Prevalence and risk factors of obesity among higher secondary school students in urban and rural schools of North Kerala

Urmila K. V., Divya Krishnan K., . Sudakaran, Muralikrishnan Nambiar


Background: Childhood overweight and obesity have become an important public health problem. Life style approach is required, and requires political and social commitment in addition to medical management. We investigated the prevalence of obesity and the association with risk factors relating to physical activities, in higher secondary school children of government and private schools.

Methods: In 2015, we surveyed higher secondary students in North Kerala both in government and private sector schools. We measured height, weight and plotted Body mass Index on CDC (Child Developement Centre) charts. Factors affecting obesity like physical and sedentary activities (using Bharathy et al questionnaire) and school-based risk factors were also studied.

Results: Multivariate logistic regression was done to evaluate the significance of these risk factors for overweight and obesity. On the basis of measurements taken in 496 higher secondary school students, the estimated provincial prevalence of overweight was found to be 7%, obesity 3% and malnutrition 18%. Children who studied in private school was found to have increased risk of overweight p=0.02 with odds ratio (OR of 2.97 95% confidence interval CI 1.27-6.97), whereas those who went to school by walking were at decreased risk (OR 2.78, 95% CI 1.16-6.65). Students involved in house hold chores for 4hours or more a week were associated with a decreased risk of overweight (OR 3.96, 95% CI 1.42-11.07) and those with less activity were at increased risk for obesity (OR 6.61, 95% CI 1.91-22.84).

Conclusions: Home and schools provide important opportunities for public health initiatives for reducing childhood overweight and obesity. Children in private schools coming from higher socio-economic background are being less physically active and has thus susceptible to obesity and its consequences.


Body mass index, Obesity, Overweight, Physical activity

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Reilly JJ, Dorosty AR. Epidemic of obesity in UK children. Lancet. 1999;354(9193):1874-5.

Cole TJ, Freeman JV, Preece MA. Body mass index reference curves for the UK, 1990. Arch Dis Child.1995;73(1):25-9.

Dorosty AR, Emmett PM, Cowin SD, Reilly JJ. Factors associated with early adiposity rebound. ALSPAC Study Team. Pediatr. 2000;105(5):1115-8.

Luepker RV, Perry CL, McKinlay SM, Nader PR, Parcel GS, Stone EJ, et al. Outcomes of a field trial to improve children's dietary patterns and physical activity. The Child and Adolescent Trial for Cardiovascular Health. CATCH collaborative group. JAMA. 1996;275(10):768-76.

Must A, Strauss RS. Risks and consequences of childhood and adolescent obesity. Int J Obes Relat Metab Disord. 1999;23(Suppl 2):S2-11.

Sahota P, Rudolf MC, Dixey R, Hill AJ, Barth JH, Cade J. Evaluation of implementation and effect of primary school based intervention to reduce risk factors for obesity. BMJ. 2001;323(7320):1027-9.

Robinson TN. Reducing children's television viewing to prevent obesity: randomized controlled trial. JAMA. 1999;282(16):1561-7.

Dishman RK, Sallis JF, Orenstein DR. The determinants of physical activity and exercise. Public Health Rep 1985;100(2):158-71.

Ford ES, Mokdad AH. Epidemiology of obesity in the Western Hemisphere. J Clin Endocrinol Metab. 2008;93(11 Suppl 1):S1-8.

Sharma R. Kuppuswamy's socioeconomic status scale - revision for 2011 and formula for real-time updating. Indian J Pediatr. 2012;79(7):961-2.

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(3):242-9.

Agarwal KN, Saxena A, Bansal AK, Agarwal DK. Physical growth assessment in adolescence. Indian Pediatr. 2001;38(11):1217-35.

Bharathi AV, Sandhya N, Vaz M. The development and characteristics of a physical activity questionnaire for epidemiological studies in urban middle class Indians. Indian J Med Res. 2000;111:95-102.

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.

Wang Y, Rimm EB, Stampfer MJ, Willett WC, Hu FB. Comparison of abdominal adiposity and overall obesity in predicting risk of type 2 diabetes among men. Am J Clin Nutr. 2005;81(3):555-63.

Musaiger AO. Overweight and obesity in the Eastern Mediterranean Region: can we control it?. East Mediterr Health J 2004;10(6): 789-93.

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(8):775-9.

Chhatwal J, Verma M, Riar SK. Obesity among pre-adolescent and adolescents of a developing country (India). Asia Pac J Clin Nutr. 2004;13(3):231-5.

Ramachandran A, Snehalatha C, Vinitha R, Thayyil M, Kumar CK, Sheeba L et al. Prevalence of overweight in urban Indian adolescent school children. Diabetes Res Clin Pract. 2002;57(3):185-902.

Piryani S, Baral KP, Pradhan B, Poudyal AK, Piryani RM. Overweight and its associated risk factors among urban school adolescents in Nepal: a cross-sectional study BMJ Open. 2016;6(5): e010335.

Giammattei J, Blix G, Marshak HH, Wollitzer AO, Pettitt DJ. Television watching and soft drink consumption: associations with obesity in 11- to 13-year-old schoolchildren. Arch Pediatr Adolesc Med. 2003;157(9):882-6.

Mistry SK, Puthussery S. Risk factors of overweight and obesity in childhood and adolescence in SouthAsian countries: a systematic review of the evidence. Public Health. 2015;129(3):200-9.

Laxmaiah A, Nagalla B, Vijayaraghavan K, Nair M. Factors affecting prevalence of overweight among 12- to 17-year-old urbanadolescents in Hyderabad, India. Obesity (Silver Spring) 2007;15(6):1384-90.

Dehghan M, Danesh NA, Merchant AT. Childhood obesity, prevalence and prevention. Heart Views. 2006;7:74-82.