Original Article

Childhood obesity: A cross-sectional study among children

aged 6–12 years attending pediatric outpatient department
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of a tertiary care teaching hospital in Kolkata, India

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Kuntala Ray, Mausumi Basu, Ankita Mishra, Vineeta Shukla, Ripan Saha1, Murari M. Mandal2
Department of Community Medicine, Institute of Post-Graduate Medical Education and Research, Kolkata, 1Department of Panchayat and
Rural Development, State Public Health Cell Research, Kolkata, 2Department of Community Medicine, North Bengal Medical College and
Hospital, Siliguri, West Bengal, India

Abstract Background: Children who develop obesity in the early years of their lives tend to remain so in their adolescence
and adulthood and are at a higher risk of developing non-communicable diseases.
Objectives: The present study was conducted to estimate the prevalence of overweight and obesity among
children attending a pediatric outpatient department (OPD) of a tertiary care teaching hospital in Kolkata and
to identify the factors associated with overweight and obesity among them.
Materials and Methods: An observational study, cross-sectional in design, was conducted among children aged
6–12 years attending a pediatric OPD of a tertiary care teaching hospital in Kolkata from October to December
2021. Data were collected from 223 participants using a predesigned, pretested, and structured schedule
by face-to-face interviews with their guardians, spot observation, and anthropometric measurements. We
summarized the data with the help of suitable descriptive statistics. Multivariable binary logistic regression
was performed to find the factors associated with overweight to obese nutritional status. All statistical analyses
were performed using Statistical Package for the Social Sciences software (SPSS) version 25.0.
Results: Out of 223 participants, 48% belonged to the age group of 6–8 years. The proportion of male-to-female
children was nearly equal. About 22% of the study population were overweight to obese. The factors associated
with overweight to obese nutritional status were less duration of outdoor play, frequent intake of processed
meat, and the occasional intake of green leafy vegetables.
Conclusion: A significant proportion of the children attending pediatric OPD were overweight to obese. Children
must be motivated by parents and teachers for adequate physical activity and avoid consuming too much fast food.

Keywords: Childhood, obesity, pediatric

Address for correspondence: Dr. Vineeta Shukla, Department of Community Medicine, Institute of Post-Graduate Medical Education and Research, Kolkata
700020, West Bengal, India.
E-mail: vineeta1992@gmail.com

INTRODUCTION

Received: 31-12-2022 Childhood obesity is a problem that needs to be dealt

Accepted: 13-04-2023 within the 21st century. The burden of this disease can be
Published: 28-06-2023

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How to cite this article: Ray K, Basu M, Mishra A, Shukla V, Saha R,

DOI: Mandal MM. Childhood obesity: A cross-sectional study among children
10.4103/mgmj.mgmj_265_22 aged 6–12 years attending pediatric outpatient department of a tertiary care
teaching hospital in Kolkata, India. MGM J Med Sci 2023;10:203-9.

© 2023 MGM Journal of Medical Sciences | Published by Wolters Kluwer ‑ Medknow 203
 Ray, et al.: Child obesity
seen in many urban areas around the world with low- and
middle-income levels. Obesity has been defined by World
Health Organization (WHO) as “excessive or abnormal
accumulation of fat which poses a risk to the health of
that individual.” At the population level, body mass index
(BMI) can be used to determine overweight and obesity.
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This information is helpful for roughly estimating body
fat percentage.[1]
There has been an alarming rise in the prevalence of
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this health disorder. Every year, more than 2.6 million
people worldwide lose their lives due to obesity or being
overweight.[1] In 2018, 20.3% of children aged 6–12 were
reported to be obese globally. There are 14.4 million obese
children in India, second only to China.[2] The National
Family Health Survey-5 (NFHS-5) data showed that
obesity is rising in most states and union territories. The
problem appeared more concerning in children. Obesity
among under-5 children increased, with 33 states and union
territories reporting an increase in overweight youngsters.
The proportion of overweight children grew from 2.1%
in NFHS-4 to 3.4% in NFHS-5.[3]
Children who become obese early are likelier to remain so
throughout adolescence and adulthood. These children are
more likely to develop non-communicable diseases, such
as diabetes and cardiovascular problems, at a younger age.
Musculoskeletal disorders and certain cancers may also
crop up among obese people.[4] According to a review
article by Akram et al.,[5] body fat percentage and BMI
are significant contributors to hypertension, especially in
children with Type 1 diabetes mellitus. Obesity has several
potential complications depending on the age at which it
is first developed and its duration. We can easily prevent
the onset of these diseases by adopting a healthy lifestyle
at a tender age and maintaining it in adulthood. The need
of the hour is to estimate the burden of the problem and
prioritize strategies for its prevention. This study strives to
estimate the prevalence of overweight and obesity among
children attending the pediatric outpatient department
(OPD) of a tertiary care teaching hospital in Kolkata and
to identify the factors associated with overweight and
obesity among them.
MATERIALS AND METHODS
An observational study, cross-sectional in design, was
conducted on children attending the pediatric OPD of the
Institute of Post-Graduate Medical Education & Research
and Seth Sukhlal Karnani Memorial Hospital (IPGMER
and SSKMH), Kolkata, India, for 12 weeks (October–
November 2021).
204
Study population and selection criteria
Children aged 6–12 years who visited the pediatric OPD
on the days of data collection were included in the study.
Those suffering from illnesses that may cause obesity, such
as diabetes mellitus, hypothyroidism, Cushing’s disease, or
congenital conditions, such as Down’s syndrome and heart
defects, were excluded from the survey. In addition, children
who regularly took corticosteroids for dermatological
conditions, acute leukemia, and the nephrotic syndrome
were also excluded.
Sample size and sampling technique
Taking the proportion (p) of obesity among children
according to WHO standards from a study by Eshwar et al.[6]
in Rajkot, Gujarat, India as 11%, q = 1 – p, and absolute
error d as 5% sample size was calculated using Cochran’s
formula:
Z 1-α 2 pq [(1.96 )2 × 0.11 × 0.89 ]
n= 2
= = 150.4 ≈ 151.
( d )2 [( 0.05 )2 ]
As data collection was spanned over 25 working days, the
initial sample size was 225 after multiplying by the design
effect of 1.5 for the sampling technique. On each day,
225/25 = 9 guardians were interviewed. Each day, nine
children were selected by simple random sampling from
the OPD registration list between 9 am to 10 am. Out of
225, we excluded two forms during analysis as they were
incomplete. Thus, the final sample size was 223.
Study tools and techniques
Initially, a one-to-one interview was conducted with the
guardians using a predesigned, pretested, and structured
schedule developed by the researchers after expert
validation and pretesting on a sample of 20 children who
were excluded from the final sample. Along with the
interview, we took anthropometric and other measurements
[with the help of the global value chain iron analog
weighing scale and WHO’s BMI for age charts] of their
children to estimate the burden of obesity among them.
The weighing scale measured weight after instructing the
child to stand straight on the weighing machine with shoes
off and minimum clothes worn on the body. A stadiometer
measured height. The child was asked to stand on the base
of the stadiometer against the vertical stand with heels, hip,
scapula, and occipital protuberance of the skull touching
the frame. During both measurements, the children were
instructed to look straight forward, keeping the eyes
parallel to the ground. All measurements were recorded
according to standard protocols by the WHO. The BMI
was then calculated applying the formula BMI = weight in
kilograms/(height in meters)2 and plotted on the WHO
BMI for age charts.[7,8]
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 Ray, et al.: Child obesity

Study variables RESULTS

Dependent variable
Overweight-to-Obesity: more than one standard deviation A total of 223 study participants were included in the study.
BMI for age and sex. Thus, there was a non-response of 7.1%. The mean age of
the study population was 8.8 ± 1.79 years, with nearly half
Independent variables of them belonging to the age group 6–8 years (48.0%).
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1. Sociodemographic characteristics: age, residence (urban,
rural), socioeconomic status as per Modified BG Prasad
Scale 2021,[9] mother’s and father’s education (illiterate,
primary, middle school, secondary, higher secondary,
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About 50.7% were boys, and a little more than two-thirds
came from rural areas (67.3%). Concerning religion, about
60.1% were Hindus, and 68.2% belonged to the general
caste. 34.5% belonged to the lower middle socioeconomic

graduate), mother’s occupation (unemployed, employed), class, and 65% were from nuclear families. About 27.8% of
father’s occupation (unskilled, skilled, clerk, semi- the mothers had completed middle school, and only 11.7%
professional, and professional). were employed. Regarding the father’s literacy, nearly 40%
2. Anthropometric measurements: height and weight. had completed middle school, and 30.5% were involved in
3. Lifestyle and dietary habits: duration of television semi-skilled work.
viewing in 24 h, time of outdoor play in 24 h, duration
of indoor space in 24 h, period of playing games More than one-fourth of the guardians reported that their
on computer or mobile in 24 h, taking homemade children spend over 3 h watching television daily (26.0%).
food to school, frequency of meal in 24 h, frequency We reported more than 30 min of outdoor play from 63.2%
consuming processed meat, confectionaries, green of guardians, whereas nearly 30% spent approximately an
leafy vegetables, milk and milk products and fruits in hour daily playing games on a computer or mobile. More
a week. than half of the study participants brought homemade
food to school daily (51.6%), and nearly 87% consumed
a nonvegetarian diet. The frequency of taking meals was
Data analysis
three times in 61.0% of the children [Table 1].
Data were analyzed using Statistical Package for the Social
Sciences (IBM, New YorkNew York) software version Regarding diet, about 35.0% of the study population
25.0. We employed descriptive statistical measures to consumed processed meat, and 51.6% finished hot chips
summarize the data. Bivariate analysis was performed and fries 1–2 times/per week. Consumption of cakes
to ascertain the relationship between the dependent and and other confectionaries 1–2 times/week was reported
the independent variables. All independent variables by nearly 51% of the study population. About 25.6% of
with P < 0.20 in the univariate regression analysis the children occasionally included green leafy vegetables,
were considered biologically plausible to include in the
multivariable logistic regression model. Data were checked Table 1: Distribution of the study population according to
for multicollinearity (variance inflation factor < 10), lifestyle factors (n = 223)
and variables with P < 0.05 were considered statistically Lifestyle factors Number
significant in the final model. (%)
Duration of T.V. viewing in 24 h No 88 (39.5)
Operational definitions[8] <1 h 62 (27.8)
1–3 h 58 (26.0)
1. Underweight: It has been defined as weight beyond –2 >3 h 15 (6.7)
Outdoor playing <30 min 82 (36.8)
standard deviation BMI for age and sex based on WHO ≥30 min 141 (63.2)
growth reference for school-aged children. Indoor playing <30 min 106 (47.5)
2. Average BMI: It has been defined as the weight between ≥30 min 117 (52.5)
Playing games on a computer/mobile No 110 (49.3)
+1 and –2 standard deviation BMI for age and sex based <1 h 66 (29.6)
on WHO growth reference for school-aged- children. 1–3 h 30 (13.5)
≥3 h 17 (7.6)
3. Overweight: It has been defined as more than one standard Bring homemade food to school Yes 115 (51.6)
deviation BMI for age and sex based on WHO growth No 108 (48.4)
reference for school-aged children. Type of diet Vegetarian 30 (13.5)
Non vegetarian 193 (86.5)
4. Obesity: As per the WHO growth reference for school- Frequency of meals in 24 hours 1–2 times 65 (29.1)
aged children, obesity can be defined as more than two Three times 136 (61.0)
≥4 times 22 (9.9)
standard deviations of BMI for age and sex.

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 Ray, et al.: Child obesity

whereas only 36.6% had milk or milk products daily
[Table 2].
Gender-wise BMI distribution of the study population has
been depicted in Figure 1. Out of the total, 48 (21.5%) were
underweight, 126 (56.5%) had normal BMI, 34 (15.2%)
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[AOR 2.51 (1.04–6.09)] and ≥ three times/week [AOR 7.17
(1.06–18.56)] and green leafy vegetables once weekly [AOR
5.85 (1.09–17.28)] had statistically significant higher odds
of overweight to obese nutritional status among the study
population. We found no sociodemographic variables to
have a statistically significant association with the dependent

were overweight, and 15 (6.7%) were obese [Figure 2]. variable in the final model [Tables 3 and 4].

Multivariable binary logistic regression was performed to DISCUSSION

find factors associated with overweight to obese nutritional
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status. Duration of outdoor play < 30 min [AOR 2.67 (1.23– Childhood obesity is a growing public health problem
5.82)], consumption of processed meat 1–2 times/week of international concern. India is currently facing the
triple burden of malnutrition, continuing prevalence of
Table 2: Distribution of the study population according to stunting, wasting, micronutrient deficiency, and an upsurge
food items consumed in a week (n = 223) in childhood obesity.[10]
Food items Number (%)
Processed meat Never 136 (61.0) The proportion of overweight to obese participants in the
1–2 times 78 (35.0) present study was 22%. A household-based study from
≥3 times 9 (4.0)
Hot chips/fries Never 46 (20.6) Babylon, Iraq, by Shalal et al.[11] revealed that the proportion
1–2 times 115 (51.6) of overweight and obese children was 48.29% and 28.29%,
≥3 times 62 (27.8)
Confectionaries Never 44 (19.7)
respectively. According to Cyril et al.[12] in their study in a
1–2 times 113 (50.7) tertiary care center in South Kerala, the highest proportion
≥3 times 66 (29.6) of obesity was found in children aged 7–8.5 years (38.6%)
Soft drinks No 111 (49.8)
<250 mL 81 (36.3) followed by age group 9–10.5 years (21.6%). The findings
≥250 mL 31 (13.9) of a study in Kerala were similar to Chandra et al.[13] study
Green leafy vegetables Daily 88 (39.5) in Telangana, where the highest prevalence of childhood
Twice a week 66 (29.6)
Weekly 12 (5.4) obesity was seen in the 8–10 years age group (31.6% obese
Occasionally 57 (25.6) and 37.3% overweight).
Milk/Milk products Daily 81 (36.3)
Twice a week 50 (22.4)
Weekly 11 (4.9) Most studies on childhood obesity in India have been
Occasionally 81 (36.3) conducted in school-based settings. The prevalence of
Fruits Daily 52 (23.3)
Twice a week 71 (31.8) overweight and obesity was 10.8% and 6.2% among
Weekly 21 (9.4) school-going children in Udupi, Karnataka, which was
Occasionally 79 (35.4)
lower than the current study.[14] Eshwar et al.,[6] in their

Figure 1: Box and whisker plot showing the gender-wise distribution of BMI of the study population (n = 223)

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 Ray, et al.: Child obesity

7%
22%
15%
Underweight
Normal
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Overweight
Obese
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56%

Figure 2: Distribution of the study population according to their nutritional status (n = 223)

Table 3: Multivariable binary logistic regression showing an association between overweight to obese nutritional status and
sociodemographic variables (n = 223)
Sociodemographic variables Overweight to obese (n) COR (95% CI) AOR (95% CI) P value
Age group 6–8 23 Ref Ref
9–10 9 0.59 (0.25–1.36) 0.41 (0.16–1.09) 0.076
11–12 17 1.82 (0.87–3.83) 1.44 (0.60–3.45) 0.412
Residence Rural 29 0.64 (0.33–1.22) 1.25 (0.46–3.41) 0.661
Urban 20 Ref Ref
Socio-economic status Upper (I) 14 3.92 (1.16–13.24) 3.22 (0.76–13.72) 0.114
Upper middle (II) 9 2.10 (0.59–7.41) 1.16 (0.25–5.40) 0.846
Middle (III) 10 0.78 (0.24–2.55) 0.59 (0.15–2.29) 0.451
Lower middle (IV) 11 0.70 (0.22–2.25) 0.62 (0.17–2.23) 0.468
Lower (V) 5 Ref Ref
Mother’s education Illiterate 7 Ref Ref
Primary 7 1.06 (0.34–3.31) 1.04 (0.29–3.70) 0.951
Middle 13 1.44 (0.52–3.96) 1.12 (0.36–3.51) 0.838
Secondary 8 1.74 (0.56–5.39) 1.13 (0.27–4.71) 0.866
≥Higher secondary 14 2.92 (1.04–8.23) 0.77 (0.17–3.35) 0.732
Mother’s occupation Unemployed 40 Ref Ref
Employed 9 2.07 (0.86–5.01) 1.78 (0.61–5.26) 0.293
Father’s education Illiterate 4 Ref Ref
Primary 2 0.61 (0.10–3.67) 0.41 (0.06–2.86) 0.366
Middle 14 1.26 (0.38–4.16) 1.06 (0.29–3.97) 0.928
Secondary 11 2.39 (0.68–8.40) 1.69 (0.41–6.98) 0.469
≥Higher Secondary 18 6.39 (1.86–11.92) 3.25 (0.64–16.59) 0.156
Father’s occupation Unskilled 7 Ref Ref
Semi-skilled 11 1.16 (0.41–3.24) 1.42 (0.42–4.80) 0.570
Skilled 15 2.81 (1.03–7.71) 3.11 (0.84–11.48) 0.088
Clerk 6 1.12 (0.35–3.67) 0.87 (0.21–3.67) 0.855
Semi-professional 8 4.80 (1.41–16.37) 2.19 (0.39–12.08) 0.367
Professional 2 12.0 (0.96–27.68) 7.79 (0.46–21.78) 0.156
COR: crude odds ratio, AOR: adjusted odds ratio

study among school students in Rajkot, Gujrat, reported
the proportion of obesity as 14% by Indian Academy of
Pediatrics standards, 11.1% by WHO standards, and 5.1%
by International Obesity Task Force (IOTF) standards,
which was also lower than this study.
Maiti et al.[15] conducted a study among adolescent girls
(10–14 years) in five Government schools in Kharagpur,
West Bengal. Prevalence of overweight and Obesity among
the participants was 10.62%, 7.64%, and 7.49% as per
WHO, Center for Disease Control, and IOTF, respectively.
The proportion of overweight children in the 6 to 12 age
group was 4.41%, and obesity was 2.12% in Puducherry,
according to Mahajan et al.[16] These findings were also lower
than the present study.
The proportion of male and female participants in the
current study was nearly equal. Overweight-to-obese
nutritional status was observed more among female
children (51%). However, this was not statistically
significant. This corroborated with the Chandra et al.
study,[13] where the prevalence of Obesity was more in girls

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 Ray, et al.: Child obesity

Table 4: Multivariable binary logistic regression showing an association between overweight to obese nutritional status and
lifestyle and dietary variables (n = 223)
Lifestyle and dietary variables Overweight to obese (n) COR (95% CI) AOR (95% CI) P value
Duration of T.V. viewing in 24 h No 13 Ref Ref
<1 h 12 1.38 (0.58–3.28) 1.41 (0.49–4.03) 0.523
1–3 h 20 3.03 (1.36–6.75) 1.86 (0.57–6.10) 0.304
>3 h 4 2.09 (0.58–7.59) 1.07 (0.18–6.33) 0.940
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Duration of outdoor play in 24 h <30 min 24 1.92 (1.01–3.65) 2.67 (1.23–5.82) 0.013
≥30 min 25 Ref Ref
Playing games on computer/mobile in 24 h No 17 Ref Ref
<1 h 14 1.47 (0.67–3.22) 0.94 (0.35–2.50) 0.901
1–3 h 13 4.18 (1.72–10.16) 2.41 (0.74–7.88) 0.144
≥3 h
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5 2.28 (0.71–7.30) 1.55 (0.33–7.39) 0.580

Bring homemade food to school Yes 30 Ref Ref
No 19 0.61 (0.32–1.15) 1.77 (0.50–2.75) 0.760
Frequency of meals in 24 h 1–2 times 10 0.39 (0.13–1.19) 0.65 (0.15–2.82) 0.562
Three times 32 0.66 (0.25–1.75) 0.71 (0.19–2.57) 0.604
≥4 times 7 Ref Ref
Processed meat Never 20 Ref Ref
1–2 times 25 2.74 (1.39–5.36) 2.51 (1.04–6.09) 0.041
≥3 times 4 4.64 (1.15–18.77) 7.17 (1.06–18.56) 0.044
Hot chips/fries Never 6 Ref Ref
1–2 times 29 2.25 (0.86–5.84) 1.75 (0.50–6.12) 0.381
≥3 times 14 1.94 (0.68–5.52) 0.99 (0.24–4.19) 0.993
Green leafy vegetables Daily 23 1.88 (0.80–4.44) 1.65 (0.59–4.63) 0.341
Twice a week 11 1.06 (0.41–2.79) 0.42 (0.13–1.39) 0.156
Weekly 6 5.33 (1.40–20.30) 5.85 (1.09–17.28) 0.039
Occasionally 9 Ref Ref
Milk/Milk products Daily 22 1.78 (0.84–3.80) 0.52 (0.19–1.46) 0.215
Twice a week 9 1.05 (0.42–2.64) 0.46 (0.15–1.43) 0.178
Weekly 4 2.73 (0.70–10.62) 2.14 (0.44–10.37) 0.345
Occasionally 14 Ref Ref
Fruits Daily 19 1.78 (0.84–3.80) 2.66 (0.88–8.000 0.081
Twice a week 13 1.05 (0.41–2.64) 0.87 (0.29–2.57) 0.803
Weekly 4 2.73 (0.70–10.62) 1.11 (0.26–4.79) 0.885
Occasionally 13 Ref Ref
COR: crude odds ratio, AOR: adjusted odds ratio

(32.8%) than boys (17.3%). A higher prevalence of obesity Limitations

among girls was also reported by Mahajan et al.[16] from the
Puducherry study down South. Gender-wise distribution
of Obesity was not mentioned by Cyril et al.[12] in Kerala.
This may be because the female-to-male participants ratio
was 1.45:1 in their study. In contrast to these studies,
Gautam and Jeong study[14] in Udupi reported that both
overweight and obese nutritional status was found more
among men (11.0% and 7.1%, respectively) than women
(10.6% and 5.4%, respectively).[6] It is also known that
women are more likely to be obese than men, owing to
inherent differences.
No sociodemographic factors characteristics were
found to have a statistically significant association with
overweight-to-obese nutritional status in the multivariable
regression model in the present study. Attending private
schools and having a father with a business occupation
was significantly associated with the overweight/obese
group in the Karnataka study.[6] In Puducherry, obesity
was observed more among urban children than rural
children.[16]
It was a hospital-based study conducted only in one OPD, so
the findings cannot be generalized. BMI fails to distinguish
between fat and fat-free mass (muscle and bone). Besides,
risk factors for childhood obesity could not be directly
studied and were largely dependent on the respondent.
CONCLUSION
A high proportion of the children attending pediatric OPD
were overweight-to-obese. The factors associated with
overweight-to-obese nutritional status were less duration
of outdoor play, frequent intake of processed meat, and
the occasional intake of green leafy vegetables.
Existing nutritional programs must be reviewed to prevent
overweight and obesity. This can be done by including more
healthy choices and supplementation based on a person’s
nutrition status. School health programs for children in
India should ensure access to healthy, nutritious, and
affordable diets (both in quantity and quality). Children need
to be motivated by their parents and teachers to engage in

208 MGM Journal of Medical Sciences | Volume 10 | Issue 2 | April-June 2023

 Ray, et al.: Child obesity
adequate physical activity and limit their consumption of
fast foods.
Ethical considerations
We obtained permission from Institutional Ethics
Committee before the start of the study (Letter No:
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Institute name/IEC/2021/598, dated 29.11.2021).
Besides, informed written consent was obtained from the
guardian/legally acceptable representative of the proposed
participant, along with the participant’s written or verbal
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permission (as applicable).
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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