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Paper text:
obesity has been declared a global epidemic by world health organization ( who ) which has not only crossed geographical boundaries but has spread across all ages . rising prevalence of obesity among children and adolescents and
the fact that two - third of childhood obesity persists into adulthood , is increasingly contributing to the escalating pool of this noncommunicable disease . both developed and developing countries have witnessed a steep rise in the prevalence of overweight and obesity among children and adolescents . the prevalence of overweight and obesity has shown increasing trends in india also .
more so , the prevalence reported among children and adolescents of some metro cities in india are comparable to that in some developed countries
westernization of culture , rapid mushrooming of fast food joints , lack of open spaces for physical activity , and increasing sedentary pursuits in the metro cities are some of the reasons implicated for increased overweight and obesity .
are the nutritional changes in small town school children following the same pattern of larger cities ? keeping these research questions in mind , a study was undertaken among the school - going adolescents of aligarh , a small town located in the central india , about 132 km from new delhi , with the following objectives : ( 1 ) to study the prevalence of overweight and obesity among school - going adolescents of aligarh and ( 2 ) to study the sociodemographic and behavioral correlates of the same .
part of this  development  includes opening up of fast food chains , increasing social norm of eating out , more access to internet , video games and television ( tv ) viewing and school children of affluent families having more spending money .
although in large sections of the population the age - old customs of eating home food still persists , multinational companies are luring the young to new eating habits .
a cross - sectional study was conducted from august 2009 to july 2010 , in two affluent ( having tuition fees more than rs .
10,000/annum ) and two nonaffluent schools ( having tuition fees < rs . 10,000/annum ) in aligarh .
taking estimated prevalence of overweight as 3.23% , alpha error of 5% , 2% absolute allowable error and 10% nonresponse rate , sample size calculated was 321 and rounded off to 330 .
thus , 330 adolescents were covered in both types of schools ( affluent and nonaffluent group ) , making the total sample size 660 .
purposive selection of two affluent and two nonaffluent schools was done to allow for practical feasibility .
probability proportionate to size of the population technique was used and systematic random sampling done .
apparently healthy school children of v  x standard , who had completed 10 years of age on the date of interview and were not more than 16 years of age ( as per school records ) were interviewed after taking informed consent from the school authorities and the parents .
children having any chronic illness , severe malnutrition , endocrinal problems , physical , and mental defects , those with apparent obesity - induced or associated with any syndrome and those found to be smokers ( defined as any amount of smoking or tobacco chewing at any time during past 6 months ) and those not cooperating for anthropometric measurements were excluded .
a predesigned and pretested questionnaire was used to collect data for sociodemographic and behavioral factors .
information regarding parent 's education and occupation and family history of obesity were collected from the child 's parents .
deficient , adequate , and excess calorie intakes per day were defined as per the total calorie requirements of adolescents , age and sex wise , as recommended by indian council of medical research .
a pretested food frequency questionnaire was used to assess the frequency of fruit and fast food intake during the past 1 month .
fast foods were defined as the foods sold in a restaurant or store which are rapidly prepared and quickly served in a packaged form for take away and included burgers , pizzas , fries , patties , nuggets , and indian foods such as pakora , samosa , and namkeen .
students were interviewed about duration of watching tv and time spent in other sedentary activities per day during the past 1 month , which were then converted into categorized variables .
total physical activity level ( pal ) of the adolescents and the total sedentary time per day was assessed using global physical activity questionnaire .
anthropometric measurements of weight ( to the nearest 0.1 kg ) and standing height ( to the nearest 0.1 cm ) were taken according to standard methodology . body mass index ( bmi )
was calculated as the ratio of body weight to body height squared expressed as kg / m .
nutritional status was defined using bmi for age and sex percentiles given by who growth reference 2007 .
for the purpose of studying determinants of overweight and obesity , all the students were grouped into ( a ) overweight ( including obese ) and ( b ) nonoverweight / nonobese . the strength of association of determinants of overweight ( including obesity )
variables having significant association were subjected to stepwise multiple logistic regression model to determine the significant independent risk factors of overweight and obesity .
data analysis was done using ibm spss version 20 and p < 0.05 was considered as statistically significant .
the age group of 1013 years included 49.1% of adolescents and 50.9% were in the > 1316 years age group .
the nutritional status of the study population according to bmi has been shown in table 1 .
nutritional status of the study population with respect to sex and type of school the overall prevalence of overweight and obesity among school - going adolescents was found to be 9.8% and 4.8% , respectively [ table 1 ] .
although a higher prevalence of overweight and obesity was found among boys ( 11.3% overweight and 5.5% obesity ) as compared to girls ( 7.9% overweight and 3.9% obesity ) , the difference was not statistically significant . the nutritional status was found to differ significantly (  = 99.593 , df = 3 , p < 0.05 ) between the affluent and nonaffluent group as shown in table 1 . in the nonaffluent schools , the proportion of underweight adolescents was significantly higher than in affluent schools .
furthermore , in the affluent schools , the proportion of overweight ( 14.8% ) and obese ( 8.2% ) adolescents were significantly higher compared to nonaffluent schools .
looking at the two ends of the spectrum , proportion of over - nutrition in affluent schools ( 14.8% overweight and 8.2% obesity ) was much higher than under - nutrition ( 13.6% ) .
the sociodemographic profile of the study population and various behavioral factors were studied according to type of school , by applying chi - square , and found to differ significantly between the affluent and nonaffluent group [ tables 2 and 3 , respectively ] .
ninety percent of the adolescents of nonaffluent group were having a large family size as compared to about three - fourth adolescents in affluent group . significantly higher proportions of adolescents from affluent group had higher paternal and maternal education .
more than 55% of the affluent adolescents had fathers with business as their occupation as compared to 40% in case of adolescents of nonaffluent group .
parental history of obesity was also found to be significantly higher among the adolescents of affluent group .
vegetarian diet , use of ghee and vanaspati , excess total calories intake , eating out at least once a week and fast food intake 5 times or more per week was found to be significantly higher among the adolescents of affluent group than the nonaffluent group .
pal was found to be high among only 15.8% of affluent group as compared to 23% among the nonaffluent group adolescents ( p < 0.05 ) .
significantly higher proportions of affluent adolescents were found to have more total sedentary time per day and tv viewing as compared to nonaffluent adolescents . on multiple logistic regression analysis , belonging to affluent group , mother 's education more than or equal to graduate , parental history of obesity , frequent fast food intake , and tv viewing more than 2 h / day were found to be the independent risk factors for overweight and obesity [ table 4 ] .
sociodemographic profile of the study subjects association between behavioral factors and type of school risk factors for overweight ( including obesity ) using stepwise logistic regression analysis
the prevalence of overweight and obesity among the school - going adolescents of aligarh was found to be almost as high as reported in larger cities of the country .
the double burden of nutritional disease faced by the asian countries is also the result of this transition .
this  double burden  of nutritional disorders is also evident in this study , with the prevalence of overweight ( including obesity ) being 14.7% ( 97 out of 660 ) while about 30% of the adolescents were underweight .
rapid urbanization has created an obesogenic environment by promoting motorized transport , unsafe roads and traffic , eating up open spaces and playgrounds on one hand ; and on another by providing more opportunities for sedentary leisure pursuits and fast food consumption outlets .
this has been reported to be the cause of rising trend of obesity in the larger cities of india , especially the affluent section of society .
interestingly , even smaller but fast developing cities are also witnessing the problem of overweight and obesity , as shown by this study .
the obesogenic environment of large metro cities is being duplicated in these cities , and unless timely action is taken to address these changes , the problem of overweight and obesity may escalate uncontrollably . in this study , it was found that adolescents of affluent schools were 2.4 times more at risk of having overweight and obesity .
this trend of increased overweight and obesity among affluent section has been reported by many other researchers too .
this may be explained by the fact that affluent group goes hand - in - hand with more spending money and more accessibility to fast foods , motorized transport , and sedentary pursuits such as computer and video games .
the affluent group in this study had significantly higher use of ghee , eating out , fast food intake , tv viewing , and time spent in sedentary activities as compared to the nonaffluent group .
a higher maternal education level was found to increase 3.1 times the odds of having overweight and obesity among school - going adolescents .
it is expected that mothers who are educated should be planning better meals for their children but apparently they are not .
this emphasizes the need for enriching and reinforcing individual awareness at family and community level . educating parents of obese children
interestingly , working status of mothers was not found to be a risk factor for overweight .
parental obesity has been implicated as a risk factor for overweight and obesity among children and adolescents by many authors and was found to be an independent risk factor in this study too .
family history of obesity in both the parents increased the odds of overweight and obesity by 6.7 times .
parental obesity may increase the risk of obesity through genetic mechanisms or by shared familial characteristics in the environment such as food preferences .
the study has found fast - food intake to be a significant risk factor of overweight and obesity , and the risk increased with increased frequency of intake .
fast food typically incorporates all of the potentially adverse dietary factors , including saturated and trans fat , high glycemic index , high energy density , and increasingly , large portion size .
another indian study has also reported the prevalence of overweight to be higher among those adolescents who were fond of junk foods .
the authors have found in their study that the children from private schools consumed more of fast food items and carbonated drinks due to easy availability in the school canteen .
fast food intake was found to be higher in affluent adolescents in this study also .
the association between fast food consumption and obesity clearly indicates the need for improvements in family and school food environments .
tv viewing > 2 h daily was found to increase the odds of overweight and obesity among adolescents by 2.8 times .
furthermore , tv advertising could adversely affect dietary patterns at other times throughout the day .
a randomized controlled trial has shown that reducing tv , videotape , and video game use may be a promising , population - based approach to help prevent childhood obesity .
on univariate analysis , low pal was found to increase the risk of overweight and obesity by 2.6 times ( ci 1.25.4 , p < 0.05 ) , but no independent risk was found on multivariate analysis . in spite of proven benefits , levels of physical activity have been decreasing among urban children and adolescents . in this study
, high pal was found to be significantly ( p < 0.5 ) lower among affluent adolescents ( 15.8% ) than among the nonaffluent adolescents ( 23.0% ) .
it can be concluded from this study that overweight and obesity among school - going adolescents is a crisis facing even smaller cities in india , and action to control it must begin now .
given the current trends in pediatric overweight and obesity , it is very crucial that preventive strategies should be implemented through schools and community - based programs involving both education and intervention .
prevention starting in early childhood ( life course approach ) is a critical area of work to prevent obesity .
limitations of the study include a purposive selection of schools and use of 24 h recall for assessment of dietary intake per day .
because most individuals diets vary greatly from day to day , data from a single 24 h recall might fail to characterize an individual 's usual diet .
as the findings of a school - based study like this can not be generalized to the whole population , a larger study conducted in schools as well as the general adolescent population can provide more conclusive results about overweight and obesity and their risk factors .
introduction : there has been an increasing secular trend in the prevalence of overweight and obesity in developing countries . 
 the prevalence reported among children and adolescents of some metro cities in india are comparable to that in some developed countries . 
 westernization of culture , rapid mushrooming of fast food joints , lack of physical activity , and increasing sedentary pursuits in the metro cities are some of the reasons implicated for this . 
 the nutritional changes in small town school children might be following the same pattern of larger cities.aims and objectives : to study the prevalence of overweight and obesity among school - going adolescents of aligarh and to study the sociodemographic and behavioral correlates of the same.materials and methods : a cross - sectional study done in two affluent and two nonaffluent schools in aligarh , taking 330 adolescents from each group ( total-660 ) . 
 study tools included a predesigned and pretested questionnaire , global physical activity questionnaire , and anthropometric measurement . 
 overweight and obesity were defined based on world health organization 2007 growth reference . 
 chi - square test and multiple logistic regression analysis were done.results:prevalence of overweight and obesity was 9.8% and 4.8% among school - going adolescents . 
 the difference in prevalence of overweight and obesity among affluent schools ( 14.8% and 8.2% ) and nonaffluent schools ( 4.8% and 1.5% ) was significant . 
 risk factors for overweight and obesity were affluence , higher maternal education , parental history of obesity , frequent fast food intake , and television ( tv ) viewing more than 2 h / day.conclusion : overweight and obesity among school - going adolescents is a crisis facing even smaller cities in india . 
 behavior change communication should be focused to adolescents , especially of the affluent section , toward restricting fast food intake , and tv viewing .