Original Article

Prevalence of obesity, overweight and central obesity among

adolescent girls in national school in Batticaloa district, Sri Lanka

Dharshini Karuppiah 1, Mithusha Markandu1

1Diabetes and Endocrine unit, Teaching Hospital, Batticaloa.

Abstract

Introduction: The prevalence of childhood obesity has increased over the recent decades. Obesity is a major risk factor
for chronic diseases and plays a central role in insulin resistance and metabolic syndrome.

Methods: The aim of the study was to assess the prevalence of obesity and abdominal obesity by means of body mass
index (BMI) and waist-to-height ratio (WHtR) in adolescent girls in a National school in Batticaloa, Sri Lanka. Based on
age and sex specific BMI percentiles (CDC Chart), the students were classified as underweight (<5th percentile), normal
weight (5th - <85th percentile), overweight (85th -<95th percentiles), and obese (≥95th percentile). Central obesity was
categorized as WHtR ≥ 0.5. Adolescent girls (aged 14-19 years) attending the ten & twelve grades (n = 310) in a girl’s high
school at Batticaloa were participated in the study.

Results: The prevalence of obesity and overweight were 5.5% and 9.4% among the girls. The prevalence of central obesity
was 21.6%. Around 11.16% of girls in the normal weight group were centrally obese. There was a significant relationship
between WHtR and BMI status (P = 0.0001).

Conclusion: Our study provides evidence showing a high prevalence of overall and central obesity in adolescent girls in
our population. We emphasize the need for further large-scale surveillance programs and preventive strategies in our
population to reduce the incidence of obesity.

Keywords: Adolescent girls, central obesity, obesity, waist-height ratio

DOI: http://doi.org/10.4038/sjdem.v8i1.7347

Received: 13th January 2018 Accepted revised version: 24th February 2018 Published: 9th April 2018

Correspondence e-mail: [email protected]

This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International License, which
permits unrestricted use, distribution and reproduction in any medium provided the original author and source are credited

Sri Lanka Journal of Diabetes, Endocrinology and Metabolism 2018/Volume 8/Issue 01 Page | 17
 Introduction
A WHtR cut off point of 0.5 has been proposed as a simple
The prevalence of obesity among children and means of indicating whether the amount of central
adolescents has increased dramatically over the recent adiposity is excessive and represents a health risk in children
decades (1). A high prevalence of adolescence obesity (25-30). Considering the scarcity of studies on obesity and
and overweight cases has been reported in India, central obesity in children and adolescents in this region of
Bangladesh and other developing countries (2, 3). the country the present study was done to assess the
Prevalence in Sri Lanka shows regional variation. A prevalence of obesity and central obesity by means of BMI
survey done in 2006 showed the prevalence of and WHtR in a girl’s high school in Eastern province, Sri
overweight was 3-5% among urban children and 1.7% in Lanka.
children living at rural regions (4). There are reports of
much higher prevalence of 14-15% among school Methods
children in Colombo metropolitan area (5).
Sample
Obesity is a major risk factor for chronic diseases and
plays a central role in insulin resistance and metabolic Adolescent girls (aged 14-18 years) attending the ten &
syndrome (6). This confers a serious issue because of the twelve grades (n = 310) in Vincent Girls high school
health consequences in childhood and adolescence and participated in the study. This study was carried out as part
also the greater risk of obesity and metabolic syndrome of "World Diabetes Day program 2017”. The survey was
in adulthood (7). Body mass index (BMI) is widely used conducted with the cooperation of school teachers, medical
as a measure to evaluate the impact of obesity on students, and staffs from Diabetic Centre, Teaching
cardiovascular and metabolic risk factors, both in Hospital Batticaloa. Informed written consent was
children and adults. However, in children, BMI changes obtained by means of a signed letter from the school
with age and therefore a single cut-off value may not be authority. Students were verbally informed about the study
used to define obesity. and consent was obtained. Questionnaires were filled by
researchers and used for the data collection.
The World Health Organization emphasizes the
assessment of BMI in children providing BMI for age Anthropometric measurements
and sex percentiles (8). Similarly, Centers for Disease
Control and Prevention (CDC) has recommended All the girls were examined by a trained team consisting of
defining childhood obesity and over-weight based on a doctors, medical students and diabetic educators. The team
BMI-for-age and sex above 85th and 95th percentiles (9). had received training and had been standardized in the
A high BMI for age has been reported to be associated measurement assessments. The assessment was carried out
with risk for biochemical abnormalities and adult obesity during school hours as time allocated by the school
(10, 11). authority. Body weight was measured by a bathroom scale
wearing light clothes. Standing height was measured with
Nevertheless, BMI is unable to differentiate muscle mass stadiometer and measurement was done to the nearest 0.1
from bone and fat mass and also does not always relate cm. Waist circumference (WC) measured to the nearest 0.5
to central obesity. Moreover, children and adolescents cm in duplicate according to standard conditions by placing
with a high proportion of visceral fat will suffer from a flexible tape midway between the lowest rib and the iliac
severe metabolic complications (12). Some studies crest. The tape did not squeeze or compress the skin and
observed that Waist Height ratio (WHtR) provide better was parallel to the floor. The measurement was taken on,
estimate of cardio vascular risk factors than BMI (13-21). relaxed subjects after gentle expiration. BMI was calculated
Whereas other studies did not prove any difference as the ratio between weight (in kilograms) and the square of
between BMI, waist circumference (WC) and WHtR in height (in meters). WHtR was calculated as the ratio
relation to cardiometabolic risk (22-24). The WHtR takes between waist and height both measured in centimetres.
into account children's height; a single cut-off point can
likely be set for the ratio without age and gender Healthy life style score
difference bias (25). It has been shown to be a simple,
We developed a healthy life score ranged from 0 to 40
non-invasive, and practical tool that correlates well with
(higher score indicative of healthier lifestyle) and included 2
visceral fat and is easier to use (25-28).
components: diet and physical activity.

Sri Lanka Journal of Diabetes, Endocrinology and Metabolism 2018/Volume 8/Issue 01 Page | 18
 Table 1: Baseline characteristics of the subjects

Mean SD

Age (years) 15.97 ± 1.047

Weight (kg) 50.08 ± 10.75

Height (m) 156.60 ±5.344

BMI (kgm-2) 20.44 ±4.114

WC (cm) 71.12 ±9.962

WHtR 0.45 ±0.062

Healthy lifestyle score 26.37 ±3.020

Cut-off values had central obesity (Figure 1). There was significant
relationship between WHtR and BMI status (P = 0.00001).
Based on age and sex specific BMI percentiles, the girls Majority of obese girls (70.58%) had positive family history
were classified as underweight (<5th percentiles) normal of non-communicable disease (NCD).
weight (5th-<85th percentiles), overweight (85th -<95th
percentiles), and obese (≥95th percentile). A cut off of 0.5 Discussion
was used to differentiate low WHtR from high WHtR (8,
9). Several epidemiologic studies in Asian populations
including Chinese, Taiwanese, Indians, and Koreans have
Data analysis demonstrated higher amounts of body fat at lower BMIs
and WC than Western populations. This leads to the
Data were processed using the Statistical Package for the greater prevalence of cardiovascular disease risk factors at
Social Sciences (SPSS). Descriptive statistics was presented lower BMIs in Asian populations than in Western
as mean ± standard deviation score for normally populations (31).
distributed data. Chi-Square test was used to evaluate the
relationship between WHtR with BMI. In Sri Lanka, the prevalence of obesity and overweight has
increased and shows regional variation. A survey done a
Results decade ago showed the overall prevalence of overweight
was 2.2% (4). Present study demonstrated the prevalence
The baseline characteristics of the subjects were shown in of obesity and overweight were 5.5% and 9.4%
table 1. Median age of the students was 15.97(±1.047) respectively.
years. Median BMI was 20.44(±4.11) Kgm-2 and median
WHtR was 0.45 (±0.06). Total number of girls participated Children from different populations vary in their rate of
in the study was 310. Among them, 215 (68.9%) were proportional growth and in fat content as ethnicity
within normal weight category. The prevalence of influences body composition (5, 32, 33). The prevalence of
overweight and Obesity were 9.4% (29) and 5.5% (17). abdominal obesity was found to be 16.7% in 1500
Forty-nine girls (15.8%) were in the under-weight group. Egyptian males and females aged 11-19 years according to
WHtR (34). Study done in UK children in 1997 reported
The prevalence of central obesity was 21.6%. 11.16% of
WHtR exceeded 0.50 in 11.7% of adolescent girls aged 11-
girls in the normal weight group were centrally obese. In 16 years (26). In Swedish study girls aged 15.6 ± 0.4 years,
overweight girls, 86.2% and in the obese group, 100% high-risk WC was detected in 30.1% of subjects (35).

Sri Lanka Journal of Diabetes, Endocrinology and Metabolism 2018/Volume 8/Issue 01 Page | 19
 350

300
Without Central
Obesity
250

200 With Central

Obesity
No of students

150

100

50

0
Underweight Normal Over weight Obese Total

Figure 1: Number of girls with and with-out central obesity (Waist-height ratio>0.5) among different body mass
index group (P = 0.0001)

In a cohort of Iranian girls (14-17 years old), 18.2% were represent the whole adolescent population in the
centrally obese (36). The overall prevalence of central community.
obesity in our sample was 21.6%. Even among the girls
who were categorized as normal-weight based on BMI, Conclusion
11.16% had central obesity.
Our study shows a high prevalence of overall and
Majority of the girls who were obese had positive family central obesity in adolescent girls. We emphasize the
history of non-communicable disease (NCD) (70.58%). need for further large-scale surveillance programs on a
There is a significant correlation with central obesity and randomized cluster samples representing whole eastern
BMI. A high prevalence of central adiposity in our province and preventive strategies in our population to
population is of concern as it increases the risk for reduce the incidence of obesity.
obesity-associated morbidity and mortality in children
and adults. Acknowledgement

Limitations We are grateful to all the students and teachers of the

school & Medical students for their support and
This study was conducted in a single school, may not cooperation.

Sri Lanka Journal of Diabetes, Endocrinology and Metabolism 2018/Volume 8/Issue 01 Page | 20
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