Skip to main content
Log in

Cross-Regional Analysis of Multiple Factors Associated with Childhood Obesity in India: A National or Local Challenge?

  • Original Article
  • Published:
The Indian Journal of Pediatrics Aims and scope Submit manuscript

Abstract

Objective

To investigate obesogenic co-causing factors, promoting rise of weight in children, associated to local differences in India.

Methods

Overall 1,680 children, aged 3–11 and balanced by gender, were recruited in school contexts distributed in seven major Indian cities. All children were weighted and measured in order to calculate their BMI. A validated cultural specific questionnaire was administered to children’s parents for assessing socio-demographic data, eating habits, physical activity, etc. Furthermore children’s brand awareness scores were computed in order to analyze their affiliation towards food-based advertisement. Descriptive statistics of frequencies, duration and intensity of the various factors were performed. Chi-square tests or Wilcoxon signed rank test were used for evaluating significance of differences in factors distribution across Indian cities.

Results

Four factors, promoting rise of children’s weight, were individuated as associated to urban differences, namely meal times consumed in the family, parents’ BMI, brand awareness and physical activity. These aspects exercised a significant impact on children’s body size in Kolkata and Chennai. Hyderabad and Mumbai, instead, were the cities where religion played some role in influencing children’s weight gain.

Conclusions

Such findings underline the need to frame obesity as a situated phenomenon rather than a national problem. Health policies, implemented in treating and preventing obesity, should be therefore specifically focused on locally situated peculiarities.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. WHO. Obesity and overweight. Media centre. Geneva: World Health Organization; 2014.

    Google Scholar 

  2. Joshi SR, Mohan V, Joshi SS, Mechanick JI, Marchetti A. Transcultural diabetes nutrition therapy algorithm: the Asian Indian application. Curr Diabetes Rep. 2012;12:204–12.

    Article  Google Scholar 

  3. Gupta R, Gupta KD. Coronary heart disease in low socioeconomic status subjects in India: “an evolving epidemic”. Indian Heart J. 2009;61:358–67.

    PubMed  Google Scholar 

  4. Evans CA, Selvadurai H, Baur LA, Waters KA. Effects of obstructive sleep apnea and obesity on exercise function in children. Sleep. 2014;37:1103–10.

    PubMed  Google Scholar 

  5. Deepa M, Anjana RM, Manjula D, Narayan KM, Mohan V. Convergence of prevalence rates of diabetes and cardiometabolic risk factors in middle and low income groups in urban India: 10-year follow-up of the Chennai urban population study. J Diabetes Sci Technol. 2011;5:918–27.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Misra A, Singhal N, Sivakumar B, Bhagat N, Jaiswal A, Khurana L. Nutrition transition in India: secular trends in dietary intake and their relationship to diet-related non-communicable diseases. J Diabetes. 2011;3:278–92.

    Article  PubMed  Google Scholar 

  7. Bauman Z. Consuming life. Cambridge: Polity Press; 2007.

    Google Scholar 

  8. Ranasinghe CD, Ranasinghe P, Jayawardena R, Misra A. Physical activity patterns among South-Asian adults: a systematic review. Int J Behav Nutr Phys Act. 2013;10:116.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Singh RB, Beegom R, Mehta AS, Niaz MA, De AK, Mitra RK, et al. Social class, coronary risk factors and undernutrition, a double burden of diseases, in women during transition, in five Indian cities. Int J Cardiol. 1999;69:139–47.

    Article  PubMed  CAS  Google Scholar 

  10. Chandra PS, Abbas S, Palmer R. Are eating disorders a significant clinical issue in urban India? A survey among psychiatrists in Bangalore. Int J Eat Disord. 2012;45:443–6.

    Article  PubMed  Google Scholar 

  11. McMichael AJ. Globalization, climate change, and human health. New Engl J Med. 2013;368:1335–43.

    Article  PubMed  CAS  Google Scholar 

  12. Ramachandran A, Snehalatha C. Rising burden of obesity in Asia. J Obes. 2010. doi:10.1155/2010/868573.

    PubMed  PubMed Central  Google Scholar 

  13. Ramachandran A, Chamukuttan S, Shetty SA, Arun N, Susairaj P. Obesity in Asia–is it different from rest of the world. Diabetes Metab Res Rev. 2012;28:S47–51.

    Article  Google Scholar 

  14. Chkili W, Nguyen DK. Exchange rate movements and stock market returns in a regime-switching environment: evidence for BRICS countries. Res Int Bus Financ. 2014;31:46–56.

    Article  Google Scholar 

  15. Mantovani G. Exploring borders. Understanding culture and psychology. London: Rootledge; 2000.

    Google Scholar 

  16. Neumark-Sztainer D, Hannan PJ, Story M, Croll J, Perry C. Family meal patterns: associations with sociodemographic characteristics and improved dietary intake among adolescents. J Am Diet Assoc. 2003;103:317–22.

    Article  PubMed  Google Scholar 

  17. Hook JL. Care in context: men’s unpaid work in 20 countries, 1965–2003. Am Sociol Rev. 2006;71:639–60.

    Article  Google Scholar 

  18. Seliske L, Pickett W, Janssen I. Urban sprawl and its relationship with active transportation, physical activity and obesity in Canadian youth. Health reports/Statistics Canada, Canadian Centre for Health Information = Rapports sur la sante/Statistique Canada, Centre canadien d'information sur la sante. 2012;23:17–25.

  19. Pepe A, Armenti A. Knowledge building processes in blended learning communities: forum usage evaluation from a participatory framework for distance cooperation. Edulearn. Barcelona: IATED; 2009. p. 5075–85.

    Google Scholar 

  20. Kautiainen S, Koivusilta L, Lintonen T, Virtanen SM, Rimpela A. Use of information and communication technology and prevalence of overweight and obesity among adolescents. Int J Obes. 2005;29:925–33.

    Article  CAS  Google Scholar 

  21. Ebrahim S, Kinra S, Bowen L, Andersen E, Ben-Shlomo Y, Lyngdoh T, et al. The effect of rural-to-urban migration on obesity and diabetes in India: a cross-sectional study. PLoS Med. 2010;7:e1000268.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Horvath CW. Measuring television addiction. J Broadcast Electron Media. 2004;48:378–98.

    Article  Google Scholar 

  23. Popkin BM, Adair LS, Ng SW. Global nutrition transition and the pandemic of obesity in developing countries. Nutr Rev. 2012;70:3–21.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Rani MA, Sathiyasekaran BW. Behavioural determinants for obesity: a cross-sectional study among urban adolescents in India. J Prev Med Public Health. 2013;46:192–200.

    Article  PubMed  PubMed Central  Google Scholar 

  25. 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.

    Article  PubMed  Google Scholar 

  26. Chadda RK, Deb KS. Indian family systems, collectivistic society and psychotherapy. Indian J Psychiatry. 2013;55:S299–309.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Borradaile KE, Sherman S, Vander Veur SS, McCoy T, Sandoval B, Nachmani J, et al. Snacking in children: the role of urban corner stores. Pediatrics. 2009;124:1293–8.

    Article  PubMed  Google Scholar 

  28. Taber DR, Chriqui JF, Powell LM, Chaloupka FJ. Banning all sugar-sweetened beverages in middle schools: reduction of in-school access and purchasing but not overall consumption. Arch Pediatr Adolesc Med. 2012;166:256–62.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Teevale T, Scragg R, Faeamani G, Utter J. Pacific parents’ rationale for purchased school lunches and implications for obesity prevention. Asia Pac J Clin Nutr. 2012;21:282–90.

    PubMed  Google Scholar 

  30. Gulati S, Misra A, Colles SL, Kondal D, Gupta N, Goel K, et al. Dietary intakes and familial correlates of overweight/obesity: a four-cities study in India. Ann Nutr Metab. 2013;62:279–90.

    Article  PubMed  CAS  Google Scholar 

  31. Wasir JS, Misra A. The metabolic syndrome in Asian Indians: impact of nutritional and socio-economic transition in India. Metab Syndr Relat Disord. 2004;2:14–23.

    Article  PubMed  Google Scholar 

  32. Franchin L, Zobec F, Ghidina M, Stefanini G, Berchialla P, Gregori D. Measuring brand awareness in as a component of eating habits in children: the development of the IBAI (Italian Brand Awareness Instrument). Prog Nutr. 2012. p. 14.

  33. Otten JJ, Hekler EB, Krukowski RA, Buman MP, Saelens BE, Gardner CD, et al. Food marketing to children through toys: response of restaurants to the first U.S. toy ordinance. Am J Prev Med. 2012;42:56–60.

    Article  PubMed  Google Scholar 

  34. Gregori D, Gulati A, Hochdorn A, Ballali S, Paramesh H, Kumar M, et al. Food packaged with toys: an investigation on potential obesogenic effects in Indian children. Indian J Pediatr. 2014. doi:10.1007/s12098-014-1448-x.

    Google Scholar 

  35. APA. Ethical principles of psychologists and code of conduct. Washington DC: American Psychological Association; 2002.

    Google Scholar 

  36. WHO. Growth reference data for 5–19 years. Geneva: World Health Organization; 2007.

    Google Scholar 

  37. WHO. The WHO Multicentre Growth Reference Study (MGRS). Geneva: World Health Organization; 2003.

    Google Scholar 

  38. IAP. IAP growth charts. Patna: Indian Academy of Pediatrics; 2014.

    Google Scholar 

  39. Vecchio MG, Ghidina M, Gulati A, Berchialla P, Paramesh EC, Gregori D. Measuring brand awareness as a component of eating habits in Indian children: the development of the IBAI questionnaire. Indian J Pediatr. 2014. doi:10.1007/s12098-014-1447-y.

    Google Scholar 

  40. Vecchio MG, Berchialla P, Didier N, Cayul O, Valdenegro D, Ghidina M, et al. The IBAI instrument to assess brand awareness toward food in children: the Chile adaptation. Open Obes J. 2013;5:S30–5.

    Article  Google Scholar 

  41. Breiman L. Random forests. Mach Learn. 2001;45:5–32.

    Article  Google Scholar 

  42. Bylander T. Estimating generalization error on two-class datasets using out-of-bag estimates. Mach Learn. 2002;48:287–97.

    Article  Google Scholar 

  43. R Development Core Team. R: a language and environment for statistical computing. Vienna: R Foundation for Statistical Computing; 2012.

    Google Scholar 

  44. Liaw A, Wiener M. Classification and regression by random forest. R News. 2002;2:18–22.

    Google Scholar 

  45. Sachs JD, Bajpai N, Ramiah A. Understanding regional economic growth in India*. Asian Econ Pap. 2002;1:32–62.

    Article  Google Scholar 

  46. Cashin P, Ratna S. Internal migration, center-state grants, and economic growth in the states of India. IMF Staff Pap. 1996;43:123–71.

    Article  CAS  Google Scholar 

  47. Hammons AJ, Fiese BH. Is frequency of shared family meals related to the nutritional health of children and adolescents? Pediatrics. 2011;127:e1565–74.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Gillman MW, Rifas-Shiman SL, Frazier AL, Rockett HR, Camargo Jr CA, Field AE, et al. Family dinner and diet quality among older children and adolescents. Arch Fam Med. 2000;9:235–40.

    Article  PubMed  CAS  Google Scholar 

  49. Videon TM, Manninf CK. Influence of on adolescents eating patterns: the importance of family meal. J Adolesc Health. 2003;32:365–73.

    Article  PubMed  Google Scholar 

  50. Shafaghi K, Shariff ZM, Taib MN, Rahman HA, Mobarhan MG, Jabbari H. Parental body mass index is associated with adolescent overweight and obesity in Mashhad, Iran. Asia Pac J Clin Nutr. 2014;23:225–31.

    PubMed  Google Scholar 

  51. Mandal A, Mandal GC. Prevalence of overweight and obesity among the urban adolescent English medium school girls of Kolkata, India. IJPH. 2012;9:1–6.

    Google Scholar 

  52. Sloutsky VM. From perceptual categories to concepts: what develops? Cogn Sci. 2010;34:1244–86.

    Article  PubMed  PubMed Central  Google Scholar 

  53. Vygotskij LS. Mind and society: the development of higher psychological processes. Cambridge: Haward University Press; 1980.

    Google Scholar 

  54. Borzekowski DL, Robinson TN. The 30-second effect: an experiment revealing the impact of television commercials on food preferences of preschoolers. J Am Diet Assoc. 2001;101:42–6.

    Article  PubMed  CAS  Google Scholar 

  55. Lobstein T, Dibb S. Evidence of a possible link between obesogenic food advertising and child overweight. Obes Rev. 2005;6:203–8.

    Article  PubMed  CAS  Google Scholar 

  56. Boyland EJ, Halford JC. Television advertising and branding. Effects on eating behaviour and food preferences in children. Appetite. 2013;62:236–41.

    Article  PubMed  Google Scholar 

  57. Forman J, Halford JC, Summe H, MacDougall M, Keller KL. Food branding influences ad libitum intake differently in children depending on weight status. Results of a pilot study. Appetite. 2009;53:76–83.

    Article  PubMed  Google Scholar 

  58. Ramachandran A, Mary S, Yamuna A, Murugesan N, Snehalatha C. High prevalence of diabetes and cardiovascular risk factors associated with urbanization in India. Diabetes Care. 2008;31:893–8.

    Article  PubMed  Google Scholar 

  59. Chacko E. From brain drain to brain gain: reverse migration to Bangalore and Hyderabad, India’s globalizing high tech cities. GeoJournal. 2007;68:131–40.

    Article  Google Scholar 

  60. WHO. Global recommendations on physical activity for health: 5–17 years old. Geneva: World Health Organization; 2014.

    Google Scholar 

  61. Reaven PD, Barrett-Connor E, Edelstein S. Relation between leisure-time physical activity and blood pressure in older women. Circulation. 1991;83:559–65.

    Article  PubMed  CAS  Google Scholar 

  62. Hamman RF, Wing RR, Edelstein SL, Lachin JM, Bray GA, Delahanty L, et al. Effect of weight loss with lifestyle intervention on risk of diabetes. Diabetes Care. 2006;29:2102–7.

    Article  PubMed  PubMed Central  Google Scholar 

  63. Willett WC, Koplan JP, Nugent R, Dusenbury C, Puska P, Gaziano TA. Prevention of chronic disease by means of diet and lifestyle changes. In: Jamison DT, Breman JG, Measham AR, Alleyne G, Claeson M, Evans DB, et al., editors. Disease control priorities in developing countries. 2nd ed. Washington (DC): Oxford University Press; 2006. p. 833–50.

    Google Scholar 

  64. Coon KA, Tucker KL. Television and children’s consumption patterns. A review of the literature. Minerva Pediatr. 2002;54:423–36.

    PubMed  CAS  Google Scholar 

  65. Bonne K, Verbeke W. Muslim consumer trust in halal meat status and control in Belgium. Meat Sci. 2008;79:113–23.

    Article  PubMed  Google Scholar 

  66. Gupta R, Guptha S, Sharma KK, Gupta A, Deedwania P. Regional variations in cardiovascular risk factors in India: India heart watch. World J Cardiol. 2012;4:112–20.

    Article  PubMed  PubMed Central  Google Scholar 

  67. Daniel CR, Prabhakaran D, Kapur K, Graubard BI, Devasenapathy N, Ramakrishnan L, et al. A cross-sectional investigation of regional patterns of diet and cardio-metabolic risk in India. Nutr J. 2011;10:12.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Contributions

DG: Designed the study; AH, DG and AG: Wrote the manuscript; DG and RC: Performed the statistical analysis. AG, IB, HP and ECP critically revised the manuscript and contributed to the discussion. All authors contributed to results interpretation, read and approved the final manuscript. DG will act as guarantor for this paper.

Conflict of Interest

None.

Source of Funding

This work is partially supported by an unrestricted grant from the Italian Ministry of Foreign Affairs, Directorate General for Country Promotion, and from Prochild ONLUS (Italy).

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Dario Gregori.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gregori, D., Gulati, A., Paramesh, E.C. et al. Cross-Regional Analysis of Multiple Factors Associated with Childhood Obesity in India: A National or Local Challenge?. Indian J Pediatr 81 (Suppl 1), 5–16 (2014). https://doi.org/10.1007/s12098-014-1550-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12098-014-1550-0

Keywords

Navigation