Int J Adolesc Med Health 2016; aop
Jayprakash I. Macwana, Kedar G. Mehta* and Rajendra K. Baxi
Predictors of overweight and obesity among school going adolescents of Vadodara city in Western India DOI 10.1515/ijamh-2015-0078 Received August 3, 2015; accepted October 17, 2015
Abstract Background: Obesity among adolescents is escalating as a global epidemic which is associated with various lifestyle disorders in later life. Objective: To assess the factors influencing overweight and obesity among school going adolescents of Vadodara city in Western India. Methods: The study was carried out among 1050 school going adolescents from 15 schools selected by systematic random sampling after taking written informed consent from the participants. A predefined pretested semi- structured questionnaire was used to collect dietary information and physical activity. Anthropometric measurements such as height, weight, triceps skin fold thickness, waist and hip circumferences was measured using standard techniques. Adolescents were classified as overweight ( > +1SD) and obese ( > +2SD) with respect to their age and sex by using WHO reference charts. Factors found to be statistically significant in bivariate analysis were considered in the multiple logistic regression model. Results: Among 1050 school going adolescents, 7.8% were overweight and 2.7% were obese, making the combined prevalence of overweight and obesity as 10.5%. Among socio-demographic predictors: early and mid adolescence, male gender, English medium of instruction, positive family history of obesity were found to be the significantly associated with overweight/obesity among the study population. Whereas consumption of outside food, meal skipping habit, infrequent consumption of staple healthy food items were found to be significant diet
*Corresponding author: Kedar G. Mehta, Assistant Professor, Department of Community Medicine (PSM), 1st Floor, College Building, GMERS Medical College, Gotri, Vadodara, Gujarat, India, Phone: +09879036835, E-mail: [email protected] Jayprakash I. Macwana: Department of Community Medicine (PSM), GMERS Medical College, Himmatnagar, Gujarat, India Rajendra K. Baxi: Department of Preventive and Social Medicine (PSM), Baroda Medical College, Vadodara, Gujarat, India
related predictor variables for overweight/obesity. Among the physical activity predictors: sedentary activities, less outdoor games and sleep deprivation were also found to be significant predictors of overweight/obesity. Conclusion: Adolescents should be motivated to take adequate amount of healthy staple food like dal-rice at home and to engage in outdoor sports related activity to prevent overweight and obesity. Keywords: adolescents; obesity; overweight; predictors; Western India. Key Messages: Adolescents should be motivated to take adequate amount of healthy staple food at home, engage in outdoor sports related activity and switching to bicycle or walking for going to school which can help to prevent overweight/obesity.
Introduction The World Health Organization (WHO) describes overweight and obesity as one of today’s most important public health problems, which is escalating as a ‘global epidemic’ (1). It is also increasingly recognized as a significant problem in developing countries and countries undergoing economic transition (2). The problem of overweight and obesity is confined not only to adults but also being reported among the children and adolescents of developed as well as developing countries. As adolescence is a period of transition from childhood to adulthood; it assumes critical position in the life cycle of human beings, characterized by an exceptionally rapid rate of growth (3). Adolescents constitute 18%–25% of the population in countries of South East Asia Region (SEAR). In India, they account for one fifth of the total population (4). In India obesity is emerging as an important health problem particularly in urban areas, paradoxically co-existing with under-nutrition imparting ‘double burden of disease’ (5). Adolescent obesity is increasingly being observed with
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2 Macwana et al.: Predictors of overweight and obesity among adolescents the changing life style of families, with increased purchasing power and increasing hours of inactivity and dietary and cultural transition (6). The consequences which are associated with adolescent obesity include increased incidence of hypertension, obstructive sleep apnea, psychological dysfunction, decreased self esteem, coronary artery diseases, Type two diabetes, metabolic syndrome and overall increase in morbidity and mortality in later life (7). So, an important step to prevent and control adolescent obesity is identification of risk factors contributing to rapid increase of adolescent obesity. Few relevant research in particular field in India has been conducted in various zones of the country but for Gujarat it is minimal (8–10). Therefore, this study was carried out to explore the determinants of overweight and obesity among school going adolescents of Vadodara city in Western India.
Materials and methods Before starting the study, necessary clearances and permissions were obtained from concerned authorities including District Education Office, School authorities and Institutional Ethical Review Committee. An analytical cross sectional study was conducted among urban School going adolescents in the age group of 11–19 years (6th to 12th standard) from August 2012 to December 2013. Studies carried out in the past have revealed that the prevalence of overweight and obesity among urban adolescents was in the range of 10%–15% (11). Assuming a current prevalence (P) of 10% overweight and obesity, with 95% confidence interval, 20% allowable error (L), sample size estimated was 865 children. [Using formula n = (Z1–α/2)2 × PQ/L2; where α = 5%, P = 10%, Q = 90%, L = 2(20% of P)] (12). Estimating the non-response rate of 20%, an additional 173 subjects were included. So, total sample size came to 1038 (865+173) which was rounded to 1050. Sampling was done in two stages. A list of all government and private schools of the entire Vadodara city was obtained from District Education Office (DEO). In the first stage, out of 112 listed schools, 15 schools were selected using probability proportional to size sampling and in the second stage, 10 students from each standard from 6th to 12th class were selected by simple random sampling technique. So 70 students from each school, and hence 1050 students were enrolled from 15 schools as shown in flow chart Figure 1. Students with any chronic systemic disease, physical deformities, or unwilling to participate were excluded from the study. A prior written consent for the study was taken from school authorities and the parents of the participants after explaining the objectives as well as the method of study. According to their age either assent or consent was also obtained from all the participating adolescents. A pre-designed and pre-tested, semi structured, self administered questionnaire was used. Our questionnaire based on the questionnaire used in earlier research study in same set up. The questionnaire was translated to vernacular language by the researchers and then back translated by one research assistant who was not involved in the primary translation process. The questionnaire was reviewed by three independent experts in the field for content validity. Then it was pilot tested in one of the school on 20 students and then finally applied for this study.
First stage: List of all 112 schools including government and private, English medium and gujarati medium of the Vadodara city was obtained from DEO. 15 schools were selected using probability proportional to size sampling (PPS). The sample had representation of all administrative wards of the city.
Second stage: Sampling was done at the school level. 10 students were selected from each standard (6th to 12th class) by the simple random sampling technique. So 70 students were selected from each school.
Thus, 1050 students from 15 schools were finally enrolled. Number of girls and boys enrolled in the study from each class was proportionate to their ratio in the class.
Figure 1: Flow chart of sampling design.
The questionnaire (Gujarati/English as per medium) was explained and then administered to the selected adolescents from each of the selected classes. The students were requested to record their responses in the presence of investigators, who provided necessary clarification to the queries, if any. Dietary information was assessed by food frequency method. It included various food items like chocolate, biscuits, chips, junk food items (pizza, burger), carbonated drinks, salads, fruit, etc. Subject’s preferences for vegetarian or non vegetarian food, home/outside was taken into consideration. It also included their perception about appropriateness of their height and weight. In physical activity questionnaire, the mode of transport used to go to school and physical activities such as participation in sports and games (indoor and outdoor), physical exercises, participation in household activities, time spend in tuition, gym, yoga, watching television, playing computer and video games were included. Anthropometric measurements such as height, weight, triceps skin fold thickness; waist and hip circumferences each of the adolescents was measured by a team of six trained paramedical staff using standard techniques. Height and weight was measured by stadiometer and adult weighing scale, respectively by standard method (13, 14). BMI was be calculated by formula weight in kg divided by square of height in meter (15). Waist circumference (WC) was measured midway between the lateral lower rib margin and the uppermost lateral border of iliac crest during the end-expiratory phase, and hip circumference (HC) was measured at the widest point over the great trochanters (the point of maximal protrusion of the buttocks). Hip circumference was measured over light clothing at the widest point over the buttocks when viewed from the side. Both waist and hip circumferences were measured in the standing position and at the end of gentle expiration using non-elastic plastic measuring tapes. During these measurements, privacy was ensured and the measurement was done by trained female paramedical staff in female adolescents. Adolescents were classified as overweight ( > +1SD) and obese
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Macwana et al.: Predictors of overweight and obesity among adolescents 3 ( > +2SD) the WHO Reference 2007 with respect to their age and sex by using reference charts (16). Privacy was ensured while taking the anthropometric measurements. Adolescents were classified into early (11–13 years), mid (14–16 years) and late (17–19 years) on the basis of their age (17). Socio Economic status is classified by using Modified Prasad Classification which includes per capita income on the basis of family income and total number of family members (18). Mixed vegetarian diet was defined as those who had non vegetarian, eggs as well as vegetarian food articles in the diet. Data was entered in Microsoft Excel Sheet and analyzed using Epi Info 3.5.1 developed by Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia (USA) and SPSS Statistics (Version 20) software developed by IBM Corp. in Armonk, NY. To adjust for the effects of factor which was found statistically significant on bivariate analysis, were simultaneously incorporated into the multiple logistic regression analysis model to examine associations between independent variables and overweight and obesity. Data safety and confidentiality was also given due consideration.
Results The socio-demographic profile of the respondents is presented in Table 1. The majority of adolescent were from early (11–13 years) and mid (14–16 years) adolescent age group and around 10% were from late (17–19 years) adolescent age group. There was almost equal distribution of boys (55%) and girls (45%). Out of 1050 participants one fourth were from English medium and the rest were from Gujarati medium schools. Majority of the participants followed Hindu religion. Almost three fourth (71.9%) participants had total number of family members less than or equal to five and one fourth with six to ten. Around one fifth (20.3%) participants have positive family history of overweight/obesity. The socio-economic status (SES) could be calculated for only one third of the participants as relevant information on family income could not be obtained from some of them. According to socio economic status, class I to IV have almost equal representation of around 20%–25% in each class, followed by only 7% from SES class V. Overall mean height, weight and BMI among adolescents was 41.9 kg, 153.6 cm and 17.5 kg/m2, respectively. Out of 1050 participants 7.8% were overweight and 2.7% were obese. So, the combined prevalence of overweight and obesity was 10.5%. Data collected on socio economic profile, dietary habits and physical activity pattern were analysed for their association with overweight/obesity. Those variables that showed significant association with overweight/ obesity (p 10 32 3 Family history of overweight/obesity Yes 213 20.3 No 837 79.7 Socio economic class (modified Prasad classification) (n = 369)a Class I 78 21.1 Class II 89 24.1 Class III 86 23.3 Class IV 90 24.4 Class V 26 7 Modified Prasad classification (18).
a
group had three times higher risk and those from mid adolescence group had 1.7 times higher risk of having overweight/obesity as compared to the ones in late adolescence. The boys had close to three times higher risk of overweight/obesity as compared to girls. Those having a positive family history had three times higher risk of overweight/obesity. Those students reporting consumption of outside food had almost two times higher risk of having overweight/obesity. Further those students who reported the habit of skipping meals also had almost 2.5 times higher risk of having overweight/obesity. Among the food items consumed the less frequent consumption of the staple food, dal-rice was found to have higher risk of overweight/obesity. As shown in the Table 2, the students having inadequate ( ≤ 7 h/day) sleep had 2.25 times higher risk of overweight/obesity. The students spending more time in sedentary activities like watching TV and playing indoor games were observed to be having higher risk of overweight/obesity. Likewise the risk of overweight/obesity was 3.3 times higher among the adolescents, who were not participated in outdoor games.
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4 Macwana et al.: Predictors of overweight and obesity among adolescents Table 2: Multivariate analysis for the exploratory variables with overweight/obesity (multiple logistic regression model). Predicted independent variable Demographic variables Age group (years)
Gender Medium of instruction Family history of obesity Computer at home Diet related variables Diet type Outside food Breakfast skipping Meal skipping Food items (per week) Pulse Dal rice Cheese/butter/paneer Waffer/fry items Pizza/burger/fast food Activities related variables (per day) Sleep
Categories
11–13 14–16 17–19 Boys Girls Gujarati English Yes No Yes No
Watching TV Playing with computer/video games Indoor games Outdoor game Walking/cycling/running Exercises/gym Model summary by pseudo R2 values
Adjusted odd’s ratio
95% C.I. of OR
Level of significance (p value)
472 453 125 577 473 770 280 213 837 443 607
3.097 1.778 Ib 2.873 Ib Ib 1.718 3.064 Ib 1.005 Ib
1.112–8.625 1.037–3.047 1.658–4.979 1.014–2.911 1.792–5.236 0.498–2.030
0.031a 0.036a
Vegetarian Mixed Yes No Yes No Yes No
703 347 648 402 355 695 196 854
2.813 Ib 1.862 Ib 1.533 Ib 2.466 Ib
1.554–5.093 1.005–3.452 0.906–2.593 1.385–4.392
0.001a
> 3 times ≤ 3 times > 3 times ≤ 3 times Yes No Yes No Yes No
173 877 929 121 529 521 774 276 493 557
Ib 2.244 Ib 3.478 1.559 Ib 1.636 Ib 1.533 Ib
0.878–5.735 1.842–6.565 0.906–2.683 0.843–3.176 0.865–2.718
≤ 7 h 480 > 7 h 570 No 117 ≤ 1 h 525 > 1 h 408 No 585 ≤ 1 h 333 > 1 h 132 No 557 ≤ 1 h 363 > 1 h 130 No 441 ≤ 1 h 296 > 1 h 313 No 187 ≤ 1 h 789 > 1 h 74 Yes 149 No 901 Cox and Snell R2: 0.182
2.259 Ib Ib 4.858 3.375 Ib 1.093 0.437 Ib 3.998 0.604 3.398 3.539 Ib 1.652 3.700 Ib Ib 1.904
1.318–3.871 1.705–13.838 1.960–5.813 0.406–2.944 0.188–1.016 1.368–11.682 0.352–1.036 1.772–6.514 1.841–6.804 0.927–2.944 0.940–14.573 0.987–3.670 Nagelkerke R2: 0.373
n = 1050
Statistically significant (p
Jayprakash I. Macwana, Kedar G. Mehta* and Rajendra K. Baxi
Predictors of overweight and obesity among school going adolescents of Vadodara city in Western India DOI 10.1515/ijamh-2015-0078 Received August 3, 2015; accepted October 17, 2015
Abstract Background: Obesity among adolescents is escalating as a global epidemic which is associated with various lifestyle disorders in later life. Objective: To assess the factors influencing overweight and obesity among school going adolescents of Vadodara city in Western India. Methods: The study was carried out among 1050 school going adolescents from 15 schools selected by systematic random sampling after taking written informed consent from the participants. A predefined pretested semi- structured questionnaire was used to collect dietary information and physical activity. Anthropometric measurements such as height, weight, triceps skin fold thickness, waist and hip circumferences was measured using standard techniques. Adolescents were classified as overweight ( > +1SD) and obese ( > +2SD) with respect to their age and sex by using WHO reference charts. Factors found to be statistically significant in bivariate analysis were considered in the multiple logistic regression model. Results: Among 1050 school going adolescents, 7.8% were overweight and 2.7% were obese, making the combined prevalence of overweight and obesity as 10.5%. Among socio-demographic predictors: early and mid adolescence, male gender, English medium of instruction, positive family history of obesity were found to be the significantly associated with overweight/obesity among the study population. Whereas consumption of outside food, meal skipping habit, infrequent consumption of staple healthy food items were found to be significant diet
*Corresponding author: Kedar G. Mehta, Assistant Professor, Department of Community Medicine (PSM), 1st Floor, College Building, GMERS Medical College, Gotri, Vadodara, Gujarat, India, Phone: +09879036835, E-mail: [email protected] Jayprakash I. Macwana: Department of Community Medicine (PSM), GMERS Medical College, Himmatnagar, Gujarat, India Rajendra K. Baxi: Department of Preventive and Social Medicine (PSM), Baroda Medical College, Vadodara, Gujarat, India
related predictor variables for overweight/obesity. Among the physical activity predictors: sedentary activities, less outdoor games and sleep deprivation were also found to be significant predictors of overweight/obesity. Conclusion: Adolescents should be motivated to take adequate amount of healthy staple food like dal-rice at home and to engage in outdoor sports related activity to prevent overweight and obesity. Keywords: adolescents; obesity; overweight; predictors; Western India. Key Messages: Adolescents should be motivated to take adequate amount of healthy staple food at home, engage in outdoor sports related activity and switching to bicycle or walking for going to school which can help to prevent overweight/obesity.
Introduction The World Health Organization (WHO) describes overweight and obesity as one of today’s most important public health problems, which is escalating as a ‘global epidemic’ (1). It is also increasingly recognized as a significant problem in developing countries and countries undergoing economic transition (2). The problem of overweight and obesity is confined not only to adults but also being reported among the children and adolescents of developed as well as developing countries. As adolescence is a period of transition from childhood to adulthood; it assumes critical position in the life cycle of human beings, characterized by an exceptionally rapid rate of growth (3). Adolescents constitute 18%–25% of the population in countries of South East Asia Region (SEAR). In India, they account for one fifth of the total population (4). In India obesity is emerging as an important health problem particularly in urban areas, paradoxically co-existing with under-nutrition imparting ‘double burden of disease’ (5). Adolescent obesity is increasingly being observed with
Brought to you by | University of Queensland - UQ Library Authenticated Download Date | 1/31/16 8:35 AM
2 Macwana et al.: Predictors of overweight and obesity among adolescents the changing life style of families, with increased purchasing power and increasing hours of inactivity and dietary and cultural transition (6). The consequences which are associated with adolescent obesity include increased incidence of hypertension, obstructive sleep apnea, psychological dysfunction, decreased self esteem, coronary artery diseases, Type two diabetes, metabolic syndrome and overall increase in morbidity and mortality in later life (7). So, an important step to prevent and control adolescent obesity is identification of risk factors contributing to rapid increase of adolescent obesity. Few relevant research in particular field in India has been conducted in various zones of the country but for Gujarat it is minimal (8–10). Therefore, this study was carried out to explore the determinants of overweight and obesity among school going adolescents of Vadodara city in Western India.
Materials and methods Before starting the study, necessary clearances and permissions were obtained from concerned authorities including District Education Office, School authorities and Institutional Ethical Review Committee. An analytical cross sectional study was conducted among urban School going adolescents in the age group of 11–19 years (6th to 12th standard) from August 2012 to December 2013. Studies carried out in the past have revealed that the prevalence of overweight and obesity among urban adolescents was in the range of 10%–15% (11). Assuming a current prevalence (P) of 10% overweight and obesity, with 95% confidence interval, 20% allowable error (L), sample size estimated was 865 children. [Using formula n = (Z1–α/2)2 × PQ/L2; where α = 5%, P = 10%, Q = 90%, L = 2(20% of P)] (12). Estimating the non-response rate of 20%, an additional 173 subjects were included. So, total sample size came to 1038 (865+173) which was rounded to 1050. Sampling was done in two stages. A list of all government and private schools of the entire Vadodara city was obtained from District Education Office (DEO). In the first stage, out of 112 listed schools, 15 schools were selected using probability proportional to size sampling and in the second stage, 10 students from each standard from 6th to 12th class were selected by simple random sampling technique. So 70 students from each school, and hence 1050 students were enrolled from 15 schools as shown in flow chart Figure 1. Students with any chronic systemic disease, physical deformities, or unwilling to participate were excluded from the study. A prior written consent for the study was taken from school authorities and the parents of the participants after explaining the objectives as well as the method of study. According to their age either assent or consent was also obtained from all the participating adolescents. A pre-designed and pre-tested, semi structured, self administered questionnaire was used. Our questionnaire based on the questionnaire used in earlier research study in same set up. The questionnaire was translated to vernacular language by the researchers and then back translated by one research assistant who was not involved in the primary translation process. The questionnaire was reviewed by three independent experts in the field for content validity. Then it was pilot tested in one of the school on 20 students and then finally applied for this study.
First stage: List of all 112 schools including government and private, English medium and gujarati medium of the Vadodara city was obtained from DEO. 15 schools were selected using probability proportional to size sampling (PPS). The sample had representation of all administrative wards of the city.
Second stage: Sampling was done at the school level. 10 students were selected from each standard (6th to 12th class) by the simple random sampling technique. So 70 students were selected from each school.
Thus, 1050 students from 15 schools were finally enrolled. Number of girls and boys enrolled in the study from each class was proportionate to their ratio in the class.
Figure 1: Flow chart of sampling design.
The questionnaire (Gujarati/English as per medium) was explained and then administered to the selected adolescents from each of the selected classes. The students were requested to record their responses in the presence of investigators, who provided necessary clarification to the queries, if any. Dietary information was assessed by food frequency method. It included various food items like chocolate, biscuits, chips, junk food items (pizza, burger), carbonated drinks, salads, fruit, etc. Subject’s preferences for vegetarian or non vegetarian food, home/outside was taken into consideration. It also included their perception about appropriateness of their height and weight. In physical activity questionnaire, the mode of transport used to go to school and physical activities such as participation in sports and games (indoor and outdoor), physical exercises, participation in household activities, time spend in tuition, gym, yoga, watching television, playing computer and video games were included. Anthropometric measurements such as height, weight, triceps skin fold thickness; waist and hip circumferences each of the adolescents was measured by a team of six trained paramedical staff using standard techniques. Height and weight was measured by stadiometer and adult weighing scale, respectively by standard method (13, 14). BMI was be calculated by formula weight in kg divided by square of height in meter (15). Waist circumference (WC) was measured midway between the lateral lower rib margin and the uppermost lateral border of iliac crest during the end-expiratory phase, and hip circumference (HC) was measured at the widest point over the great trochanters (the point of maximal protrusion of the buttocks). Hip circumference was measured over light clothing at the widest point over the buttocks when viewed from the side. Both waist and hip circumferences were measured in the standing position and at the end of gentle expiration using non-elastic plastic measuring tapes. During these measurements, privacy was ensured and the measurement was done by trained female paramedical staff in female adolescents. Adolescents were classified as overweight ( > +1SD) and obese
Brought to you by | University of Queensland - UQ Library Authenticated Download Date | 1/31/16 8:35 AM
Macwana et al.: Predictors of overweight and obesity among adolescents 3 ( > +2SD) the WHO Reference 2007 with respect to their age and sex by using reference charts (16). Privacy was ensured while taking the anthropometric measurements. Adolescents were classified into early (11–13 years), mid (14–16 years) and late (17–19 years) on the basis of their age (17). Socio Economic status is classified by using Modified Prasad Classification which includes per capita income on the basis of family income and total number of family members (18). Mixed vegetarian diet was defined as those who had non vegetarian, eggs as well as vegetarian food articles in the diet. Data was entered in Microsoft Excel Sheet and analyzed using Epi Info 3.5.1 developed by Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia (USA) and SPSS Statistics (Version 20) software developed by IBM Corp. in Armonk, NY. To adjust for the effects of factor which was found statistically significant on bivariate analysis, were simultaneously incorporated into the multiple logistic regression analysis model to examine associations between independent variables and overweight and obesity. Data safety and confidentiality was also given due consideration.
Results The socio-demographic profile of the respondents is presented in Table 1. The majority of adolescent were from early (11–13 years) and mid (14–16 years) adolescent age group and around 10% were from late (17–19 years) adolescent age group. There was almost equal distribution of boys (55%) and girls (45%). Out of 1050 participants one fourth were from English medium and the rest were from Gujarati medium schools. Majority of the participants followed Hindu religion. Almost three fourth (71.9%) participants had total number of family members less than or equal to five and one fourth with six to ten. Around one fifth (20.3%) participants have positive family history of overweight/obesity. The socio-economic status (SES) could be calculated for only one third of the participants as relevant information on family income could not be obtained from some of them. According to socio economic status, class I to IV have almost equal representation of around 20%–25% in each class, followed by only 7% from SES class V. Overall mean height, weight and BMI among adolescents was 41.9 kg, 153.6 cm and 17.5 kg/m2, respectively. Out of 1050 participants 7.8% were overweight and 2.7% were obese. So, the combined prevalence of overweight and obesity was 10.5%. Data collected on socio economic profile, dietary habits and physical activity pattern were analysed for their association with overweight/obesity. Those variables that showed significant association with overweight/ obesity (p 10 32 3 Family history of overweight/obesity Yes 213 20.3 No 837 79.7 Socio economic class (modified Prasad classification) (n = 369)a Class I 78 21.1 Class II 89 24.1 Class III 86 23.3 Class IV 90 24.4 Class V 26 7 Modified Prasad classification (18).
a
group had three times higher risk and those from mid adolescence group had 1.7 times higher risk of having overweight/obesity as compared to the ones in late adolescence. The boys had close to three times higher risk of overweight/obesity as compared to girls. Those having a positive family history had three times higher risk of overweight/obesity. Those students reporting consumption of outside food had almost two times higher risk of having overweight/obesity. Further those students who reported the habit of skipping meals also had almost 2.5 times higher risk of having overweight/obesity. Among the food items consumed the less frequent consumption of the staple food, dal-rice was found to have higher risk of overweight/obesity. As shown in the Table 2, the students having inadequate ( ≤ 7 h/day) sleep had 2.25 times higher risk of overweight/obesity. The students spending more time in sedentary activities like watching TV and playing indoor games were observed to be having higher risk of overweight/obesity. Likewise the risk of overweight/obesity was 3.3 times higher among the adolescents, who were not participated in outdoor games.
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4 Macwana et al.: Predictors of overweight and obesity among adolescents Table 2: Multivariate analysis for the exploratory variables with overweight/obesity (multiple logistic regression model). Predicted independent variable Demographic variables Age group (years)
Gender Medium of instruction Family history of obesity Computer at home Diet related variables Diet type Outside food Breakfast skipping Meal skipping Food items (per week) Pulse Dal rice Cheese/butter/paneer Waffer/fry items Pizza/burger/fast food Activities related variables (per day) Sleep
Categories
11–13 14–16 17–19 Boys Girls Gujarati English Yes No Yes No
Watching TV Playing with computer/video games Indoor games Outdoor game Walking/cycling/running Exercises/gym Model summary by pseudo R2 values
Adjusted odd’s ratio
95% C.I. of OR
Level of significance (p value)
472 453 125 577 473 770 280 213 837 443 607
3.097 1.778 Ib 2.873 Ib Ib 1.718 3.064 Ib 1.005 Ib
1.112–8.625 1.037–3.047 1.658–4.979 1.014–2.911 1.792–5.236 0.498–2.030
0.031a 0.036a
Vegetarian Mixed Yes No Yes No Yes No
703 347 648 402 355 695 196 854
2.813 Ib 1.862 Ib 1.533 Ib 2.466 Ib
1.554–5.093 1.005–3.452 0.906–2.593 1.385–4.392
0.001a
> 3 times ≤ 3 times > 3 times ≤ 3 times Yes No Yes No Yes No
173 877 929 121 529 521 774 276 493 557
Ib 2.244 Ib 3.478 1.559 Ib 1.636 Ib 1.533 Ib
0.878–5.735 1.842–6.565 0.906–2.683 0.843–3.176 0.865–2.718
≤ 7 h 480 > 7 h 570 No 117 ≤ 1 h 525 > 1 h 408 No 585 ≤ 1 h 333 > 1 h 132 No 557 ≤ 1 h 363 > 1 h 130 No 441 ≤ 1 h 296 > 1 h 313 No 187 ≤ 1 h 789 > 1 h 74 Yes 149 No 901 Cox and Snell R2: 0.182
2.259 Ib Ib 4.858 3.375 Ib 1.093 0.437 Ib 3.998 0.604 3.398 3.539 Ib 1.652 3.700 Ib Ib 1.904
1.318–3.871 1.705–13.838 1.960–5.813 0.406–2.944 0.188–1.016 1.368–11.682 0.352–1.036 1.772–6.514 1.841–6.804 0.927–2.944 0.940–14.573 0.987–3.670 Nagelkerke R2: 0.373
n = 1050
Statistically significant (p
