different. Hence it can be inferred that as area changes from rural to urban, the BMI varies significantly. On the other hand BMI do not show any variation due to gender, area and gender considered together.

When the rural and urban adolescents were distributed on the basis of obesity category, it is revealed that there is association between obesity category and area of residence. But it is satisfactory to note most of the adolescents irrespective of their area of residence, in spite of their long hours of sedentary behavior are falling under normal category, indicating their health consciousness attitude at the same time. More overweight and obese are from urban area in comparison to rural area. The result showed that overweight and obese of rural and urban adolescents participation in sports, do physical exercise less often than normal weight participants. The result showed physical activities did influence changes in BMI. Food habit did not have any significant effect on prevalence of normal, overweight and obese adolesents.BMI has a strong independent association with family history of obesity in both rural and urban adolescents. This indicates that adolescents having family history of obesity are more prone to become obese or overweight. Awareness programs at all level for the consequences of obesity and its prevention need to be initiated. This will also help to prevent diabetes burden, burden of heart disease and certain cancer burdens to a considerable extent. As a result the economic growth of the nation having healthy citizens will also be accelerated for healthy public policies in the state under study and also in India.9, 10, 11, 12, 13, 14

Conclusion

Of the reproductive age, one in two women is anemic, one in three children under five years of age is stunted, and one in five children under five years is wasted in India. Inequalities are evident for stunting with its prevalence being 10.1% higher in rural vs urban areas. Rates of overweight or obesity is 20.7% in adult women and 18.9% in adult men in India. With coexistence of undernutrition and overweight or obesity, India faces the double burden of malnutrition (WHO).6

Optimizing the collection, quality, availability and accessibility of population-level nutrition and overweight data and integrating into health information systems would be a major improvement and an invaluable asset for public health responses. It is important to invest in the comprehensive integration of nutrition strategies especially the coexistence of undernutrition and overweight or obesity, comprehensive health and nutrition information systems are a complex, but essentially feasible and will have multiple benefits for public health concerning overweight and obesity.

Nutrition care, preventive and curative strategies, targeting undernutrition and overweight must be fully integrated into national health responses, supported by a strengthened multisectoral approach. Essential nutrition services should be part of the standard package of universally available healthcare services. Front-line workers involved in public health nutrition service delivery should have the required pre - and in-service training, means and motivation to perform their assigned roles. Nutrition products, such as ready-to-use therapeutic foods, should be readily available and affordable concerning targeting undernutrition and overweight. Innovative technological solutions, such as remote counselling and web applications, can enhance access to quality nutrition care, particularly for those in the areas of harder to reach. Public health nutrition services should be regularly monitored and evaluated to address inequities in delivery, coverage and access. The collection, analysis and dissemination of high-quality disaggregated nutrition data should be mainstreamed in public health information systems, to underpin the design and implementation of equitable nutrition interventions for optimizing public health outcomes for those populations in greater need. This public health problem of obesity can be preventable by spreading public awareness about obesity and its health consequences. Governmental agencies should promote the benefits of public health nutrition interventions, healthy life style, food habits and physical activity for addressing overweight and obesity.

Source of Funding

None.

Conflict of Interest

The authors declare that there is no conflict of interest.

References

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Y Lee D Mozaffarian S Sy Y Huang J Liu PE Wilde Cost-effectiveness of financial incentives for improving diet and health through Medicare and Medicaid: a microsimulation studyPLoS Med2013163e100276110.1371/journal.pmed.1002761

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U Kapil Prevalence of obesity among affluent adolescentsIndian Paediatr200239544952

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A Lata Prevalence or Obesity and Overweight among high school childrenJ Appl Med Sci20145263842

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T Nawab Influence or behavioral determinants on the prevalence of over -weight and obesity among school going adolescentsIndian J Public Health2014581214

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HS Ramya Body mass index, waist hip ratio and body fat percentage as early predictors of obesity in adolescentsCurr Pediatr Res20172132734

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M Taneja Identification of family risk factors of obesity in urban adolescentsJ Obes Metab Res201522848



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Received : 25-03-2021

Accepted : 23-06-2021

Available online : 27-07-2021


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https://doi.org/10.18231/j.jchm.2021.015


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