Effects of lifestyle habits on the prevalence of obesity among school going adolescents residing in urban Lucknow.
Childhood obesity in developing countries is emerging as a potential public health issue. The prevalence of obesity varies between 10.0-30.0 percent among urban adolescents. [1-11] Prevalence of obesity within countries differs due to differences in the lifestyle, dietary pattern and involvement in physical activity. In addition to this, industrialization and urbanization are mainly responsible for the rise in the prevalence of childhood obesity.  Sedentary behaviours among children and adolescents eats into the time available for involvement in physical activity, which results in overall less expenditure of energy  and thus, sedentary behaviour is interrelated to chronic health problems. [14-16]
The association between the prevention of obesity in children and their lifestyle habits like exercise, eating pattern and spending leisure time [17-20] have been mentioned in the earlier studies. The prevention of obesity should start from childhood and must be combined with health education strategies and other measures for the encouragement of health promoting habits. It is necessary for the healthy growth of body and mind of adolescents. 
No published literature has been found in this part of the country assessing the prevalence and determinants of obesity among adolescents. The present could be a useful tool in planning and developing appropriate intervention methods. Thus the aim of this study is to assess the factors associated with the prevalence of obesity among school going adolescents.
Materials and Methods
This was a cross sectional study which was carried out amongst school going adolescents of urban Lucknow. Multi stage random sampling technique was used to select the requisite number of school going adolescents.
At first stage, Lucknow was divided into two zones--Cis Gomti and Trans Gomti, at the second stage, each zone was further divided into two parts and from each part one senior secondary school was randomly selected. Thus a total of four schools were randomly selected. At the third stage, from the selected schools, students of classes VI to XII aged 10-19 years were selected through systemic random sampling and if the selected student was not cooperative during the interview, then the subject was considered as non-respondent and the next student was enrolled as replacement in the study.
The weight of the respondents was recorded without heavy clothing, using an electronic weighing scale with an error of [+ or -] 100 g. Height was measured to the nearest of 0.5 cm with subject standing barefooted using portable stadiometer. Calibration of the instrument was done weekly with the known standards. BMI was calculated using standard equation. The cut off value for non-obese was 15th to <85th percentile and for overweight it was >85th percentile of 2007 WHO reference standards. A total of 720 school going adolescents of urban Lucknow were interviewed using predesigned and pretested schedule. Out of these, 40 subjects had BMI <15th percentile (underweight)--so they were not included. Information was collected on frequency of eating fast foods, consumption of aerated drinks, eating food with family, eating breakfast daily, duration and frequency of participation in sports, mode of transport to school and time spent in watching television, playing computer & video games. The statistical analysis was carried out using multiple logistic regression analyses and p<0.05 was taken as the significant level for all the statistical tests.
Majority (71.5%) of the adolescents used to eat food with family and this was significantly (p=0.0001) associated with the low prevalence of overweight. About 44.6% adolescents were found eating fast food once in a month, while 28.4 percent, 21.8 percent, 4.7 percent, 0.6 percent ate fast food once a week, occasionally, never and daily respectively. The percentage of overweight was higher among those who ate fast food daily in comparison to other fast food habits and this was statistically significant (p=0.0001). More than one third (41.2%) adolescents took aerated drinks at least once in a week followed by at least once in a month (28.4%), occasionally (18.8%) and daily (9.7%) and the association of habit of consumption of aerated drink with BMI was found to be statistically significant (p=0.0001). Majority of adolescents (75.3%) took breakfast daily. There was no significant (p>0.05) association between habit of eating breakfast and overweight. (Table-1)
A maximum of (47.8%) of school going adolescents walked to school and 27.6 percent used public/private transports. The prevalence of overweight was lower (15.1%) among those who walked to school than in those using other modes of transport and it was statistically significant (p=0.0001). Daily Participation in active sport was present among 29.3% of the subjects and the prevalence of overweight was significantly (p=0.0001) lower among this group of adolescents. Among those who participated in sports, the duration of sports was one hour among majority of the subjects (76.4%) and there was no significant (p>0.05) association between duration of sports and prevalence of overweight. Duration of Sleep was also not correlated with the prevalence of overweight (Table-2).
The multivariate logistic regression analysis revealed that the prevalence of overweight was significantly lower [OR=0.31(95%CI=0.20-0.47)] among those who were eating food with family, than those who did not. The prevalence of overweight was 1.86 and 3.06 times higher among those who used cycling and public/private transport respectively than who walked and this was statistically significant (p<0.05). The prevalence of overweight was 3.04 and 7.49 times higher who watched TV 2-3 hours and 4 hours respectively than who watched one hour (Table-3).
The findings of the present study showed that 71.5 percent adolescents ate food with family and this factor was significantly (p=0.0001) associated with less prevalence of overweight among school going adolescents. The finding is in accordance with the study done in Japan on school going children, wherein, 80.6 percent school going children ate food with their family, and was associated with the low occurrence of obesity  Eating food with family is a parent related factor which depends on working condition such as part time or full time [19,22] Eating in a lively environment may reduce the risk of obesity and contributes to the development of good lifestyle habits.
The present study showed that there is no significant difference (p>0.05) in the association of consumption of breakfast and overweight--similar result was found in the study done in Baltimore city among elementary school going children, wherein, the role of consumption of breakfast was examined and no significant correlation (p>0.05) was found.  Consumption of breakfast is one of the potential factor that can be considered as a risk factor for obesity. But interestingly, it was not significantly correlated with overweight and it may be because of very little research being available on this factor in relation to obesity.
Another finding which was found statistically significant (p<0.0001) was the daily participation in active sport--it was associated with the lower prevalence of overweight. Similarly, the prevalence of overweight was significantly (p<0.001) lower in children who participated in outdoor games in a study done on adolescents of Hyderabad. M Prevalence of overweight was 3.04 and 7.49 times higher in those who watched TV 2-3 hours and 4 hours respectively, than who watched one hour. The findings of the present study resembles the findings of the study done among adolescent of Hyderabad where the prevalence of overweight was 1.92 times higher in those watching television >3 hours per day  Similarly, the risk of overweight was 7.3 times higher among those adolescents who watched television for >4 hours per day. 
The points of interest drawn from this study are the lifestyle habits of adolescents that included eating food with family, frequency of eating fast food and aerated drink showed the association with increased prevalence of overweight. The prevalence of overweight was found lower among those adolescents who walked to school than using other modes of transport. In the same way, prevalence of obesity was lower in adolescent, who regularly took active participation in sports. The sedentary behaviour, like spending >3 hours per day on watching television, showed association with the increased prevalence of obesity. Thus there is clear relationship of participation in sports, consumption of fast food and viewing television with overweight/obesity. Therefore, there is urgent need to educate parents and teachers regarding healthy lifestyle and healthy eating behaviour.
The authors gratefully acknowledge the invaluable contributions of the Principals of schools where in the study was undertaken, we would also like to thank the Council of Science & Technology, UP, India for financial support for this study.
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Source of Support: Nil
Conflict of interest: None declared
Prerana Singh (1), Nar Singh Verma (1), Shivendra Kumar Singh (2), Sandeep Bhattacharya (1), Abbas Ali Mahdi (3), Saumya Mishra (1), Baby Anjum (1), Manish Kumar Manar (2), Rajesh Khare (4)
(1) Department of Physiology, King George's Medical University, Lucknow, Uttar Pradesh, India
(2) Upgraded Department of Community Medicine and Public Health, King George's Medical University, Lucknow, Uttar Pradesh, India
(3) Department of Biochemistry, King George's Medical University, Lucknow, Uttar Pradesh, India
(4) Medical Practioner, Lucknow, Uttar Pradesh, India
Correspondence to: Nar Singh Verma (email@example.com)
Received Date: 25.06.2014
Accepted Date: 01.08.2014
Table-1: Association of dietary habits with BMI Dietary Habits Overweight & Above Non-obese N % N % Eat food Yes 83 17.1 403 82.9 with Family No 72 37.1 122 62.9 Daily 2 50.0 2 50.0 Once in a week 79 40.9 114 59.1 Fast food Once in a month 54 17.8 249 82.2 Occasionally or rare 18 12.2 130 87.8 Never 2 6.3 30 93.8 Daily 18 27.3 48 72.7 Once in a week 87 31.1 193 68.9 Aerated Once in a month 26 13.5 167 86.5 drinks Occasionally and rare 23 18.0 105 82.0 Never 1 7.7 12 92.3 Everyday 118 23.0 394 77.0 Breakfast 2-3 days/week 22 20.4 86 79.6 Not at all 15 25.0 45 75.0 Dietary Habits Total p-value N % Eat food Yes 486 71.5 0.0001 * with Family No 194 28.5 Daily 4 0.6 Once in a week 193 28.4 Fast food Once in a month 303 44.6 0.0001 * Occasionally or rare 148 21.8 Never 32 4.7 Daily 66 9.7 Once in a week 87 41.2 Aerated Once in a month 26 28.4 0.0001 * drinks Occasionally and rare 23 18.8 Never 13 1.9 Everyday 512 75.3 Breakfast 2-3 days/week 108 15.9 0.76 Not at all 60 8.8 Table-2: Association of physical activity with BMI Overweight Physical Activity & Above Non-obese N % N % By Walk 15.1 276 84.9 Mode of Cycling 58 34.7 109 65.3 transport Public/Private 48 25.5 140 74.4 Transport Daily 44 22.1 155 77.9 Active sports Alternate day 25 27.8 65 72.2 Twice a week 18 23.4 59 76.6 Once a week 37 26.4 103 73.6 None 31 17.8 143 82.2 Duration <7 hours 100 25.9 286 74.1 of sports [greater than 24 20.2 95 79.8 per week or equal to]7 hours Duration of 1 hour 33 11.7 250 88.3 watching 2-3 hours 108 29.1 263 70.9 television 4hours 14 53.8 12 46.2 per day Sleeping 7-8 hours 59 19.7 240 80.3 >8 hours 96 25.2 285 74.8 Physical Activity Total N % p-value By Walk 325 47.8 Mode of Cycling 167 24.6 0.0001 * transport Public/Private 188 27.6 Transport Daily 199 29.3 Active sports Alternate day 90 13.2 Twice a week 77 11.3 0.0001 * Once a week 140 20.6 None 174 25.6 Duration <7 hours 386 76.3 of sports [greater than 120 23.7 0.2 per week or equal to]7 hours Duration of 1 hour 283 41.6 watching 2-3 hours 371 54.6 0.0001 * television 4hours 26 3.8 per day Sleeping 7-8 hours 299 44 >8 hours 381 56 0.09 Table-3: Multivariate logistic regression analysis of determinants of obesity Factors [beta]- Adjusted coefficient OR Eat food Yes -1.16 0.31 No 1.00 (Ref) By Walk 1.00 (Ref) Mode of Cycling 0.62 1.86 transport Public/Private 1.12 3.06 Transport Duration of 1 hour 1.00 (Ref) watching 2-3 hours 1.11 3.04 Television 4 hours 2.01 7.49 Factors 95%CI p- value Eat food Yes 0.20-0.47 0.0001 * No 1.00 (Ref) By Walk 1.00 (Ref) Mode of Cycling 1.14-3.03 0.01 * transport Public/Private 1.87-5.02 0.0001 * Transport Duration of 1 hour 1.00 (Ref) watching 2-3 hours 1.93-4.79 0.0001 * Television 4 hours 2.96-18.94 0.0001 *
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|Title Annotation:||RESEARCH ARTICLE|
|Author:||Singh, Prerana; Verma, Nar Singh; Singh, Shivendra Kumar; Bhattacharya, Sandeep; Mahdi, Abbas Ali; M|
|Publication:||International Journal of Medical Science and Public Health|
|Date:||Oct 1, 2014|
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