Indian Pediatrics

, Volume 48, Issue 2, pp 105–110 | Cite as

Measuring obesity among school-aged youth in India: A comparison of three growth references

  • Melissa H. Stigler
  • M. Arora
  • P. Dhavan
  • V. Tripathy
  • R. Shrivastav
  • K. S. Reddy
  • C. L. Perry
Research Paper

Abstract

Objective

To compare three growth references that can be used to assess the weight status of school-aged youth living in India, with a particular focus on identifying overweight and obese youth.

Study Design

Cross-sectional study. Kappa scores were used to measure agreement between growth references. Regression models were used to test for differences in weight status by grade level, gender, and school type, using each growth reference.

Setting

Private (n=4) and Government schools (n=4) in Delhi, India.

Participants

Students (n=1818) in eighth and tenth grade attending the schools.

Main outcome measures

Weight status was derived using age- and gender-specific cut-points provided by: (a) a national growth reference specific to India; (b) an international reference recommended by the International Obesity Task Force (IOTF); and (c) a new international reference recommended by the World Health Organization (WHO).

Results

The IOTF reference consistently classified participants in a lower weight status category, compared with the national reference (κ=0.57) and the WHO reference (κ=0.69). The agreement between the WHO and the national references was higher (κ=0.84).

Conclusions

To date, all published studies of childhood obesity in India have used the IOTF reference, the national reference, or an old WHO reference to measure weight status among school-going youth. The new WHO reference may be a better choice. Compared to the IOTF reference, it does not appear to underestimate obesity and can still be used to compare trends, globally.

Key words

Adolescents Growth reference India Measurement Obesity 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Prentice AM. The emerging epidemic of obesity in developing countries. Intl J Epi. 2006;35:93–99.CrossRefGoogle Scholar
  2. 2.
    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. 2007; 15:1384–1390.PubMedCrossRefGoogle Scholar
  3. 3.
    Aggarwal T, Bhatia RC, Singh D, Sorti PC. Prevalence of obesity and overweight in affluent adolescents from Ludhiana, Punjab. Indian Pediatr. 2008; 45: 500–502.PubMedGoogle Scholar
  4. 4.
    Raj M, Sundaram KR, Paul M, Deepa AS, Kumar RK. Obesity in Indian children: Time trends and relationship with hypertension. Nat Med J India. 2007;20:288–293.Google Scholar
  5. 5.
    UK Prospective Diabetes Study Group. UK Prospective Diabetes Study XII: Differences between Asian, Afro-Caribbean, and white Caucasian type 2 diabetic patients at diagnosis of diabetes. Diab Med. 1994;11:670–677.CrossRefGoogle Scholar
  6. 6.
    Misra A. Revisions of cutoffs of body mass index to define overweight and obesity are needed for the Asian-ethnic groups. Intl J Obesity. 2003;27:1294–1296.CrossRefGoogle Scholar
  7. 7.
    Agarwal KN, Saxena A, Bansal AK, Agarwal DK. Physical growth assessment in adolescence. Indian Pediatr. 2001;38: 1217–1235.PubMedGoogle Scholar
  8. 8.
    Physical status: the use and interpretation of anthropometry. Report of a WHO Expert Committee. World Health Organ Tech Rep Ser. 1995;854:161–262.Google Scholar
  9. 9.
    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.CrossRefGoogle Scholar
  10. 10.
    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;85:660–667.PubMedCrossRefGoogle Scholar
  11. 11.
    WHO Multicentre Growth Reference Study Group. WHO Child Growth Standards based on length/height, weight, and age. Acta Paediatr Suppl. 2006;450:76–85.Google Scholar
  12. 12.
    De Onis M. The use of anthropometry in the prevention of childhood overweight and obesity. Int J Obes Relat Metab Disord. 2004;28:S81–S85.PubMedCrossRefGoogle Scholar
  13. 13.
    Lohman T, Roche A, Martorell R. Anthropometric Standardization Reference Manual. Champaign, IL: Human Kinetics Books; 1988.Google Scholar
  14. 14.
    Cohen J. A coefficient of agreement for nominal scale. Educat Psychol Measure. 1960;20:37–46.CrossRefGoogle Scholar
  15. 15.
    Cohen J. Weighted kappa: nominal scale agreement with provision for scaled disagreement or partial credit. Psychol Bull. 1968;70:213–220.PubMedCrossRefGoogle Scholar
  16. 16.
    Raudenbush SW, Bryk AS. Hierarchical linear models: Applications and data analysis methods (2nd Ed). Thousand Oaks, CA: Sage Publications; 2002.Google Scholar
  17. 17.
    WHO Country Office, India. National Workshop on Adoption of New WHO Child Growth Standards, 8–9 February 2007, India Habitat Center, New Delhi. Available from www.whoindia.org/en/Section6/Section426_1375.htm. Accessed on May 12, 2009.
  18. 18.
    Kiess W, Marcus C, Wabitsch M. Obesity in Childhood and Adolescence. Basel, Switzerland: Karger; 2004.Google Scholar
  19. 19.
    Sharma A, Sharma K, Mathur KP. Growth pattern and prevalence of obesity in affluent schoolchildren in Delhi. Public Health Nutrition. 2007;10:485–491.PubMedGoogle Scholar
  20. 20.
    Agrawal PK. Emerging obesity in northern Indian states: A serious threat for health. Paper presented at the IUSSP Conference in Bangkok, June. 10–2, 2002.Google Scholar

Copyright information

© Indian Academy of Pediatrics 2011

Authors and Affiliations

  • Melissa H. Stigler
    • 1
    • 3
  • M. Arora
    • 2
  • P. Dhavan
    • 1
  • V. Tripathy
    • 2
  • R. Shrivastav
    • 2
  • K. S. Reddy
    • 2
  • C. L. Perry
    • 1
  1. 1.Michael & Susan Dell Center for Advancement of Healthy Living, School of Public HealthUniversity of TexasAustin and HoustonUSA
  2. 2.HRIDAY (Health-Related Information Dissemination Amongst Youth)DelhiIndia
  3. 3.Michael & Susan Dell Center for Healthy Living, Austin Regional Campus, School of Public Health, UT HealthUniversity of Texas Administration Building (UTA)AustinUSA

Personalised recommendations