Association of nutritional status with dietary and behavioural patterns among adolescents

Kandathil Eapen Elizabeth, David Ashok Ashwin, Kesavadev Jothydev


Background: Changing trends in dietary habits, behavioral patterns, and prevalence of overweight/obesity among adolescents is of great concern.

Methods: 6469 school children from five districts of Kerala, India were enrolled. Dietary habits and behavioral patterns were collected using a pretested questionnaire. Anthropometric measurements were recorded and compared with regional Indian Academy Pediatrics (IAP) reference charts. Data was computed and analyzed.  

Results: Mean age: Boys 14.51±0.93, Girls 14.42±1.04 years. Male: Female ratio 0.92:1. Practices like missing breakfast, non-compliance to weekly Iron Folic Acid supplementation and not taking exercise >2 hours/week were more in girls. Increased consumption of junk food, screen time >2 hours/week and not sharing life events with parents were more in boys. Mean anthropometric parameters were <50th percentile of reference charts. 6.1% had low BMI (boys, 4.2% vs. girls,7.6%,), 12.3% were overweight (boys, 14.9% vs. girls,10.2%) and 4.4% had obesity (boys, 4.7% vs. girls, 4.2%). Mean anthropometric parameters were higher in more urbanized districts.  Daily consumption of junk food showed significant association with obesity and exercise >2 hours/week with normal BMI.

Conclusions: Dietary and behavioral patterns and prevalence of overweight/obesity showed variability with respect to gender and region of residence. 12% were overweight and 4% had obesity. Daily consumption of junk food showed significant association with overweight/obesity and daily exercise >2 hours/week with normal BMI. Health education addressing behavioral change is recommended for better health. 


Dietary habits, Behavioral pattern, Adolescent children, Obesity, Junk food

Full Text:



Blüher M. Obesity: global epidemiology and pathogenesis. Nat Rev Endocrinol. 2019; 15:288-98.

Menon NR. The health status of Kerala. Health Millions. 2000;26(2):11-3.

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

Cherian AT, Cherian SS, Subbiah S. Prevalence of obesity and overweight in urban school children in Kerala, India. Indian Pediatr. 2012;49:475-7.

Khadilkar V, Yadav S, Agrawal KK, Tamboli S, Banerjee M, Cherian A, et al. Revised IAP growth charts for height, weight and body mass index for 5 to 18 year old Indian children. Indian Pediatr. 2015; 52:47-55.

WHO Child Growth Standards. Acta Pediatr Supplement. 2006;450:5-101.

Cole TJ, Bellizzi MC, Flegal KM, Dietz WH. Establishing a standard definition for child overweight and obesity worldwide: International survey. BMJ. 2000;320:1-6.

Chudasama RK, Eshwar T, Thakrar D, Eshwar ST. Prevalence and comparison of obesity, overweight, and thinness by different growth standards among affluent schoolchildren (8–18 years) in Rajkot. J Mahatma Gandhi Inst Med Sci. 2017;22:99-104.

Esfahani BN, Dashti GN, Dashti GM, Noorv MI, Koon PB. Dietary Predictors of Overweight and Obesity in Iranian Adolescents, Iran Red Crescent Med J. 2016;18(9):e25569.

National Nutrition Monitoring Bureau, National Institute of Nutrition, ICMR, 2017. Avaliable at: Accessed on 25 June 2020.

Kumar S, Ray S, Roy D, Ganguly K, Dutta S, Mahapatra T, et al. Exercise and eating habits among urban adolescents: a cross-sectional study in Kolkata, India. BMC Public Health. 2017;17(1):468.

Gupta P, Shah D, Praveen K, Sachdev HS. Indian Academy of Pediatrics Guidelines on the Fast and Junk Foods, Sugar Sweetened Beverages, and Energy Drinks, for the Pediatric and Adolescent Nutrition Society (Nutrition chapter) of Indian Academy of Pediatrics. Indian Pediatr. 2019 Oct 15;56(10):849-63.

Kapil U, Gupta A. Can we eliminate anemia from India? Indian J Comm Health. 2018; 30Supp:01-03.

Bhatia V, Sahoo DP, Parida SP. India steps ahead to curb anemia: Anemia Mukt Bharat. Indian J Community Health.2018;30(4):312 -6.

National Family Health Survey-4. Key findings from NFHS-4 fact sheets for key indicators based on final data- Kerala, 2015-16. Available at: Accessed on 25 June 2020.

Johnston CCA, Steele RG, Herrera EA, Phipps S. Parent and Child Reporting of Negative Life Events: Discrepancy and Agreement across Pediatric Samples Journal of Pediatric Psychology. 2003;28(8):579-88.