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Different obesity measures in adolescents in Mumbai

Miranda, et al., 2014; Patil, Shejul, Bhandarkar, et al., 2018). Similarly, general and abdominal fat measures are also
associated with cardiovascular risk factors, independent of body mass index (BMI) (Gishti, Gaillard, Durmus, et al., 2015).
BMI does not distinguish lean mass from fat mass; furthermore, it significantly underestimates adiposity. Prevention of
obesity in early life may be important to reduce the risk of coronary heart disease in later life (Lurbe, Alvarez, Liao, et
al., 1998). Subcutaneous and visceral adipose tissue (VAT) are correlated with metabolic risk factors, while VAT remains
strongly associated with an adverse metabolic risk profile (Pou, Massaro, Hoffmann, et al., 2007).
India with 19.6% adolescent population is one of the youngest nations in the world (Office of the Registrar General
and Census Commissioner, 2011). Obesity status has been evidenced to be influenced by rapid changes in lifestyle and
diet (Goyal, Shah, Saboo, et al., 2014). Obesity and overweight status of any child in India are revealed using the BMI
percentile chart. BMI requires a calculation of anthropometric measures. In busy clinics, it is often difficult to assess
obesity status using BMI percentile charts because for every adolescent referring age-sex specific percentile table and
decide the cutoff points is quite difficult and time-consuming (August, Caprio, Fennoy, et al., 2008). As a result, a
simple calculation of physical growth parameters, representative of general obesity may of immense importance and
interest to the practitioners and researchers. Considering variability in general adiposity, regional as well as global growth
charts are available (World Health Organization, 2009; de Onis, and Lobstein, 2010; Khadilkar and Khadilkar, 2015).
Adiposity depends on an anthropometric indicator, a reference population and cutoff points that best identify individuals
as overweight/obese (Shah and Braverman, 2012). Further, central adiposity indices are related to general adiposity.
Important indicators of central adiposity include waist circumference (WC), waist to height ratio (WHtR), and waist-to-
hip ratio (WHR) (Nyamdorj, Qiao, Lam, et al., 2008).
In sum, because adolescent obesity and adiposity are associated with various cardiometabolic risk factors (Weiss,
Dziura, Burgert, et al., 2004; Jagadesan, Harish, Miranda, et al., 2014; Patil, Shejul, Bhandarkar, et al., 2018; Pillai,
2018) and because the early prevention of childhood obesity could reduce morbidity and mortality in adulthood and
further reduce global socioeconomic burden of cardiovascular disease and Type II diabetes (Zimmet, Alberti, Kaufman,
et al., 2007), studying obesity and adiposity among school-age children has a far-reaching significance. It is important to
validate the available methods of obesity estimation in accessing the adolescent obesity status in busy clinics. With the
use of junk food, sugar additive drinks, and restricted outdoor activities, Indian urban kids are most vulnerable to lifestyle
and obesity-related disease, which makes the high levels of the prevalence of obesity among adolescents (Yadav, Yadav,
Gautam, et al., 2015). By 2025 India with more than 17 million obese children will stand second in the world (Sen, 2013).
Many studies have discussed adolescent obesity in numerous sets of populations and with the basis of growth estimation
using regional, national, and international registry standards, yet studies focusing on the city of Mumbai are rare. As one
of the most populous cities in the world (United Nations, 2018), Mumbai not only comprises the representative population
of India but also has its unique value for studying obesity of adolescents. This study aims to check the relationship
between BMI and central adiposity among the adolescent population. Specifically, we aim to estimate the general obesity
for school-age children in Mumbai using Indian Academy of Pediatrics (IAP), International Obesity Task Force (IOTF),
and the World Health Organization (WHO) growth charts and also to evaluate the central adiposity.

2. Data and Methods
The study is based on a cross-sectional survey conducted at five schools in Mumbai from December 2016 to June 2017.
Data were collected by trained medical professionals at Atomic Energy Central Schools (AECS) in Mumbai. One division
from each standard across all the schools was randomly selected. All the healthy adolescents aged 9-15 years were
included, while those who were having a known case of chronic illness and were not able to stand erect at the time of the
survey were excluded from this study.
Selected adolescents were interviewed, and their anthropometry measurements such as height, weight, and waist and
hip circumference were taken. Standard equipment and procedures were followed in measurements. On digital scale
weight were measured after calibration to zero and with the least count of 0.1 kg. Similarly, for height wall-mounted
stadiometer (Ishnee Stature Meter) was used for least count of 0.1 cm. While measuring the height of children, it is
ensured that children were standing upright, barefoot on ground with heels, buttocks, upper back and head making firm
contact with the wall, chin tucked-in slightly and the head held erect. Waist was measured at mid-point of the lower border
of tenth rib and the superior border of the iliac crest. Hip circumference measured below the waist, where maximum
reading was observed.
BMI was calculated as a ratio of weight in kilogram to the square of height in meter. Further, the adolescents in the
study population were classified as overweight and obese according to the IAP (Khadilkar and Khadilkar, 2015), IOTF

36 International Journal of Population Studies | 2018, Volume 4, Issue 2