A Comparative Study to Evaluate the Body Mass Index in Urban and Rural School Children of Belagavi

Introduction

Body mass index (BMI) is calculated by dividing a person’s weight in kilograms by the square of their height in meters. It is an economical and easy method to categorize weight, which may help identify potential medical ailments. BMI is age and gender specific and is often referred to as BMI-for-age for children and teens. Monitoring growth patterns over time can help ensure that a child is achieving or maintaining a healthy weight.

In recent years, the combined burden of childhood underweight and obesity has become a significant challenge for developing countries. Obesity in children is a high-level epidemic in India.¹ In the second wave of Covid-19 pandemic, children were a vulnerable group. According to reports, it was found that children in India were overweight and had poor lifestyle, along with poor health and fitness levels.² In 1990, only 2% of children and adolescents aged 5-19 (31 million individuals) were classified as obese, but by 2022, this figure rose to 8% (160 million individuals). In the same country, it is very common for both undernutrition and obesity to co-exist within community and households.³

A survey conducted by the Sportz Village schools in Delhi revealed that over 51% of children have an unhealthy BMI, meaning that every 1 in 2 may be overweight and have a poor lifestyle.⁴ A meta-analysis conducted in 2023 revealed the estimated pooled prevalence of obesity in children as 8.4%, while the prevalence of overweight was estimated to be 12.4%. Compared to female children, male children were found to be at an elevated risk for obesity, while the children attending private schools were found to be more susceptible to develop obesity than those attending government schools.⁵

An article published in 2021 in the Times of India reported a study by Edu-Sports company conducted to gauge the fitness levels of children. The study revealed that half of Indian children do not have a healthy BMI (18.5-22.9).⁶ A book edited by Edlyne Eze Anugwom and Niyi Awofeso on “Public Health in Developing Countries - Challenges and Opportunities” stated that obesity is a growing concern among schoolchildren in India. To address this threat, an unrelenting multifaceted strategy is needed, with all allies joining hands. The tactic should begin at pre-conception, and continue through pregnancy to infancy and childhood.⁷ The objective of this article is to evaluate and compare the BMI of rural and urban school children.

Materials and Methods

The current study was a descriptive research study and cross-sectional design was used to collect the data. Students were sampling frames. The study population was selected from three urban and two rural schools in Belagavi city. Purposive sampling technique was used to include a sample of 748 urban and 443 rural school children. Materials used were measuring tape, weighing machine, paper, and pen. A total of 1191 students were screened to collect primary data regarding the age, gender, height, and weight of the children in the school health checkups conducted from A.M. Shaikh Homoeopathic Medical College and P.G. Research centre, Belagavi. Body Mass Index (BMI) was calculated using the formula, BMI = weight (kg) / Ht (m²). The collected data were analyzed using descriptive statistics, with tables and graphs. Children of both the genders belonging to 6-16 years age group from urban and rural schools of Belagavi were included. The children who were not present in school during the data collection were not considered. The process of data collection was undertaken only after obtaining permission from the concerned school authorities and only those children providing oral assent were included. For children aged below 12 years, data collection was done only in the presence of parents. Ethical clearance for conducting the study was obtained from the institution.

Results

In the current study, among school children from urban area, 384/454 (84.5%) boys were underweight, 68/454 (14.9%) were of healthy weight, 1/454 (0.22%) were overweight, and 1/454 (0.22%) was obese. Of the girls, 225/294 (76.5%) were underweight, 65/294 (22.1%) were of healthy weight, 1/294 (0.34%) was overweight, 3/294 (1.02%) were obese.

Among rural school children, 197/248 (79.4%) boys were underweight, 50/248 (20.1%) were of healthy weight, none were overweight and 1/248 (0.4%) was obese. Of the girls, 123/195 (63.1%) were underweight, 70/195 (35.9%) were of healthy weight, 1/195(0.5%) was overweight and 1/195 (0.5%) was obese.

Discussion

A retrospective review study conducted in Poonamallee, Tamil Nadu reported the prevalence of overweight/ obesity and thinness in rural schools as 16.2% and 12.2%, respectively, whereas in the urban schools, it was 24% and 6.4%, respectively.⁸

In another cross-sectional study conducted in Mysuru, 9/240 (3.75%) boys and 8/200 (4%) girls were found to be obese, 31/240 (12.9%) boys and 23/200 (11.5%) girls were overweight, while 42/240 (17.5%) boys, 30/200 (15%) girls were underweight.⁹

Another cross-sectional study conducted in a hill state in North India showed the highest prevalence of overweight in urban private school children (32.7%), followed by rural private school children (22.4%).¹⁰

Our study findings showed that urban school girls 3/294 (1.02%) were more prone to obesity than rural girls 1/195 (0.5%), while in boys, not much difference in obesity was noted between urban 1/454 (0.002%) and rural areas 1/248 (0.004%).

A cross-sectional study conducted among school going children aged 6-16 years, studying at schools affiliated to Adichunchanagiri Institute of Medical College, B. G. Nagara, rural Mandya, Karnataka, India, between February 2020 to September 2021 showed an overall prevalence of overweight and obesity as 12.9% and 7%, respectively. The prevalence of overweight was more in girls (13.6%) in comparison to boys (11.3%), whereas obesity was more in boys (8.2%) than girls (5.6%).¹¹

When urban and rural school children were compared in our study, less number of rural school boys were found underweight (79.4%) than urban school boys (84.5%), whereas overweight was more in urban school boys (0.22%) compared to rural school boys. About 0.22% of urban school boys and 0.4% of rural school boys were found obese.

Similar findings were observed among rural and urban school girls. Compared to urban school girls (76.5%), less number of rural school girls (63.1%) were underweight. Overweight was more of a concern among rural school children (0.5%), while obesity was observed to be more concerning among urban school girls (1.02%) compared to rural school girls (0.5%).

Cross-sectional, observational, questionnaire-based study conducted in Vadodara enrolled 188 school subjects (89 rural and 99 urban school). Amongst these children, 17.6% (33) were obese, 20.2% (38) were overweight, 59% (111) were of normal weight and 3.2% (6) were underweight. About 65.22% of males and 62.26% of females in urban areas were either obese or overweight, in contrast to 15.78% of males and 3.92% of females in rural areas (P <0.0001).¹²

Conclusion

Unlike the common concern regarding obesity in Indian school children, this study indicates that underweight is more prevalent, especially among urban school children (both boys and girls) compared to rural school children. Obesity in urban and rural children was found negligible (0.22%, 0.4% in urban and rural school boys, respectively; 1.02% & 0.5% in urban and rural girls, respectively).

Limitations

Since the study was undertaken in a limited number of schools, a more extensive study involving a larger number of schools is recommended. Also, it is hard to accurately determine whether the school children are from rural or urban backgrounds due to migration for educational purposes. Therefore, the location of school (urban or rural) cannot be a definite marker of children’s origin. Furthermore, this study did not assess factors such as dietary intake, familial tendencies, or systemic diseases, which may contribute to undernutrition, obesity, overweight etc.

Financial support

Nil

Conflicts of interest

Nil

Acknowledgements

We would like to thank all the 5 school Heads, children of Belagavi city, who allowed us to carry out this study and special thanks to Dr. Jenisca Da Silva, Dr. Aishwarya Sakhe, Dr. Ashwini Hasbe P.G. scholars (Paediatric dept) & Dr. Archana Kulkarni Asso. Professor Materia medica dept. A.M. Shaikh homoeopathic medical college, Belagavi, who helped us in getting this data for study.