DOI: 10.17354/ijpphs/2016/11
Original Article
Prevalence of Overweight and Obesity Among College
Going Students at Kancheepuram Town, Tamil Nadu
K S Premlal1, Balaji Arumugam2, Saranya Nagalingam3
Assistant Professor, Department of Community Medicine, Malabar Medical College, Calicut, Kerala India, 2Associate Professor, Department of
Community Medicine, Tagore Medical College and Hospital, Chennai, Tamil Nadu, India, 3Intern, ACS Medical College and Hospital, Chennai,
Tamil Nadu, India
1
ABSTRACT
Background: Obesity is the growing concern in developing countries because of its association with many noncommunicable
diseases. The prevalence of overweight and obesity is escalating in all the age groups in India.
Aims and Objectives: This study was conducted among college going students to assess the prevalence of overweight and
obesity and its associated risk factors.
Materials and Methods: This study was done as a community based cross-sectional study among college going students
near Kancheepuram Town. The study participants were randomly selected from nearby colleges. Data collection were done
using preformed questionnaire and the obesity measures were obtained from all the study participants after getting the informed
consent.
Results: In total, 606 study participants were interviewed and the prevalence of overweight and obesity 11.7% and 21.5%
according to WHO guidelines. The risk factors associated with overweight and obesity was male gender, urban residents, higher
socio-economic status, and family history of obesity, inadequate physical activity, and dietary patterns. The less time spent in
physical activities and more time spent sedentary activities were highly significantly associated with obesity.
Conclusion: The presence study had explored that the most important age group of 18-24 years were overweight and obese
with well-documented significant association with risk factors.
Key words: Lifestyle, Obesity, Overweight, Physical activity, Social class
INTRODUCTION
Prevalence
Obesity may be defined as an abnormal growth of the adipose
tissue due to an enlargement of fat cell size (hypertrophic
obesity) or an increase in fat cell number (hyperplastic obesity)
or a combination of both.1 However, obese individuals differ
not only in the amount of excess fat that they store but also
in the regional distribution of the fat within the body. The
distribution of fat induced by the weight gain affects the risk
associated with obesity and the kind of disease that results.
It is useful, therefore, to be able to distinguish between those
at increased risk as a result of “abdominal fat distribution” or
“android obesity” from those with the less serious “gynoid”
fat distribution, in which fat is more evenly and peripherally
distributed around the body.
Globally, the prevalence of obesity and the risk
factors associated with obesity are escalating. In 2013,
Obesity is perhaps the most prevalent form of malnutrition and
it has been estimated to affect 20 to 40% of the adults and
10-20% of children and adolescents in developed countries.2
The adverse effects of obesity among the population in transition
are hypertension, hyperlipidemia and glucose intolerance, while
coronary heart disease and the long-term complications of
diabetes, such as renal failure begin to emerge several years
(or decades) later.3 The epidemiological determinants of obesity
are increasing age, gender, genetic factors, endocrine factors,
ethnicity, socio-economic status, physical inactivity, eating habits,
psychosocial factors, stress, alcohol, smoking, and drugs.4,5
CORRESPONDING AUTHOR:
Dr. Balaji Arumugam,
Department of Community Medicine, Tagore Medical College and Hospital, Rathinamangalam, Vandalur,
Chennai - 600 048, Tamil Nadu, India.
Phone: 9840234857/9942432840.
E-mail: [email protected]
Submission: 12-2015; Peer Review: 01-2016; Acceptance: 02-2016; Publication: 03-2016
International Journal of Preventive and Public Health Sciences • Mar-Apr 2016 • Vol 1 • Issue 6 15
Premlal, et al.: Prevalence of overweight and obesity
www.ijpphs.com
the American Medical Association classified obesity as a
disease.6,7
d = allowable error = 15% of prevalence is allowed to
calculate the value of “d”
India was always focused for “undernutrition” and poverty
with poor health status. Recently, India is undergoing a greater
transition phase in nutrition. Interventions have to be taken to
understand this phase of transition and reduce its prevalence
because obesity has an ability to cause diseases that reduce
the life expectancy of an individual.
d = 15% 0f 22% = 3.3
Increase in literacy levels which have extended
occupational opportunities that empowered people with a
higher socio-economic status. Higher socio-economic status
with less physical activity and more dietary consumption
or difference in food consumption patterns with a life of
sophistication are the major contributing factors for the
intensification of the obese populace in India. In the developing
world, women, men, and children from high social classes
have greater risks for obesity.8
n = (1.96) ×
Many studies have been conducted in India emphasizing
the increased prevalence of obesity among adolescents and
elderly population. However, there exists a very few number
of studies that accentuates the solemnity of obesity in college
going students. Hence, presence study was conducted with
the aim of exploring the prevalence and risk factors associated
with obesity in college going students.
Aims and Objective
•
•
To estimate the burden of overweight and obesity among
college students aged 18-24 years
To assess the risk factors associated with overweight and
obesity among college going students.
MATERIALS AND METHODS
A cross-sectional study was conducted among college students
aged 18-24 years at three colleges which were randomly
selected among regular colleges around Kanchipuram Town,
Tamil Nadu during 2012-2013.
Exclusion Criteria
•
•
•
Students who are not willing to be included for the study
Students with history of past or present pregnancy
Students who had engaged into strenuous physical activity
during the previous 12 h.
d2 = (3.3)2
d2 = 10.89% rounded of to 11
n = Z a2
PQ
d2
2
22 × 78 6589
=
11
11
Sample size = 599.
Sampling Method
The names of college students who were from the selected
colleges were listed. Exclusion criteria were applied to eliminate
the students whose age was below 18 years and above
25 years. The rest of the students who exactly fit into the study
age group 18-25 years were included in the sample frame who
got equal chances for being selected. Hence, serial numbers
were assigned to the list of students.
A simple random sampling method was adopted to select
the participants for the study, until we get 690 students, taking
into account 15% absentism or nonresponse.
Sampling Unit
Individual college students who have given the completed
data through questionnaire and also appeared for physical
measurements are considered to be study sample unit.
Ethical Clearance
A clearance from the Institutional Ethical Committee was
obtained. Permission to conduct the study was obtained from
the Head of Institute of all three colleges were the study was
planned. Informed written consent was obtained from each
student before the interview.
Data Collection
All individuals who participated in this study received verbal
(in Tamil language) and written explanation (in English language)
of the procedures involved and the benefits expected from the
study. After obtaining informed consent, interview schedule was
administered to the subjects also explained that all the results
would be reported only as group data.
Sample Size Calculation
Study Instruments
Formula
The study used four instruments to obtain the data.
1.Predesigned, pretested, semi-structured interview
schedule
2. Assessment of physical measurements including height
and weight for the calculation of body mass index (BMI),
waist and hip circumference for waist-hip ratio.
4Pq
n= 2
d
Different sample sizes can be calculated based on different
prevalence level of different risk factors. Here, the sample size
was arrived with the prevalence of obesity in Tamil Nadu among
men is 19.8 and among women is 24.4%, according to NFHS-3.
P=
19.8 + 24.4
2
P = 44.2/2
P = 22.1
P value rounded off to 22
P = 22%
q = 78%
16
These instruments are explained in detail below:
Questionnaire
As stated, this study used the predeigned, pretested, and semistructured interview schedule. This questionnaire was designed
to elicit information about participants’ demographic and socioeconomic characteristics, including the following: Age, sex,
family income and total members in the family. Information
on smoking habits, alcohol consumption, family history of
overweight or obesity, knowledge about obesity, diet pattern,
and physical activity.
International Journal of Preventive and Public Health Sciences • Mar-Apr 2016 • Vol 1 • Issue 6
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Physical measurements
Physical measurements of weight, height, waist circumference
were recorded by the following methods:
Weight
A standardized weighing scale was used to measure weight.
Each participant was requested to remove shoes, heavy outer
clothes (such as aprons or jackets), mobile phones, belts from
their waist, etc. They were also asked to empty their pockets
(such as wallets, keys, etc.). The same scale was used for all
participants and weight of each participant was recorded to the
nearest 0.5 kg.
Height
Height was measured by making using a portable
Anthropometry rod. Participants were instructed to stand with
their back against the rod and to look straight ahead, with heels
together standing on a level surface without footwear. A scale
was used as a sliding horizontal bar that rested gently on the
head compressing the hair. The height was measured to the
nearest 0.1 cm.
consuming vegetables daily where are 47 (7.8%) of study
populations not had the habit of eating vegetables, 108 (17.9%)
were consuming fried rice daily, 100 (16.6%) were consuming
bottled drink/juices.
Physical Activity
Among the study population 136 (22.4%) play outdoor games,
46 (7.6%) go for jogging, 10 (1.7%) go for running, and 18 (3%)
involve in gym work out. Out of total study population only 18% of
them spend time adequately for any one type of physical activity.
Prevalence and Distribution of Obesity (Body Mass
Index)
The prevalence of overweight and obesity among the study
population was 11.7% and 21.5% respectively. Surprisingly
20.6% of the study population was underweight (Table 1).
While participants were still in their light clothing, these
measurements were taken. For measuring waist circumference,
the tape used to measure is placed on the layer of light clothing
on horizontally half way between the lowest rib and the top of
the hip bone and measured in centimeters. This is roughly in
the line at the belly bottom. For measuring hip circumference,
the tape is placed over the maximum circumference over the
buttocks. Students were asked to breathe normally while
measuring. The height, weight, waist, and hip circumference
for female students were measured in a separate cabin with the
help of female interns.
1. When gender was compared males showed significant
results with more risk of overweight and obesity than
females (P < 0.0001) (Chi-square = 168.48), (df = 3)
2. In the locality of residence, the students from urban area
were overweight and obese (P < 0.0001) (Chi-square
= 49.94) (df = 3) when compared to the students who
came from rural areas
3. The students who belonged to socio-economic status
Class 1 had higher prevalence of overweight and obesity
(P < 0.0001) (Chi-square = 51.35) (df = 12)
4. The students who had family history of obesity showed
significant association for overweight and obesity
(P < 0.0001) (Chi-square = 53.7) (df = 9)
5. In the diet pattern, there is not significant association
with the overweight and obesity (vegetarian/mixed diet)
(P = 0.339) (Chi-square = 6.8) (df = 6)
6. % body fat is significantly associated with BMI, Chi=217.8,
df=6, P<0.001.
Statistical Analysis
Means
The data analysis was performed using SPSS Version
20 software. The test of significance was done using Chi-square
test with statistical significance level set at P < 0.05.
Sedentary activities were assessed by asking the subjects on
time spent on watching TV, sitting on laptop, speaking over
phone, hearing music, reading books (Table 2).
Waist and hip circumference
RESULTS
In total, 606 college students were interviewed among three
randomly selected colleges of which 52% were females
and 57.6% belonged to rural area. Among the total study
population 319 (52.6%) belong to Class I socioeconomic
status, 165 (27.3%) were from Class II, 72 (12.1%) were from
Class III. Approximately, 10 (1.7%) had a history of smoking
and 16 (2.6%) had history of alcohol intake of the total study
population. Out of 606 subjects, 76 (12.6%) had a family history
of parents obesity of which 22 (3.6%) replied that both parents
were obese, among the parents 36(6%) of mothers were obese
whereas only 18 (3%) father is obese, 17 (3%) of them replied
that their siblings are obese.
While comparing the mean time spent on various
sedentary activities, television watching is the maximum
time-consuming sedentary activity 822 ± 27.5 in min/week.
Average time spent on sedentary activities by the subjects is
3896.9 ± 80.5 min/week. The physical activities involved by
the participants were assessed for walking, running, jogging,
cycling, working out in a gym and other physical activities. The
Table 1: Association of variables and obesity
χ2
df
P
Gender (male)
168.48
3
<0.0001, significant
Residence (urban)
49.94
3
<0.0001, significant
Socioeconomic status (Class I)
51.35
12
<0.0001, significant
Eating Habits
Family history of obesity
53.7
9
<0.0001, significant
As far as the eating habits were concerned, the invariably,
23 (3.8%) of total populations had a habit of consuming
fast food daily and 120 (19.8%) had a habit of taking Fast
food 3-5 times a week irrespective of proximity of fast food
shops. Around 42 (7%) of the study population gave history
of not having or skipping breakfast and 115 (19%) responded
that they eat breakfast rarely. 243 (40.2%) had the habit of
Diet pattern (vegetarian/mixed)
6.8
6
0.339 (NS)
Systolic hypertension
70.8
6
<0.0001, significant
Diastolic hypertension
14.87
3
<0.002, significant
Inadequate physical activity
7.76
3
0.05, significant
Siblings obese
22.5
6
<0.001, significant
% Body fat
217.7
6
<0.001, significant
Variable
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Premlal, et al.: Prevalence of overweight and obesity
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time spent on each activity that they involved was recorded,
and the descriptive statistics are given in Table 3.
18-25 years in Kanchipuram Town. The risk factors like thyroid
disorder, tobacco smoking, alcohol consumption, obesity,
abdominal obesity, hypertension, body fat percentage, physical
inactivity, unhealthy food habits, and family history of obesity
were studied. Among the 606 participants, 201 (33.4%) were
overweight and obese by Indian guidelines, whereas by the WHO
guidelines 130 (21.5%) were overweight and obese. According
to WHO global health observatory data in 2008, 35% of adults
aged 20+ were overweight (BMI >25). The worldwide prevalence
of obesity has nearly doubled between 1980 and 2008. The
prevalence of overweight and obesity were highest in the WHO
regions of Americas and lowest in the WHO region for South
East Asia.9 According to a study on the prevalence of obesity
among college going girls in Agra district of Uttar Pradesh, the
On an average each subject consumed 314.9 ± 14 min/
week for physical activities. Among all physical activities walking
scored highest with 185 ± 9.4 min/week while the outdoor
games scored second with 91.8 ± 8 min/week. According
to WHO guidelines for physical activity, 600 min/week is
recommended. Only 109 (18%) out of 606 subjects met the
recommended minutes.
DISCUSSION
The objective of the study was to estimate the prevalence of
overweight and obesity among college going students aged
Table 2: Times spent in sedentary activities and body mass index classification
BMI status
Time spent (min) on various sedentary activities
Television
Laptop/computer
Video games
Phone
Music
Reading books
Others
Total minutes
Mean
790.29
477.43
624.96
563.25
763.91
610.07
104.36
3934.27
Standard error of mean
40.711
37.932
48.710
40.845
37.576
39.123
18.988
114.214
Mean
933.69
505.38
672.46
643.15
722.36
712.15
185.08
4374.28
Standard error of mean
64.350
51.805
68.071
68.806
69.287
69.134
39.916
184.084
Mean
901.69
332.96
543.38
431.83
463.82
620.28
64.72
3358.68
Standard error of mean
78.834
51.260
84.246
69.979
50.103
96.490
27.601
241.454
Mean
735.84
360.00
559.68
588.72
670.62
533.76
173.76
3622.38
Standard error of mean
53.921
41.792
69.316
69.359
41.427
60.130
42.480
168.475
Mean
822.87
442.28
612.13
570.25
700.60
617.43
131.34
3896.89
Standard error of mean
27.544
23.362
31.939
29.113
25.326
28.800
15.472
80.520
Normal
Obese
Over weight
Under weight
Total
BMI: Body mass index
Table 3: Times spent in physical activities versus body mass index
BMI status
Time spent for physical activities in minutes/week
Outdoor games
Walking
Jogging
Running
Cycling
Mean
112.18
182.04
Standard error of mean
13.056
13.380
Mean
57.23
168.69
Standard error of mean
13.000
17.644
Mean
62.96
213.80
15.85
3.80
Standard error of mean
19.051
30.868
7.647
2.164
Mean
98.40
195.84
8.56
1.44
Standard error of mean
19.131
23.471
4.368
1.014
Mean
91.78
185.74
15.61
1.49
Standard error of mean
8.085
9.428
2.697
0.466
Gym
Total minutes
14.63
1.61
3.835
0.714
20.25
4.82
325.02
5.077
1.973
21.407
24.38
0.00
7.387
0.000
21.69
9.23
274.77
7.267
4.561
27.362
39.30
3.86
338.79
13.915
2.194
35.219
16.32
3.84
321.04
6.888
2.595
33.827
21.98
5.45
314.99
3.551
1.464
14.072
Normal
Obese
Over weight
Under weight
Total
BMI: Body mass index
18
International Journal of Preventive and Public Health Sciences • Mar-Apr 2016 • Vol 1 • Issue 6
www.ijpphs.comPremlal, et al.: Prevalence of overweight and obesity
prevalence of overweight and obesity according to revised Indian
guidelines, surprisingly, 42.5% were classified as overweight
and obese amongst which 23% were obese with remaining
19.5% overweight. By WHO, 2000 guideline, the prevalence
of overweight and obesity was 18.5% and 4.5% respectively.
45.5% of the subjects had a normal weight and 31.5% were
underweight.10 In presence study, the prevalence of overweight
and obesity was higher in males when compared to females.
However, the overall prevalence is higher in females in all states
of India according to 2007 National Family Health Survey.11
Similarly, a study conducted in Gwalior City among higher income
and 30 years and above aged group showed that the males
were having more obesity and overweight than the females. This
shows that again the obesity prevalence differs according to age,
in lesser age groups men are generally overweight and obese
than women and vice versa in higher age groups.12 The higher
prevalence in males in presence study is due to fact that woman’s
BMI increases with successive pregnancies. Similarly, presence
study also confirmed the association between Obesity and male
gender, higher socio-economic status, sedentary activities, family
history of obesity and urban residents. Typically, the presence
study had explored the mean time spent in physical activities per
week and the association with overweight and obesity.
Recommendations
Currently, there is limited available research on the nutrition
and physical activity goals of college students. Colleges and
universities can impact the health behaviors of young adults
through nutrition education and programming at this critical age.
Many colleges and universities have health services and campus
recreation centers which are a prime setting for nutrition education
to occur. However, due to the many factors affecting dietary and
physical activity habits of college students, these programs should
be developed with the goals of college students in mind.
CONCLUSION
This study had shown moderate to high prevalence of
overweight and obesity and lack of physical activity being the
most common risk factors associated with obesity among
highly active age groups (college going students). Awareness
on obesity and overweight and the importance of good lifestyle
changes has to be started to these types of the population
to protecting them from developing the complications due to
overweight and obesity.
REFERENCES
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
Häger A. Adipose tissue cellularity in childhood in relation to the development
of obesity. Br Med Bull 1981;37:287-90.
Available from: http://www.who.int/childgrowth/publications/physical_
status/en/. [Last accessed on 2015 Dec 21].
WHO. (2002), International Agency for Research on Cancer, IARC
Handbooks of Cancer Prevention - Weight Control and Physical Activity.
Lyon: IARC Press; 2002.
Available from: http://www.who.int/nutrition/publications/obesity/WHO_
TRS_894/en/. [Last accessed on 2015 Dec 20].
Charney E, Goodman HC, McBride M, Lyon B, Pratt R. Childhood
antecedents of adult obesity. Do chubby infants become obese adults? N
Engl J Med 1976;295:6-9.
Pollack A. American Medical Association Recognizes Obesity as a Disease.
New York Times. Archived from the Original on June 18, 2013.
Matthew W. (June 21, 2013). The Facts about Obesity. H&HN. American
Hospital
Association.
Available
from:
http://www.hhnmag.com/
articles/6385-the-facts-about-obesity. [Last retrieved on 2013 Jun 24].
Sobal J, Stunkard AJ. Socioeconomic status and obesity: A review of the
literature. Psychol Bull 1989;105:260-75.
Available from: http://www.who.int/gho/ncd/risk_factors/obesity_text/en.
[Last accessed on 2015 Dec 15].
Thakkar HK, Misra SK, Gupta SC, Kaushal SK. A study on prevalence of
obesity among college going girls in Agra district of UP. Indian J Community
Health 2010;21:61-4.
Available from: http://www.rchiips.org/nfhs/nfhs3.shtml. [Last accessed on
2015 Dec 15].
Tiwari R, Srivastava D, Gour N. A Cross-sectional Study to Determine
Prevalence of Obesity in High Income Group Colonies of Gwalior City. Indian
J Community Med 2009;34:218-22.
HOW TO CITE THIS ARTICLE:
Premlal KS, Arumugam B, Nagalingam S. Prevalence of Overweight and
Obesity Among College Going Students at Kancheepuram Town, Tamil
Nadu. Int J Prevent Public Health Sci 2016;1(6):15-19.
International Journal of Preventive and Public Health Sciences • Mar-Apr 2016 • Vol 1 • Issue 6 19