CHILDHOOD OBESITY IN URBAN AND RURAL INDIA: A SYSTEMATIC REVIEW AND META-ANALYSES OF PREVALENCE STUDIES

Abraham Minnu; Joyce Eberechukwu  Idomeh; Kennedy Oberhiri  Obohwemu; Gordon Mabengban Yakpir; Ama Maame Owusuaa-Asante; Gabriel Olaoluwa Abayomi; Oluwatoyin Aderinsola Bewaji; Ibiangake Friday Ndioho; Nourhan Abdelkader; Temitayo Oluwakemi Fynecontry; Victoria Yewande Soyobi

doi:10.37547/tajiir/Volume06Issue11-04

Authors

Abraham Minnu
MSPH, Faculty of Science and Technology, Middlesex University, Hendon Campus, London, United Kingdom
Joyce Eberechukwu Idomeh
PhD, Department of Social Works (DSW), College of Education, Psychology and Social Work, Flinders University, Bedford Park Campus, Sturt Road, Bedford Park 5042, South Australia
Kennedy Oberhiri Obohwemu
PhD, Department of Health, Wellbeing & Social Care, Global Banking School/Oxford Brookes University, Birmingham, United Kingdom; PENKUP Research Institute, Birmingham, United Kingdom
Gordon Mabengban Yakpir
PhD, Department of Health, Wellbeing & Social Care, Global Banking School/Oxford Brookes University, Birmingham, United Kingdom
Ama Maame Owusuaa-Asante
PhD Department of Health, Wellbeing & Social Care, Global Banking School/Oxford Brookes University, Birmingham, United Kingdom
Gabriel Olaoluwa Abayomi
PhD, Department of Health, Wellbeing & Social Care, Global Banking School/Oxford Brookes University, Manchester, United Kingdom
Oluwatoyin Aderinsola Bewaji
PhD, Department of Health, Wellbeing & Social Care, Global Banking School/Oxford Brookes University, Manchester, United Kingdom
Ibiangake Friday Ndioho
PhD, Department of Health Professions, Manchester Metropolitan University, Manchester, United Kingdom
Nourhan Abdelkader
MSc, Department of Health, Wellbeing & Social Care, Global Banking School/Oxford Brookes University, Birmingham, United Kingdom
Temitayo Oluwakemi Fynecontry
MSPH Flexible Support Options, Newcastle, United Kingdom
Victoria Yewande Soyobi
MBBS, Oni Memorial Children Hospital, Ibadan, Nigeria; Riverside Nursing Home, Aberdeen, United Kingdom

DOI:

https://doi.org/10.37547/tajiir/Volume06Issue11-04

Keywords:

childhood obesity prevalence studies urban and rural India

Abstract

Background: Childhood obesity has become a pressing global public health issue, particularly in low- and middle-income countries like India. This systematic review aims to investigate the prevalence of childhood obesity and its associated risk factors in urban and rural regions of India.

Methods: A comprehensive systematic search was conducted in PubMed, Embase, and Scopus databases to identify relevant English-language studies published within the past decade. Inclusion criteria included studies conducted in India, focusing on children and adolescents aged 0-18, and reporting either the prevalence of childhood obesity or related risk factors. Ten studies, comprising both cross-sectional and quantitative research designs, met these criteria.

Results: The findings reveal a significant disparity in childhood obesity prevalence between urban and rural areas of India. Urban regions exhibit notably higher rates, with a pooled prevalence estimated at 9.0% (95% CI: 2.0 to 17), compared to 4.0% (95% CI: 4.0 to 5.0) in rural areas. Risk factors associated with childhood obesity in urban settings include unhealthy dietary habits, limited physical activity, higher income levels, parental education, and attendance at private schools. In rural areas, gender, age, and household size emerged as potential risk factors.

Discussion: These findings underscore the urgent need for geographically tailored interventions to address the urban-rural disparities in childhood obesity. Lifestyle-oriented strategies promoting healthier dietary patterns and increased physical activity are essential. Gender-inclusive programs targeting both boys and girls are crucial. Future research should consider regional and cultural diversity to design more effective public health responses.

Conclusion: This systematic review provides valuable insights into the prevalence and risk factors of childhood obesity in India. It highlights the necessity for customized interventions and lifestyle adjustments to combat this escalating public health challenge and reduce disparities in health outcomes.

ZENODO DOI:- https://doi.org/10.5281/zenodo.14050307

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PUBLISHED DATE: - 07-11-2024
DOI: -

https://doi.org/10.37547/tajiir/Volume06Issue11-04

PAGE NO.: - 15-63

CHILDHOOD OBESITY IN URBAN AND RURAL
INDIA: A SYSTEMATIC REVIEW AND META-
ANALYSES OF PREVALENCE STUDIES

Minnu Abraham

MSPH, Faculty of Science and Technology, Middlesex University, Hendon
Campus, London, United Kingdom

Idomeh Eberechukwu Joyce

PhD, Department of Social Works (DSW), College of Education, Psychology
and Social Work, Flinders University, Bedford Park Campus, Sturt Road,

Bedford Park 5042, South Australia

Obohwemu Oberhiri Kennedy

PhD, Department of Health, Wellbeing & Social Care, Global Banking

School/Oxford Brookes University, Birmingham, United Kingdom;

PENKUP Research Institute, Birmingham, United Kingdom

Yakpir Mabengban Gordon

PhD, Department of Health, Wellbeing & Social Care, Global Banking

School/Oxford Brookes University, Birmingham, United Kingdom

Owusuaa-Asante Maame Ama

PhD Department of Health, Wellbeing & Social Care, Global Banking

School/Oxford Brookes University, Birmingham, United Kingdom

Abayomi Olaoluwa Gabriel

PhD, Department of Health, Wellbeing & Social Care, Global Banking

School/Oxford Brookes University, Manchester, United Kingdom

Bewaji Aderinsola Oluwatoyin

PhD, Department of Health, Wellbeing & Social Care, Global Banking

School/Oxford Brookes University, Manchester, United Kingdom

Ndioho Friday Ibiangake

PhD, Department of Health Professions, Manchester Metropolitan

University, Manchester, United Kingdom

RESEARCH ARTICLE

Open Access

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Abdelkader Nourhan

MSc, Department of Health, Wellbeing & Social Care, Global Banking
School/Oxford Brookes University, Birmingham, United Kingdom

Fynecontry Oluwakemi Temitayo

MSPH Flexible Support Options, Newcastle, United Kingdom

Soyobi Yewande Victoria

MBBS, Oni Memorial Children Hospital, Ibadan, Nigeria;
Riverside Nursing Home, Aberdeen, United Kingdom

Corresponding Author:

Obohwemu Kennedy Oberhiri

, PhD

INTRODUCTION

Childhood obesity has emerged as one of the most
pressing global public health issues of the 21st
century. Over the last few decades, the prevalence
of childhood obesity has risen at an alarming rate,

affecting both developed and developing nations.
Historically, obesity was largely seen as a problem
of high-income countries, but recent data suggest
that the phenomenon is increasingly becoming a

Abstract

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concern for low- and middle-income countries
(LMICs) as well. This global rise in childhood
obesity has profound implications not only for the
health and well-being of children but also for the
future economic and healthcare burdens on
societies. The World Health Organization (WHO)
reported that by 2019, there were over 38 million
overweight children under the age of five, and in
2016, more than 340 million children and
adolescents aged 5-19 were classified as
overweight or obese (1). According to the World
Obesity Federation, childhood overweight and
obesity rates increased by more than double in
LMICs from approximately 8.5% in 1980 to over
20% by 2020 (2). A significant amount of change
has taken place over a relatively short period of
time, which is particularly concerning. There were
only 4% of overweight children in the 1970s.
According to the NCD Risk Factor Collaboration,
that figure rose to over 18% by 2016 (3). These
figures reflect a rapid and unprecedented increase
in the number of overweight and obese children,
presenting a formidable public health challenge.

The escalation of childhood obesity worldwide has
not occurred in isolation. A combination of dietary
shifts, sedentary lifestyles, and environmental
changes has contributed to this phenomenon.
Globally, there has been a shift in diets toward
energy-dense foods that are high in fats, sugars,
and salt but low in essential nutrients like vitamins
and minerals (4). These dietary changes are
coupled with a decline in physical activity due to
the increasingly sedentary nature of work, leisure
activities, and transportation (5). Urbanization has
played a significant role in exacerbating these
issues, as cities tend to promote fewer active
lifestyles and provide easier access to unhealthy
food options. Children in urban settings are more
likely to engage in sedentary activities such as
watching television, playing video games, or using
smartphones for extended periods, all of which
contribute to the rising rates of obesity (5).

In addition to lifestyle factors, several other
contributors to childhood obesity have been
identified, including genetic, psychological, and
socio-environmental factors. While genetics may
predispose certain individuals to obesity, it is the
interaction with environmental and lifestyle
factors that largely determines outcomes.
Psychological factors, such as stress, depression,
and anxiety, have also been linked to childhood
obesity, with some children turning to food as a
coping mechanism. Socio-environmental factors,
including parental influence, socioeconomic status,
and access to health education, also play a crucial
role. For instance, children from wealthier families
or those attending private schools may have better
access to unhealthy foods, such as sugary snacks
and fast food, contributing to higher rates of
obesity (6).

The health implications of childhood obesity are
extensive and often persist into adulthood.
Children who are obese are at a higher risk of
developing non-communicable diseases (NCDs)
such as type 2 diabetes, cardiovascular disease,
and various musculoskeletal disorders (6). These
conditions, once thought to be primarily adult
concerns, are now being diagnosed at increasingly
younger ages. Childhood obesity is also associated
with a range of psychosocial issues, including low
self-esteem, depression, and social isolation (7).
Obese children may face discrimination or bullying
from

their

peers,

further

exacerbating

psychological distress and potentially leading to
academic underachievement. As these children
grow into adults, they often carry these health and
psychological challenges with them, increasing
their risk of premature death and disability.

Economically, the rise in childhood obesity places
a significant burden on healthcare systems
worldwide. The direct medical costs associated
with treating obesity-related conditions are
substantial, and the loss of productivity due to ill

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health further compounds this burden (8). In many
countries, healthcare systems are already
stretched thin, and the growing number of obese
children threatens to overwhelm them. The
economic implications of childhood obesity are not
limited to healthcare costs alone. The societal
costs, including lost educational opportunities and
decreased workforce participation, further
underscore the need for urgent action to address
this issue.

While childhood obesity was once considered a
problem primarily confined to affluent nations, its
prevalence in LMICs has been growing at an
alarming rate. This rise in obesity in LMICs can be
attributed to the globalization of unhealthy
lifestyles, which has led to a dramatic shift in
dietary habits and physical activity levels. In these
countries, the traditional diets, which were often
rich in fibre and low in fat, have been replaced by
more Westernized diets that are high in processed
foods, fats, and sugars (9). At the same time,
technological advances and urbanization have
reduced the need for physical activity, both in daily
life and in leisure activities. Children in these
countries are increasingly adopting sedentary
behaviours, such as spending more time watching
television or using digital devices, rather than
engaging in physical play (10).

India provides a compelling case study of the rise
of childhood obesity in an LMIC. The country is
currently undergoing a rapid epidemiological
transition, with an increase in non-communicable
diseases (NCDs) such as obesity, diabetes, and
cardiovascular disease, particularly in urban areas
(11). Childhood obesity is becoming increasingly
prevalent in India, with studies showing a higher
burden in urban areas compared to rural regions.
This urban-rural divide is likely driven by
differences in lifestyle, dietary habits, and access to
healthcare and educational resources. In urban
areas, children are more likely to consume energy-

dense, nutrient-poor foods and engage in
sedentary behaviours, while in rural areas,
traditional diets and more physically demanding
lifestyles may provide some protection against
obesity (12).

Despite this, childhood obesity is by no means
limited to urban areas in India. As rural areas
become more developed and lifestyles change, the
prevalence of childhood obesity is also rising in
these regions. Access to processed foods is
increasing, and rural children are becoming more
exposed to the same unhealthy dietary and
lifestyle influences as their urban counterparts
(13). This shift is concerning, as it suggests that the
protective factors traditionally associated with
rural life are being eroded, leading to a
convergence in obesity rates between urban and
rural areas.

The rise in childhood obesity in India has serious
implications for the country's future health and
economic stability. Obese children are more likely
to develop NCDs such as type 2 diabetes and
cardiovascular disease, conditions that place a
significant burden on healthcare systems. In India,
where healthcare resources are already limited,
the growing number of obese children threatens to
overwhelm an already strained system (14).
Moreover, childhood obesity can have long-lasting
effects on a child's mental health and academic
performance, with potential consequences for
their future economic productivity and quality of
life.

The National Family Health Surveys (NFHS) in
India have consistently shown a worrying trend of
increasing

obesity

among

children

and

adolescents, particularly in urban areas. This trend
is reflective of the broader global shift toward
unhealthy lifestyles, but it is exacerbated in India
by the country's rapid urbanization and economic
growth. As India continues to develop, it is likely
that the prevalence of childhood obesity will

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continue to rise unless urgent action is taken to
address the root causes of this epidemic (15).

One of the key challenges in addressing childhood
obesity in India is the lack of comprehensive,
nationwide data on its prevalence and associated
risk factors (16). While several studies have been
conducted on childhood obesity in India, they often
focus on specific regions or populations, making it
difficult to get a clear picture of the overall
situation. This systematic review aims to fill this
gap by synthesizing the existing research on
childhood obesity in India, with a focus on both
urban and rural areas. By providing a
comprehensive overview of the current state of
childhood obesity in India, this review aims to
inform policymakers and public health advocates
about the scale of the problem and the most
effective strategies for addressing it.

Public health interventions aimed at preventing
and reducing childhood obesity in India must take
into account the country's unique socio-cultural
context. For example, interventions in urban areas
may need to focus on reducing the consumption of
processed foods and encouraging physical activity
in a highly sedentary environment. In contrast,
interventions in rural areas may need to address
the growing availability of unhealthy food options
while promoting the retention of traditional, more
physically

active

lifestyles.

Moreover,

interventions must be tailored to address the
socioeconomic disparities that exist between
different regions and populations in India.
Children from lower-income families may face
different challenges in accessing healthy food and
opportunities for physical activity compared to
their wealthier counterparts (17).

In addition to addressing the immediate health
concerns associated with childhood obesity, public
health interventions must also consider the long-
term economic and societal impacts of this
epidemic. Childhood obesity is not only a health
issue but also an economic one, as it has the
potential to affect a country's workforce and
overall productivity. By investing in prevention
and early intervention, India can mitigate the long-
term costs associated with childhood obesity and
ensure a healthier, more productive future for its
citizens (18,19).

Essentially, childhood obesity is a growing public
health concern in India, with significant
implications for the country's future health and
economic well-being. The rise in obesity among
Indian children is driven by a combination of
factors, including dietary shifts, sedentary
lifestyles, and the globalization of unhealthy
behaviours. Addressing this issue will require a
comprehensive, multi-sectoral approach that
considers the unique challenges and opportunities
presented by India's rapidly changing social and
economic

landscape.

Through

targeted

interventions and public health initiatives, India
can combat the rising tide of childhood obesity and
protect the health and well-being of its future
generations.

SEARCH STRATEGY

To conduct the literature search, a comprehensive
search strategy was developed using the SPIDER
(Sample, Phenomenon of Interest, Design,
Evaluation, Research type) framework (20,21).
The search terms used are presented in the
following tables.

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Table 1: SPIDER Framework for Literature Search Terms

Element

Description

Search Terms

Sample

Children in urban and rural areas of
India

Children, Adolescents, Youth,
School-aged

Phenomenon of
Interest

Obesity and associated risk factors

Obesity, Overweight, Body Mass
Index, BMI

Design

Studies examining prevalence and/or
risk factors

Cross-sectional, Cohort, Case-
control, Survey

Evaluation

Measurement of obesity and
identification of risk factors

Prevalence, Incidence, Risk
factors, Determinants

Research type

Both quantitative and mixed method
research

Quantitative, Study

Table 2: Search Strategy

NB: Search terms for childhood obesity, location,
setting, outcome measure, and study design are
presented in Table 1.

The search strategy was conducted in PubMed,
Embase, and Scopus, which are among the most
reputable and comprehensive health and
biomedical research databases (22-23). PubMed is
a premier database for biomedical literature,
encompassing a vast range of topics relevant to the
study's focus on childhood obesity (22). Embase's
strong emphasis on pharmacology and drug

research provides extensive literature on clinical
and medical interventions, which is invaluable for
understanding obesity treatment and prevention
(23). Scopus, being one of the largest abstract and
citation databases, offers broad interdisciplinary
coverage, ensuring a comprehensive scope for
collating varied research on obesity (23).

The search results were screened for eligibility
based on the inclusion and exclusion criteria, and
the quality of the included studies was assessed
using the Cochrane Risk of Bias Tool (25). The data

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extraction process was conducted using a
standardized data extraction form, and the
extracted data were analysed using descriptive
statistics and meta-analysis (26).

INCLUSION CRITERIA

Inclusion and exclusion criteria are essential
components of a systematic review, ensuring
consistency, relevance, and rigor. They provide
clear guidelines for identifying pertinent studies,
eliminating potential biases, and addressing the
research question comprehensively. Moreover,
they enhance the review's transparency and
replicability, establishing trust in the findings (21).
This study adopted the following inclusion criteria:

•

Geographical context: Studies conducted in
India, focusing on either urban or rural
settings, or both.

•

Target population: Studies examining
children and adolescents up to the age of 18
years.

•

Outcomes of interest: Studies that report on
the prevalence of childhood obesity or
identify specific risk factors associated with
childhood obesity in India.

•

Study types: Both mixed-method studies
and quantitative primary research studies,
including cross-sectional, cohort, case-
control, and observational studies.

•

Publication language: Studies published in
English.

•

Time frame: Studies published in the last ten
years to ensure relevance and capture
recent trends and developments.

Exclusion Criteria

•

Out of scope: Studies focusing on adult
obesity without separate data for the child
and adolescent age group.

•

Geographical irrelevance: Studies that are

not specific to India or do not differentiate
results between India and other countries.

•

Unrelated outcomes: Studies that discuss
childhood weight or nutrition but do not
specifically report obesity prevalence or
associated risk factors.

•

Review articles: Systematic reviews,
literature reviews, meta-analyses, and other
secondary publications.

•

Non-empirical studies: Opinion pieces,
editorials, and commentaries without
original research data

•

Language barrier: Studies not published in
English and for which a reliable translation
is unavailable.

Quality Assessment

Studies meeting a predetermined threshold of
quality criteria were included in the review,
ensuring that the synthesized findings are both
reliable and valid. The "Strengthening the
Reporting

of

Observational

Studies

in

Epidemiology" (STROBE) checklist was used to
appraise the studies (26). The checklist includes
critical reporting suggestions for the study
heading, abstract, introduction or background,
utilized methods in each study, findings of the
studies, and discussion. Each paper's quality is
presented in Appendix 3.

DATA EXTRACTION

Initially, a standardized data extraction form was
designed, capturing pertinent details such as
authors, publication year, study design, and key
findings among others (27). The form's
effectiveness was evaluated through pilot testing
on select studies, allowing for refinements as
needed (28). The compiled data was meticulously
documented, with digital tools like spreadsheets
facilitating organization (29). As a quality control
measure, a random subset of studies underwent a

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cross-check to validate the extraction process's
accuracy.

Data Synthesis and Analysis

Data synthesis and analysis in systematic reviews
are pivotal for amalgamating disparate pieces of
information into a cohesive understanding of the
studied phenomenon. Narrative synthesis was
used to summarize the findings of the selected
studies and to meet the objectives of this research
study. Pooled prevalence was also assessed. I²
value was assessed to find out the heterogeneity
level of the studies. A forest plot was also created.

RESULTS

Study Selection

The study selection process was conducted in
accordance with the Preferred Reporting Items for

Systematic Reviews and Meta-Analyses (PRISMA)
guidelines (30). A PRISMA chart (Figure 1) was
used to summarize the overall study selection
process.

The search strategy identified 861 records, which
were then screened for duplicates. A total of 294
duplicate records were removed, leaving 567
unique records. These records were then screened
based on the eligibility criteria outlined in the
methodology chapter, resulting in the removal of
334 records.

The remaining 233 full reports were assessed for
eligibility, and some were deemed ineligible due to
their evident ineligibility. After this stage, 10
articles were identified as eligible and selected for
this study. All the selected articles were
quantitative studies.

Identification

Duplicates removed:

294

Screened (Abstracts and headings):

567

Eligibility assessed:

233

Selected:

10

Excluded:

334

Not English:

5

Other nations:

202

Different aspects:

16

Screening

Eligibility

Selection

Identified articles/resources:

861

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Figure 1: Study selection approach

Study Characteristics

Ten research studies, all employing a cross-sectional design, were included in this review. All studies
focused on children or adolescents aged 18 or younger. The specific age groups of participants in each
study are detailed in Appendix 2. Table 3 provides information on the study settings, including urban or
rural locations, for the ten research studies.

Table 3: Study settings

Study

Study location

Setting information

(30)

Jaipur, Rajasthan

Urban

(38)

Pune, Maharashtra

Urban

(39)

Ganjam, Odisha

Urban and rural

(33)

Chennai, Tamilnadu

Urban

(34)

Vadodara, Gujarat

Urban and rural

(35)

Trichy, Tamilnadu

Rural

(32)

Kanchipuram, Tamilnadu

Rural

(36)

Coimbatore, Tamilnadu

Rural

(37)

Bangalore, Karnataka

Rural

(31)

Trissur, Kerala

Urban

As shown in Figure 2, the sample sizes of the studies included in this review ranged from 100 to 1842
participants. The 10 research studies employed various random sampling methods to recruit eligible
study subjects, as detailed in Appendix 2.

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Figure 2: Sample sizes of selected studies

BMI was calculated for all participants in the
included studies, along with the administration of
other relevant tools and questionnaires.
Descriptive and inferential statistics were
employed to identify the prevalence and risk
factors of childhood obesity. Ethical standards
were adhered to in most of the investigations.

Prevalence of Childhood Obesity

A narrative synthesis was conducted to address
the research questions. The total prevalence, as
well as urban-rural and gender-based prevalence,
were reported.

The reported total prevalence among the ten
studies ranged from 4.08% to 7.30%, with a mean

(SD) of 6.5 (3.9). The specific prevalence rates for
each study are as follows: 5.60% (30), 5.62% (38),
5.00% (39), 5.20% (33), 17.60% (34), 6.00% (35),
4.40% (32), 4.72% (36), 4.08% (37), and 7.30%
(31).

Urban-Rural Disparities

Eight of the ten studies focused exclusively on
either rural or urban settings, while two studies
reported on both. In rural areas, the prevalence of
childhood obesity ranged from 2.20% to 6.00%,
with a mean (SD) of 4.12 (1.2). In urban areas, the
prevalence ranged from 5.2% to 31.3%, with a
mean (SD) of 10.2 (10.3). The prevalence rates for
both rural and urban settings are depicted in
Figure 3.

1000

1281

180

1842

188

100

934

890

1127

1104

0

200

400

600

800

1000

1200

1400

1600

1800

2000

Sample size

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Figure 3: Rural vs urban prevalence of childhood obesity

Pooled prevalence: Rural and urban

Urban

The pooled prevalence of obesity in children from urban areas was estimated to be 9.0% (95% CI: 2.0 to
17), as shown in Figure 4. The results of the I² statistic (99.06%) indicate a high level of heterogeneity
between the studies, which is statistically significant (p-value < 0.001).

0

5

10

15

20

25

30

35

(Jain et al., 2016)

(Ghonge et al., 2015)

(Pradhan et al., 2022)

(Rani and Sathiyasekaran, 2013)

(Pathak et al., 2018)

(Vidhya et al., 2023)

(Danasekaran and Ranganathan, 2019)

(Shanmugam et al., 2016)

(Kumar et al., 2019)

(Viswambharan and Abraham, 2021)

Rural and urban prevalence

Urban
prevalence

Rural
prevalence

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Figure 4: Forest plot of urban settings

Rural

As demonstrated in Figure 5, the pooled prevalence of obesity in rural children is 4.0% (95% CI: 4.0 to
5.0). The I² value of 0.0% suggests that there is no significant heterogeneity among the studies, indicating
a high degree of consistency in the findings. While this may seem counterintuitive given the diversity of
the included studies, it could be attributed to several factors, such as the relatively small number of
studies, the similarity in study designs, or the limited variation in the prevalence of childhood obesity
across the included rural regions.

Random-Effects Model (k = 6)

Estimate

se

Z

p

CI Lower Bound

CI Upper Bound

Intercept

0.0949

0.0358

2.65

0.008

0.025

0.165

.

Note. Tau² Estimator: Restricted Maximum-Likelihood

Heterogeneity Statistics

Tau

Tau²

I²

H²

R²

df

Q

p

0.085

0.0073 (SE=

0.0049 )

99.06%

105.949

.

5.000

34.904

< .001

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Figure 5: Forest plot of rural prevalence

Gender-Based Prevalence

While gender-based prevalence was reported in
only three studies (30,31,38), all conducted in
urban settings, significant disparities were
observed. Urban male children had a higher
prevalence of obesity [mean (SD): 10.27 (6.8)]
compared to urban female children [mean (SD):
9.53 (5.53)]. In rural settings, gender differences
were less pronounced, with similar prevalence
rates for male and female children.

Critical appraisal of selected studies

A systematic review of ten research studies was
conducted to assess the prevalence and risk factors
of childhood obesity in India. The STROBE
checklist was used to appraise the methodological
quality of these studies.

While all studies demonstrated various strengths,
areas for improvement were also identified.
Several studies explicitly outlined their study
design in the title or abstract, providing clarity to
readers. However, some studies (29) could have
benefited from a clearer statement of their

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hypothesis to enhance interpretation.

Regarding confounding factors, (30) missed
addressing potential confounders, which can
significantly impact the depth of a study. The
inclusion of rural perspectives by (31) and (32)
enriched the overall div of research. However,
consistency in addressing potential biases was
lacking among the studies. While (32) addressed
some biases, a more exhaustive account of
statistical methods, particularly concerning
confounding variables, was needed in some cases.
(33) stood out in terms of methodology, but
addressing missing data could have further
enhanced the accuracy of their findings.

In terms of results, (27) and (29) effectively linked
their findings to the study objectives. However, a
more in-depth discussion of missing data,
confounding

adjustments,

and

broader

implications is necessary for a more holistic
interpretation of results.

DISCUSSION

This systematic review presents a comprehensive
analysis of the prevalence and risk factors
associated with childhood obesity in urban and
rural India. The findings indicate an average
obesity prevalence of 9.0% in urban areas and
4.0% in rural regions, highlighting a significantly
higher burden in urban settings. Notably, gender-
based differences were observed, with male
children showing higher prevalence rates in urban
areas. Several risk factors were identified,
including socioeconomic determinants such as
higher income and parental education, unhealthy
lifestyle behaviours, and environmental factors
like increased access to junk food and sedentary
habits. These results underscore the critical need
for targeted interventions, particularly in urban
India, to address childhood obesity.

The outcomes of this systematic review carry
significant

implications

for

understanding

childhood obesity dynamics in both urban and
rural contexts, aligning closely with the primary
research objectives. The notably higher prevalence
of obesity in urban settings (9.0% versus 4.0% in
rural areas) reflects the influence of urbanization
on lifestyle and dietary habits, underscoring the
need for tailored interventions in urban regions
(34,39). While there is a slight gender-based
difference in urban areas, with boys showing a
higher prevalence, this variation lacks statistical
significance. In rural areas, gender differences are
less pronounced, suggesting that childhood
obesity is a concern that spans across gender
boundaries and requires inclusive strategies for
both boys and girls (31,33,38).

Socioeconomic and Environmental Risk
Factors

Socioeconomic factors, such as higher income,
parental education, and private school attendance,
emerged as significant contributors to childhood
obesity in urban areas (33,38). This finding
illustrates the complex relationship between
socioeconomic status and childhood obesity,
where increased access to resources can lead to
both healthier choices and the adoption of
unhealthy dietary and lifestyle behaviours.
Effective interventions must account for these
socioeconomic complexities to be successful in
combating childhood obesity in urban settings.

Lifestyle and environmental factors also play a
pivotal role. Unhealthy eating habits, such as
frequent consumption of junk food, and sedentary
behaviours, like excessive screen time, were
identified as significant risk factors in both urban
and rural settings. The prevalence of unhealthy
food options in school canteens and the pervasive
influence of technology further underscore the
need for comprehensive interventions addressing
these lifestyle factors (32,34,36,37,39). Public
health policies should be based on empirical
evidence and designed to encourage healthier

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lifestyles, improve dietary habits, and promote
physical activity, particularly in urban areas where
childhood obesity is more prevalent. Tailoring
these approaches to the socioeconomic and gender
dynamics specific to each region is crucial for their
success (30,31,38).

Gender-Inclusive

and

Context-Specific

Strategies

While the gender differences in obesity prevalence
observed in the included studies were not
statistically significant, they do suggest a potential
trend that warrants attention in the design of
interventions. Public health initiatives should aim
to engage both boys and girls equitably, ensuring
that all children benefit from these programs
(33,38).

This review underscores the urgent need for a
multifaceted approach to preventing childhood
obesity in India, addressing urban-rural
disparities, socioeconomic factors, and lifestyle
determinants. Collaborative efforts between
policymakers, healthcare professionals, and
community stakeholders are essential for
developing

evidence-based,

context-specific

interventions that effectively combat childhood
obesity.

Some specific strategies include:

•

Gender-sensitive interventions: Develop
programs that address the unique needs and
challenges faced by boys and girls in relation
to obesity.

•

Community-based initiatives: Implement
community-based programs that promote
healthy eating habits, increase physical
activity levels, and create supportive
environments for children and families.

•

School-based

interventions:

Integrate

healthy eating and physical activity into
school curricula and provide nutrition
education to students.

•

Healthcare provider education: Train
healthcare providers to screen for childhood
obesity, provide counselling on healthy
lifestyles, and refer patients to appropriate
resources.

•

Policy interventions: Implement policies
that promote healthy eating and physical
activity, such as restricting the marketing of
unhealthy foods to children and creating
safe and accessible spaces for physical
activity.

•

Socioeconomic

interventions:

Address

underlying socioeconomic factors that
contribute to childhood obesity, such as
poverty, inequality, and lack of access to
healthcare.

By adopting a comprehensive and multi-sectoral
approach, India can effectively address the
growing problem of childhood obesity and
improve the health and well-being of its young
population.

Future Research and Policy Recommendations

The findings of this review highlight the
importance of adopting longitudinal research
designs in future studies to better understand the
causal relationships and long-term trends
associated with childhood obesity. Furthermore,
rigorous evaluations of interventions are needed
to assess their effectiveness within the Indian
context, considering the unique urban-rural
disparities (34,39). This systematic review offers
valuable insights into the multifaceted challenge of
childhood

obesity

in

India,

equipping

policymakers, healthcare practitioners, and
researchers with the information needed to design
targeted

interventions

that

address

the

complexities faced by both urban and rural
populations.

These findings also contribute significantly to the
existing literature on childhood obesity in India.

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The observed prevalence rates align with previous
studies that have documented rising trends in
obesity among Indian children (33,38). The higher
prevalence in urban areas is consistent with global
patterns linking urbanization to unhealthy
lifestyles, reinforcing the need for targeted
interventions in urban regions (34). This
observation mirrors global evidence showing the
impact of urbanization on dietary habits and
physical activity levels (3). Additionally, the
identification of socioeconomic factors as key
contributors to childhood obesity in urban areas
corroborates international research highlighting
the complex relationship between income,
education, and obesity (40). This emphasizes the
necessity

of

addressing

socioeconomic

determinants in any intervention strategy.

Strengths and Limitations

This systematic review employed a rigorous
methodology, including comprehensive literature
searches, standardized data extraction, and quality
assessment of included studies. The inclusion of
studies from diverse urban and rural settings
across India strengthens the generalizability of the
findings.

However, some limitations must be acknowledged.
The relatively small number of studies meeting the
inclusion criteria and the heterogeneity in
prevalence estimates across these studies may
limit the generalizability of the findings. While the
review provides valuable insights into childhood
obesity in India, caution should be exercised when
extrapolating the results to all regions and
populations within the country.

Further research is needed to validate and expand
upon these findings, particularly in local contexts.
Addressing existing data gaps, such as the limited
number of studies in certain regions, will allow for
a more comprehensive understanding of
childhood obesity dynamics in India.

Additionally, future research should focus on:

•

Longitudinal studies: To track changes in
childhood obesity prevalence and risk
factors over time.

•

Qualitative research: To explore the social,
cultural, and environmental factors that
contribute to childhood obesity.

•

Cost-effectiveness analysis: To evaluate the
economic impact of different interventions
aimed at addressing childhood obesity.

By addressing these limitations and conducting
further research, policymakers and healthcare
providers can develop more effective and tailored
interventions to combat childhood obesity in India.

CONCLUSION

This systematic review aimed to explore the
prevalence of childhood obesity and its associated
risk factors in both urban and rural regions of
India. The primary research question focused on
understanding the extent of childhood obesity in
these settings and identifying the factors
contributing to this pressing health concern. The

study’s significance stemmed from the alarming

rise in childhood obesity rates across India,
necessitating evidence-based insights to inform
the development of effective public health policies
and interventions.

Employing a rigorous systematic review
methodology, this study critically assessed 10
primary research studies conducted within the
Indian context. The findings revealed a
pronounced disparity in the prevalence of
childhood obesity, with higher rates documented
in urban areas compared to rural counterparts.
Key factors contributing to this disparity included
unhealthy dietary practices, insufficient physical
activity levels, and socioeconomic determinants.
The implications of these findings are substantial,
emphasizing the urgent need for region-specific
interventions tailored to address the urban-rural

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disparity in childhood obesity rates. Such
interventions

should

prioritize

promoting

healthier lifestyles and improving access to
nutritional education and physical activity
opportunities, particularly in urban settings where
the problem appears more pronounced. Lifestyle-
focused strategies that promote healthier diets and
increased physical activity are crucial. Gender-
inclusive programs should be developed, targeting
both boys and girls. Additionally, this study
underscores the need for more extensive research
in diverse Indian contexts to enhance the evidence
base and facilitate effective public health
responses. In essence, this systematic review
sheds light on the pressing issue of childhood
obesity in India, highlighting the importance of
tailored interventions, lifestyle modifications, and
gender-sensitive approaches to combat this
growing public health concern.

Future research endeavours should extend and
enhance the insights gained from this study by
addressing critical areas in the context of
childhood obesity in urban and rural India.
Longitudinal studies are essential to track the
trajectories of childhood obesity and assess its
long-term

health

outcomes.

Geographical

variations within urban and rural settings warrant

exploration, considering India’s diverse cultural,

dietary, and socioeconomic landscape. In-depth
investigations into cultural

and societal

determinants, such as food preferences, family
dynamics, and peer influences, are needed to
uncover underlying causes. Evaluating the
effectiveness of interventions, including school-
based programs, community initiatives, and policy
changes, will provide evidence for evidence-based
strategies. Furthermore, studies examining
disparities in obesity prevalence and healthcare
access among different socioeconomic groups can
guide targeted interventions to reduce health
inequities. Qualitative research can illuminate the
psychosocial aspects and barriers to behaviour

change. To comprehensively address childhood
obesity in India, future research should embrace a
multidisciplinary approach, consider regional and
cultural diversity, and foster collaboration among
researchers,

healthcare

professionals,

policymakers, and communities.

CONFLICTS OF INTEREST

The author reports no conflicts of interests.

FUNDING

No funding required for this study.

ACKNOWLEDGEMENT

The lead author would like to acknowledge his
dissertation supervisor Dr. Joyce E. Idomeh for her
support, guidance and mentorship throughout the
research. All authors would like to acknowledge
the management and technical staff of PENKUP
Research Institute, Birmingham, United Kingdom
for their excellent assistance and for providing
manuscript

writing/editorial

support

in

accordance with Good Publication Practice (GPP3)
guidelines.

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Supplemental Materials

Appendix 1: Quality Appraisal I

Study 1: The study of obesity among children aged 5-18 years in Jaipur,
Rajasthan

Item

No

Recommendation

Yes/No/

Not
clear

Page
number

Comments

Title and
abstract

1

(

a

) Indicate the study’s design with a

commonly used term in the title or the
abstract

Yes

125

Clearly
mentioned

(

b

) Provide in the abstract an informative

and balanced summary of what was done
and what was found

Yes

125

Clearly
mentioned

Introduction

Background/
rationale

2

Explain the scientific background and
rationale for the investigation being
reported

Yes

125-126

Clearly
mentioned

Objectives

3

State-specific objectives, including any
prespecified hypotheses

Yes

125-126

Hypothesis not
mentioned

Methods

Study design

4

Present key elements of study design early
in the paper

Yes

126

Clearly
mentioned

Setting

5

Describe the setting, locations, and relevant
dates, including periods of recruitment,
exposure, follow-up, and data collection

Yes

126

Dates not
mentioned

Participants

6

(

a

) Give the eligibility criteria, and the

sources and methods of selection of
participants

Yes

126

Clearly
mentioned

Variables

7

Clearly define all outcomes, exposures,
predictors, potential confounders, and effect
modifiers. Give diagnostic criteria, if
applicable

Yes

126

Outcomes
defined and
others were
not applicable

Data sources/
measurement

8*

For each variable of interest, give sources

of data and details of methods of assessment
(measurement). Describe comparability of
assessment methods if there is more than
one group

Yes

126

No
comparison is
there

Bias

9

Describe any efforts to address potential
sources of bias

Yes

126

Sampling
randomly done

Study size

10

Explain how the study size was arrived at

Yes

126

Clearly
mentioned

Quantitative
variables

11

Explain how quantitative variables were
handled in the analyses. If applicable,
describe which groupings were chosen and
why

Not
clear

NA

Statistical
methods

12

(

a

) Describe all statistical methods,

including those used to control for

Yes

127-129

Not about
confounders

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confounding
(

b

) Describe any methods used to examine

subgroups and interactions

Yes

127-129

Chi-square test

(

c

) Explain how missing data were

addressed

No

NA

Not mentioned

(

d

) If applicable, describe analytical

methods taking account of sampling
strategy

Not
clear

NA

(

e

) Describe any sensitivity analyses

No

NA

Results

Participants

13*

(a) Report numbers of individuals at each
stage of study—eg numbers potentially
eligible, examined for eligibility, confirmed
eligible, included in the study, completing
follow-up, and analysed

Yes

126

As per cross-
sectional study

(b) Give reasons for non-participation at
each stage

NA

(c) Consider use of a flow diagram

NA

Descriptive data

14*

(a) Give characteristics of study participants
(eg demographic, clinical, social) and
information on exposures and potential
confounders

Yes

126-127

Not about
exposure and
confounders

(b) Indicate number of participants with
missing data for each variable of interest

NA

No missing
data

Outcome data

15*

Report numbers of outcome events or
summary measures

Yes

127

Prevalence
reported

Main results

16

(

a

) Give unadjusted estimates and, if

applicable, confounder-adjusted estimates
and their precision (eg, 95% confidence
interval). Make clear which confounders
were adjusted for and why they were
included

NA

(

b

) Report category boundaries when

continuous variables were categorized

Yes

127

Age, income,
are categorized

(

c

) If relevant, consider translating estimates

of relative risk into absolute risk for a
meaningful time period

NA

Other analyses

17

Report other analyses done—eg analyses of
subgroups and interactions, and sensitivity
analyses

NA

Discussion

Key results

18

Summarise key results with reference to
study objectives

Yes

128-130

Mentioned

Limitations

19

Discuss limitations of the study, taking into
account sources of potential bias or
imprecision. Discuss both direction and
magnitude of any potential bias

No

NA

Not mentioned

Interpretation

20

Give a cautious overall interpretation of
results considering objectives, limitations,
multiplicity of analyses, results from similar
studies, and other relevant evidence

Yes

128-130

Mentioned

Generalisability

21

Discuss the generalisability (external

Yes

130

Implications

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validity) of the study results

provided

Other information

Funding

22

Give the source of funding and the role of
the funders for the present study and, if
applicable, for the original study on which
the present article is based

NA

130

No funding

Study 2: Prevalence of obesity and overweight among school children of
Pune city, Maharashtra, India: a cross-sectional study

Item

No

Recommendation

Yes/No/

Not
clear

Page
number

Comments

Title and
abstract

1

(

a

) Indicate the study’s design with a

commonly used term in the title or the
abstract

Yes

3599

Clearly
mentioned

(

b

) Provide in the abstract an informative

and balanced summary of what was done
and what was found

Yes

3599

Clearly
mentioned

Introduction

Background/
rationale

2

Explain the scientific background and
rationale for the investigation being reported

Yes

3599- 3600

Clearly
mentioned

Objectives

3

State-specific objectives, including any
prespecified hypotheses

Yes

3599- 3600

Only
objectives
mentioned

Methods

Study design

4

Present key elements of study design early
in the paper

Yes

3600

Clearly
mentioned

Setting

5

Describe the setting, locations, and relevant
dates, including periods of recruitment,
exposure, follow-up, and data collection

Yes

3600

Applicable
aspects
mentioned

Participants

6

(

a

) Give the eligibility criteria and the

sources and methods of selection of
participants

Not
clear

NA

Eligibility
criteria not
clear

Variables

7

Clearly define all outcomes, exposures,
predictors, potential confounders, and effect
modifiers. Give diagnostic criteria, if
applicable

Yes

3600

Outcome
measures
were
explained
and others
were not
mentioned

Data sources/
measurement

8*

For each variable of interest, give sources

of data and details of methods of assessment
(measurement). Describe comparability of
assessment methods if there is more than
one group

Yes

3600

No
comparison
is there

Bias

9

Describe any efforts to address potential
sources of bias

Yes

3600

Random type
sampling
done

Study size

10

Explain how the study size was arrived at

Yes

3600

Clearly

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38

mentioned

Quantitative
variables

11

Explain how quantitative variables were
handled in the analyses. If applicable,
describe which groupings were chosen and
why

Yes

3600

mentioned

Statistical
methods

12

(

a

) Describe all statistical methods,

including those used to control for
confounding

Not
clear

NA

Not
explained

(

b

) Describe any methods used to examine

subgroups and interactions

Yes

3601-3602

Chi-square
test

(

c

) Explain how missing data were

addressed

NA

(

d

) If applicable, describe analytical

methods taking account of sampling
strategy

Not
clear

NA

(

e

) Describe any sensitivity analyses

No

NA

Results

Participants

13*

(a) Report numbers of individuals at each
stage of study—eg numbers potentially
eligible, examined for eligibility, confirmed
eligible, included in the study, completing
follow-up, and analysed

Yes

3600

Sample size
mentioned

(b) Give reasons for non-participation at
each stage

NA

(c) Consider use of a flow diagram

No

NA

Descriptive data

14*

(a) Give characteristics of study participants
(eg demographic, clinical, social) and
information on exposures and potential
confounders

Yes

3600

Mentioned
except
exposures
and potential
confounders

(b) Indicate number of participants with
missing data for each variable of interest

NA

Outcome data

15*

Report numbers of outcome events or
summary measures

Yes

3601

Prevalence
mentioned

Main results

16

(

a

) Give unadjusted estimates and, if

applicable, confounder-adjusted estimates
and their precision (eg, 95% confidence
interval). Make clear which confounders
were adjusted for and why they were
included

Not
clear

NA

Chi-square
results only
mentioned

(

b

) Report category boundaries when

continuous variables were categorized

Not
clear

NA

(

c

) If relevant, consider translating estimates

of relative risk into absolute risk for a
meaningful time period

NA

Other analyses

17

Report other analyses done—eg analyses of
subgroups and interactions, and sensitivity
analyses

NA

Discussion

Key results

18

Summarise key results with reference to
study objectives

Yes

128-130

Mentioned

Limitations

19

Discuss limitations of the study, taking into

No

NA

Not

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account sources of potential bias or
imprecision. Discuss both direction and
magnitude of any potential bias

mentioned

Interpretation

20

Give a cautious overall interpretation of
results considering objectives, limitations,
multiplicity of analyses, results from similar
studies, and other relevant evidence

Yes

128-130

Mentioned

Generalisability

21

Discuss the generalisability (external
validity) of the study results

Yes

130

Implications
provided

Other information

Funding

22

Give the source of funding and the role of
the funders for the present study and, if
applicable, for the original study on which
the present article is based

NA

130

No funding

Study 3: Prevalence of obesity among adolescent school children in rural
and urban south Odisha

Item

No

Recommendation

Yes/No/

Not
clear

Page
number

Comments

Title and
abstract

1

(

a

) Indicate the study’s design with a

commonly used term in the title or the
abstract

Yes

261

Clearly
mentioned

(

b

) Provide in the abstract an informative

and balanced summary of what was done
and what was found

Yes

261

Clearly
mentioned

Introduction

Background/
rationale

2

Explain the scientific background and
rationale for the investigation being
reported

Yes

261-262

Clearly
mentioned

Objectives

3

State-specific objectives, including any
prespecified hypotheses

Yes

262

Only
objectives
mentioned

Methods

Study design

4

Present key elements of study design early
in the paper

Yes

262

Clearly
mentioned

Setting

5

Describe the setting, locations, and relevant
dates, including periods of recruitment,
exposure, follow-up, and data collection

Yes

262

Applicable
aspects
mentioned

Participants

6

(

a

) Give the eligibility criteria and the

sources and methods of selection of
participants

Not
clear

NA

Eligibility
criteria not
clear

Variables

7

Clearly define all outcomes, exposures,
predictors, potential confounders, and effect
modifiers. Give diagnostic criteria, if
applicable

Not
clear

NA

Only
outcome
measures
were
explained

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Data sources/
measurement

8*

For each variable of interest, give sources

of data and details of methods of assessment
(measurement). Describe comparability of
assessment methods if there is more than
one group

Yes

262

Mentioned

Bias

9

Describe any efforts to address potential
sources of bias

Yes

262

Random
sampling
done

Study size

10

Explain how the study size was arrived at

Yes

262

Clearly
mentioned

Quantitative
variables

11

Explain how quantitative variables were
handled in the analyses. If applicable,
describe which groupings were chosen and
why

Yes

262

Mentioned
about coding

Statistical
methods

12

(

a

) Describe all statistical methods,

including those used to control for
confounding

Yes

262

Not about
confounders

(

b

) Describe any methods used to examine

subgroups and interactions

Yes

262

Chi-square
test

(

c

) Explain how missing data were

addressed

NA

Not
mentioned

(

d

) If applicable, describe analytical

methods taking account of sampling
strategy

Not
clear

NA

(

e

) Describe any sensitivity analyses

No

NA

Results

Participants

13*

(a) Report numbers of individuals at each
stage of study—eg numbers potentially
eligible, examined for eligibility, confirmed
eligible, included in the study, completing
follow-up, and analysed

Yes

262

As per the
cross-
sectional
study

(b) Give reasons for non-participation at
each stage

NA

(c) Consider use of a flow diagram

No

NA

No diagram

Descriptive data

14*

(a) Give characteristics of study participants
(eg demographic, clinical, social) and
information on exposures and potential
confounders

Yes

262-263

No
information
on exposures
and potential
confounders

(b) Indicate number of participants with
missing data for each variable of interest

NA

Outcome data

15*

Report numbers of outcome events or
summary measures

Yes

263

Prevalence
mentioned

Main results

16

(

a

) Give unadjusted estimates and, if

applicable, confounder-adjusted estimates
and their precision (eg, 95% confidence
interval). Make clear which confounders
were adjusted for and why they were
included

No

NA

(

b

) Report category boundaries when

continuous variables were categorized

Yes

263-264

mentioned

(

c

) If relevant, consider translating estimates NA

NA

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VOLUME 06 ISSUE11

41

of relative risk into absolute risk for a
meaningful time period

Other analyses

17

Report other analyses done—eg analyses of
subgroups and interactions, and sensitivity
analyses

NA

Discussion

Key results

18

Summarise key results with reference to
study objectives

Yes

264-265

Mentioned

Limitations

19

Discuss limitations of the study, taking into
account sources of potential bias or
imprecision. Discuss both direction and
magnitude of any potential bias

Yes

264-265

Mentioned

Interpretation

20

Give a cautious overall interpretation of
results considering objectives, limitations,
multiplicity of analyses, results from similar
studies, and other relevant evidence

Yes

264-265

Mentioned

Generalisability

21

Discuss the generalisability (external
validity) of the study results

Yes

265

Implications
provided

Other information

Funding

22

Give the source of funding and the role of
the funders for the present study and, if
applicable, for the original study on which
the present article is based

NA

No funding

Study 4: Behavioural Determinants for Obesity: A Cross-sectional Study
Among Urban Adolescents in India

Item

No

Recommendation

Yes/No/

Not
clear

Page
number

Comments

Title and
abstract

1

(

a

) Indicate the study’s design with a

commonly used term in the title or the
abstract

Yes

192

Clearly
mentioned

(

b

) Provide in the abstract an informative

and balanced summary of what was done
and what was found

Yes

192

Clearly
mentioned

Introduction

Background/
rationale

2

Explain the scientific background and
rationale for the investigation being
reported

Yes

192-193

Clearly
mentioned

Objectives

3

State-specific objectives, including any
prespecified hypotheses

Yes

193

Only
objectives
mentioned

Methods

Study design

4

Present key elements of study design early
in the paper

Yes

193

Clearly
mentioned

Setting

5

Describe the setting, locations, and relevant
dates, including periods of recruitment,
exposure, follow-up, and data collection

Yes

193

Applicable
aspects
mentioned

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Participants

6

(

a

) Give the eligibility criteria and the

sources and methods of selection of
participants

Not
clear

NA

Method of
selection
mentioned

Variables

7

Clearly define all outcomes, exposures,
predictors, potential confounders, and effect
modifiers. Give diagnostic criteria, if
applicable

Yes
(only
outcome
)

194

Outcome
measures
were
explained
and others
were not
applicable

Data sources/
measurement

8*

For each variable of interest, give sources

of data and details of methods of assessment
(measurement). Describe comparability of
assessment methods if there is more than
one group

Yes

193-194

Mentioned

Bias

9

Describe any efforts to address potential
sources of bias

Yes

193

Random
sampling
done

Study size

10

Explain how the study size was arrived at

Yes

193

Clearly
mentioned

Quantitative
variables

11

Explain how quantitative variables were
handled in the analyses. If applicable,
describe which groupings were chosen and
why

Yes

194

Grouping
based on
tools

Statistical
methods

12

(

a

) Describe all statistical methods,

including those used to control for
confounding

Yes

194

Mentioned

(

b

) Describe any methods used to examine

subgroups and interactions

Yes

194

Chi-square
test,
multivariate
analysis

(

c

) Explain how missing data were

addressed

NA

Not
mentioned

(

d

) If applicable, describe analytical

methods taking account of sampling
strategy

Not
clear

NA

(

e

) Describe any sensitivity analyses

No

NA

Results

Participants

13*

(a) Report numbers of individuals at each
stage of study—eg numbers potentially
eligible, examined for eligibility, confirmed
eligible, included in the study, completing
follow-up, and analysed

Yes

193

As per the
cross-
sectional
study

(b) Give reasons for non-participation at
each stage

Yes

194

Some not
provide
consent

(c) Consider use of a flow diagram

No

NA

No diagram

Descriptive data

14*

(a) Give characteristics of study participants
(eg demographic, clinical, social) and
information on exposures and potential
confounders

Yes

194

No
information
on exposures
and potential
confounders

(b) Indicate number of participants with

NA

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43

missing data for each variable of interest

Outcome data

15*

Report numbers of outcome events or
summary measures

Yes

196

Prevalence
mentioned

Main results

16

(

a

) Give unadjusted estimates and, if

applicable, confounder-adjusted estimates
and their precision (eg, 95% confidence
interval). Make clear which confounders
were adjusted for and why they were
included

Yes

196

Logistic
regression

(

b

) Report category boundaries when

continuous variables were categorized

Yes

195

mentioned

(

c

) If relevant, consider translating estimates

of relative risk into absolute risk for a
meaningful time period

NA

Other analyses

17

Report other analyses done—eg analyses of
subgroups and interactions, and sensitivity
analyses

NA

Discussion

Key results

18

Summarise key results with reference to
study objectives

Yes

196

Mentioned

Limitations

19

Discuss limitations of the study, taking into
account sources of potential bias or
imprecision. Discuss both direction and
magnitude of any potential bias

Yes

198

Mentioned

Interpretation

20

Give a cautious overall interpretation of
results considering objectives, limitations,
multiplicity of analyses, results from similar
studies, and other relevant evidence

Yes

196-198

Mentioned

Generalisability

21

Discuss the generalisability (external
validity) of the study results

Yes

198

Implications
provided

Other information

Funding

22

Give the source of funding and the role of
the funders for the present study and, if
applicable, for the original study on which
the present article is based

Yes

198

Just funding
only
mentioned

Study 5: Prevalence of obesity among urban and rural school going
adolescents of Vadodara, India: a comparative study

Item

No

Recommendation

Yes/No/

Not
clear

Page
number

Comments

Title and
abstract

1

(

a

) Indicate the study’s design with a

commonly used term in the title or the
abstract

Yes

1355

Clearly
mentioned

(

b

) Provide in the abstract an informative

and balanced summary of what was done
and what was found

Yes

1355

Clearly
mentioned

Introduction

Background/

2

Explain the scientific background and

Yes

1355-1356 Clearly

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VOLUME 06 ISSUE11

44

rationale

rationale for the investigation being reported

mentioned

Objectives

3

State-specific objectives, including any
prespecified hypotheses

Yes

1356

Only purpose
mentioned

Methods

Study design

4

Present key elements of study design early
in the paper

Yes

1356

Clearly
mentioned

Setting

5

Describe the setting, locations, and relevant
dates, including periods of recruitment,
exposure, follow-up, and data collection

Yes

1356

Applicable
contents
mentioned

Participants

6

(

a

) Give the eligibility criteria and the

sources and methods of selection of
participants

Not
clear

NA

Method of
selection
mentioned

Variables

7

Clearly define all outcomes, exposures,
predictors, potential confounders, and effect
modifiers. Give diagnostic criteria, if
applicable

Yes
(only
outcome
)

1356

BMI were
explained and
others were
not applicable

Data sources/
measurement

8*

For each variable of interest, give sources

of data and details of methods of assessment
(measurement). Describe comparability of
assessment methods if there is more than
one group

Yes

1356

Mentioned

Bias

9

Describe any efforts to address potential
sources of bias

No

NA

Study size

10

Explain how the study size was arrived at

No

NA

Quantitative
variables

11

Explain how quantitative variables were
handled in the analyses. If applicable,
describe which groupings were chosen and
why

Yes

1356

Mentioned

Statistical
methods

12

(

a

) Describe all statistical methods,

including those used to control for
confounding

Yes

1356

Mentioned

(

b

) Describe any methods used to examine

subgroups and interactions

Yes

1356

Different tests
done

(

c

) Explain how missing data were

addressed

NA

Not mentioned

(

d

) If applicable, describe analytical

methods taking account of sampling
strategy

Not
clear

NA

(

e

) Describe any sensitivity analyses

No

NA

Results

Participants

13*

(a) Report numbers of individuals at each
stage of study—eg numbers potentially
eligible, examined for eligibility, confirmed
eligible, included in the study, completing
follow-up, and analysed

Yes

1356

As per the
cross-sectional
study

(b) Give reasons for non-participation at
each stage

Yes

1356

Mentioned
about
incomplete
data of some
children

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(c) Consider use of a flow diagram

No

NA

No diagram

Descriptive data

14*

(a) Give characteristics of study participants
(eg demographic, clinical, social) and
information on exposures and potential
confounders

Yes

1356

No
information on
exposures and
potential
confounders

(b) Indicate number of participants with
missing data for each variable of interest

Yes

1356

36 data record
sheets were
incomplete

Outcome data

15*

Report numbers of outcome events or
summary measures

Yes

1357

Prevalence
mentioned

Main results

16

(

a

) Give unadjusted estimates and, if

applicable, confounder-adjusted estimates
and their precision (eg, 95% confidence
interval). Make clear which confounders
were adjusted for and why they were
included

Not
clear

NA

(

b

) Report category boundaries when

continuous variables were categorized

Yes

1356

mentioned

(

c

) If relevant, consider translating estimates

of relative risk into absolute risk for a
meaningful time period

NA

Other analyses

17

Report other analyses done—eg analyses of
subgroups and interactions, and sensitivity
analyses

Yes

1356

Some analysis
done

Discussion

Key results

18

Summarise key results with reference to
study objectives

Yes

1357

Mentioned

Limitations

19

Discuss limitations of the study, taking into
account sources of potential bias or
imprecision. Discuss both direction and
magnitude of any potential bias

Yes

1358

Mentioned

Interpretation

20

Give a cautious overall interpretation of
results considering objectives, limitations,
multiplicity of analyses, results from similar
studies, and other relevant evidence

Yes

1357-1358 Mentioned

Generalisability

21

Discuss the generalisability (external
validity) of the study results

Not
clear

NA

Other information

Funding

22

Give the source of funding and the role of
the funders for the present study and, if
applicable, for the original study on which
the present article is based

Yes

1358

No funding

Study 6: A cross-sectional study on the Prevalence of overweight and
obesity among school children of 6-12 years age in a rural area in Trichy
district, Tamil Nadu

Item

No

Recommendation

Yes/No/ Page

number

Comments

THE USA JOURNALS

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VOLUME 06 ISSUE11

46

Not
clear

Title and
abstract

1

(

a

) Indicate the study’s design with a

commonly used term in the title or the
abstract

Yes

210

Clearly
mentioned

(

b

) Provide in the abstract an informative

and balanced summary of what was done
and what was found

Yes

210

Clearly
mentioned

Introduction

Background/
rationale

2

Explain the scientific background and
rationale for the investigation being reported

Yes

210

Clearly
mentioned

Objectives

3

State-specific objectives, including any
prespecified hypotheses

Yes

210

Only aim
mentioned

Methods

Study design

4

Present key elements of study design early
in the paper

Yes

211

Clearly
mentioned

Setting

5

Describe the setting, locations, and relevant
dates, including periods of recruitment,
exposure, follow-up, and data collection

Yes

211

Applicable
contents
mentioned

Participants

6

(

a

) Give the eligibility criteria and the

sources and methods of selection of
participants

Yes

211

Mentioned

Variables

7

Clearly define all outcomes, exposures,
predictors, potential confounders, and effect
modifiers. Give diagnostic criteria, if
applicable

Yes
(only
outcome
)

211

BMI was
explained and
others were
not applicable

Data sources/
measurement

8*

For each variable of interest, give sources

of data and details of methods of assessment
(measurement). Describe comparability of
assessment methods if there is more than
one group

Yes

211

Mentioned

Bias

9

Describe any efforts to address potential
sources of bias

No

NA

Study size

10

Explain how the study size was arrived at

No

NA

Quantitative
variables

11

Explain how quantitative variables were
handled in the analyses. If applicable,
describe which groupings were chosen and
why

Yes

211

Grouping not
clear

Statistical
methods

12

(

a

) Describe all statistical methods,

including those used to control for
confounding

Yes

211

No mention on
control for
confounding

(

b

) Describe any methods used to examine

subgroups and interactions

Yes

212

Chi square

(

c

) Explain how missing data were

addressed

NA

Not mentioned

(

d

) If applicable, describe analytical

methods taking account of sampling
strategy

Not
clear

NA

(

e

) Describe any sensitivity analyses

No

NA

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Results

Participants

13*

(a) Report numbers of individuals at each
stage of study—eg numbers potentially
eligible, examined for eligibility, confirmed
eligible, included in the study, completing
follow-up, and analysed

Yes

211

Sample size
mentioned

(b) Give reasons for non-participation at
each stage

NA

(c) Consider use of a flow diagram

No

NA

No diagram

Descriptive data

14*

(a) Give characteristics of study participants
(eg demographic, clinical, social) and
information on exposures and potential
confounders

Yes

211

No
information on
exposures and
potential
confounders

(b) Indicate number of participants with
missing data for each variable of interest

NA

Outcome data

15*

Report numbers of outcome events or
summary measures

Yes

211

Prevalence
mentioned

Main results

16

(

a

) Give unadjusted estimates and, if

applicable, confounder-adjusted estimates
and their precision (eg, 95% confidence
interval). Make clear which confounders
were adjusted for and why they were
included

No

NA

(

b

) Report category boundaries when

continuous variables were categorized

Yes

212

mentioned

(

c

) If relevant, consider translating estimates

of relative risk into absolute risk for a
meaningful time period

NA

Other analyses

17

Report other analyses done—eg analyses of
subgroups and interactions, and sensitivity
analyses

NA

Discussion

Key results

18

Summarise key results with reference to
study objectives

Yes

213

Mentioned

Limitations

19

Discuss limitations of the study, taking into
account sources of potential bias or
imprecision. Discuss both direction and
magnitude of any potential bias

Yes

213

Mentioned

Interpretation

20

Give a cautious overall interpretation of
results considering objectives, limitations,
multiplicity of analyses, results from similar
studies, and other relevant evidence

Yes

213

Mentioned

Generalisability

21

Discuss the generalisability (external
validity) of the study results

Not
clear

NA

Other information

Funding

22

Give the source of funding and the role of
the funders for the present study and, if
applicable, for the original study on which
the present article is based

No

213

No funding

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48

Study 7: Prevalence of overweight and obesity among rural adolescent
school students in Kanchipuram district, Tamil Nadu

Item

No

Recommendation

Yes/No/

Not
clear

Page
number

Comments

Title and
abstract

1

(

a

) Indicate the study’s design with a

commonly used term in the title or the
abstract

Yes

173

Clearly
mentioned

(

b

) Provide in the abstract an informative

and balanced summary of what was done
and what was found

Yes

173

Clearly
mentioned

Introduction

Background/
rationale

2

Explain the scientific background and
rationale for the investigation being reported

Yes

173

Clearly
mentioned

Objectives

3

State-specific objectives, including any
prespecified hypotheses

Yes

173

Not specified
it as
objectives, just
mentioned

Methods

Study design

4

Present key elements of study design early
in the paper

Yes

173

In abstract
only

Setting

5

Describe the setting, locations, and relevant
dates, including periods of recruitment,
exposure, follow-up, and data collection

Yes

174

Not all
applicable

Participants

6

(

a

) Give the eligibility criteria and the

sources and methods of selection of
participants

Not
clear

NA

Not clear. But
mentioned few
points

Variables

7

Clearly define all outcomes, exposures,
predictors, potential confounders, and effect
modifiers. Give diagnostic criteria, if
applicable

Yes
(only
outcome
)

174

BMI were
explained and
others were
not applicable

Data sources/
measurement

8*

For each variable of interest, give sources

of data and details of methods of assessment
(measurement). Describe comparability of
assessment methods if there is more than
one group

Not
clear

NA

Not clear

Bias

9

Describe any efforts to address potential
sources of bias

Yes

174

Simple
random
technique used
for sampling

Study size

10

Explain how the study size was arrived at

Yes

174

Mentioned

Quantitative
variables

11

Explain how quantitative variables were
handled in the analyses. If applicable,
describe which groupings were chosen and
why

Yes

174

Grouping not
clear

Statistical

12

(

a

) Describe all statistical methods,

No

NA

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49

methods

including those used to control for
confounding
(

b

) Describe any methods used to examine

subgroups and interactions

No

NA

(

c

) Explain how missing data were

addressed

NA

Not mentioned

(

d

) If applicable, describe analytical

methods taking account of sampling
strategy

Not
clear

NA

(

e

) Describe any sensitivity analyses

No

NA

Results

Participants

13*

(a) Report numbers of individuals at each
stage of study—eg numbers potentially
eligible, examined for eligibility, confirmed
eligible, included in the study, completing
follow-up, and analysed

Yes

174

Sample size
mentioned

(b) Give reasons for non-participation at
each stage

NA

(c) Consider use of a flow diagram

No

NA

No diagram

Descriptive data

14*

(a) Give characteristics of study participants
(eg demographic, clinical, social) and
information on exposures and potential
confounders

Yes

174-175

No
information on
exposures and
potential
confounders

(b) Indicate number of participants with
missing data for each variable of interest

NA

Outcome data

15*

Report numbers of outcome events or
summary measures

Yes

175

Prevalence
mentioned

Main results

16

(

a

) Give unadjusted estimates and, if

applicable, confounder-adjusted estimates
and their precision (eg, 95% confidence
interval). Make clear which confounders
were adjusted for and why they were
included

No

NA

(

b

) Report category boundaries when

continuous variables were categorized

Not
clear

NA

(

c

) If relevant, consider translating estimates

of relative risk into absolute risk for a
meaningful time period

NA

Other analyses

17

Report other analyses done—eg analyses of
subgroups and interactions, and sensitivity
analyses

NA

Discussion

Key results

18

Summarise key results with reference to
study objectives

Yes

175

Mentioned

Limitations

19

Discuss limitations of the study, taking into
account sources of potential bias or
imprecision. Discuss both direction and
magnitude of any potential bias

Yes

175

Mentioned

Interpretation

20

Give a cautious overall interpretation of
results considering objectives, limitations,
multiplicity of analyses, results from similar

Yes

175

Mentioned

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studies, and other relevant evidence

Generalisability

21

Discuss the generalisability (external
validity) of the study results

Yes

175

implications

Other information

Funding

22

Give the source of funding and the role of
the funders for the present study and, if
applicable, for the original study on which
the present article is based

No

175

No funding

Study 8: Prevalence of overweight and obesity among children aged 5-15
years in a rural school in Coimbatore

Item

No

Recommendation

Yes/No/

Not
clear

Page
number

Comments

Title and
abstract

1

(

a

) Indicate the study’s design with a

commonly used term in the title or the
abstract

Yes

2186

Clearly
mentioned

(

b

) Provide in the abstract an informative

and balanced summary of what was done
and what was found

Yes

2186

Clearly
mentioned

Introduction

Background/
rationale

2

Explain the scientific background and
rationale for the investigation being reported

Yes

2186-2187 Clearly

mentioned

Objectives

3

State-specific objectives, including any
prespecified hypotheses

Yes

2186-2187 Not specified

about
hypothesis

Methods

Study design

4

Present key elements of study design early
in the paper

Yes

2187

mentioned

Setting

5

Describe the setting, locations, and relevant
dates, including periods of recruitment,
exposure, follow-up, and data collection

Yes

2187

Not all
applicable

Participants

6

(

a

) Give the eligibility criteria and the

sources and methods of selection of
participants

Not
clear

NA

Not clear.

Variables

7

Clearly define all outcomes, exposures,
predictors, potential confounders, and effect
modifiers. Give diagnostic criteria, if
applicable

Yes
(only
outcome
)

2187

BMI were
explained and
others were
not applicable

Data sources/
measurement

8*

For each variable of interest, give sources

of data and details of methods of assessment
(measurement). Describe comparability of
assessment methods if there is more than
one group

Yes

2187

Mentioned

Bias

9

Describe any efforts to address potential
sources of bias

No

NA

No mention

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51

Study size

10

Explain how the study size was arrived at

No

NA

No mention

Quantitative
variables

11

Explain how quantitative variables were
handled in the analyses. If applicable,
describe which groupings were chosen and
why

Yes

2187

Grouping not
clear

Statistical
methods

12

(

a

) Describe all statistical methods,

including those used to control for
confounding

No

NA

(

b

) Describe any methods used to examine

subgroups and interactions

No

NA

(

c

) Explain how missing data were

addressed

NA

Not mentioned

(

d

) If applicable, describe analytical

methods taking account of sampling
strategy

Not
clear

NA

(

e

) Describe any sensitivity analyses

No

NA

Results

Participants

13*

(a) Report numbers of individuals at each
stage of study—eg numbers potentially
eligible, examined for eligibility, confirmed
eligible, included in the study, completing
follow-up, and analysed

Yes

2187

Sample size
mentioned

(b) Give reasons for non-participation at
each stage

NA

(c) Consider use of a flow diagram

No

NA

No diagram

Descriptive data

14*

(a) Give characteristics of study participants
(eg demographic, clinical, social) and
information on exposures and potential
confounders

Yes

2187

No
information on
exposures and
potential
confounders

(b) Indicate number of participants with
missing data for each variable of interest

NA

Outcome data

15*

Report numbers of outcome events or
summary measures

Yes

2187

Prevalence
mentioned

Main results

16

(

a

) Give unadjusted estimates and, if

applicable, confounder-adjusted estimates
and their precision (eg, 95% confidence
interval). Make clear which confounders
were adjusted for and why they were
included

No

NA

(

b

) Report category boundaries when

continuous variables were categorized

Not
clear

NA

(

c

) If relevant, consider translating estimates

of relative risk into absolute risk for a
meaningful time period

NA

Other analyses

17

Report other analyses done—eg analyses of
subgroups and interactions, and sensitivity
analyses

NA

Discussion

Key results

18

Summarise key results with reference to
study objectives

Yes

2187

Mentioned

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Limitations

19

Discuss limitations of the study, taking into
account sources of potential bias or
imprecision. Discuss both direction and
magnitude of any potential bias

Yes

2187

Mentioned

Interpretation

20

Give a cautious overall interpretation of
results considering objectives, limitations,
multiplicity of analyses, results from similar
studies, and other relevant evidence

Yes

2187-2188 Mentioned

Generalisability

21

Discuss the generalisability (external
validity) of the study results

Yes

2188

implications

Other information

Funding

22

Give the source of funding and the role of
the funders for the present study and, if
applicable, for the original study on which
the present article is based

No

2189

No funding

Study 9:

Study on prevalence of overweight and obesity amongst school

children of Bangalore

Item

No

Recommendation

Yes/No/

Not
clear

Page
number

Comments

Title and
abstract

1

(

a

) Indicate the study’s design with a

commonly used term in the title or the
abstract

Yes

159

Clearly
mentioned

(

b

) Provide in the abstract an informative

and balanced summary of what was done
and what was found

Yes

159

Clearly
mentioned

Introduction

Background/
rationale

2

Explain the scientific background and
rationale for the investigation being reported

Yes

159-160

Clearly
mentioned

Objectives

3

State-specific objectives, including any
prespecified hypotheses

Yes

160

Not specified
about
hypothesis

Methods

Study design

4

Present key elements of study design early
in the paper

Yes

160

Mentioned

Setting

5

Describe the setting, locations, and relevant
dates, including periods of recruitment,
exposure, follow-up, and data collection

Yes

160

Mentioned
applicable
aspects

Participants

6

(

a

) Give the eligibility criteria and the

sources and methods of selection of
participants

Yes

160

Not clear. But
mentioned

Variables

7

Clearly define all outcomes, exposures,
predictors, potential confounders, and effect
modifiers. Give diagnostic criteria, if
applicable

Yes
(only
outcome
)

160

Outcomes
defined

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Data sources/
measurement

8*

For each variable of interest, give sources

of data and details of methods of assessment
(measurement). Describe comparability of
assessment methods if there is more than
one group

Yes

160-162

Mentioned

Bias

9

Describe any efforts to address potential
sources of bias

No

NA

No mention

Study size

10

Explain how the study size was arrived at

No

NA

No mention

Quantitative
variables

11

Explain how quantitative variables were
handled in the analyses. If applicable,
describe which groupings were chosen and
why

Yes

160

Grouping not
clear

Statistical
methods

12

(

a

) Describe all statistical methods,

including those used to control for
confounding

No

NA

(

b

) Describe any methods used to examine

subgroups and interactions

No

NA

(

c

) Explain how missing data were

addressed

NA

Not mentioned

(

d

) If applicable, describe analytical

methods taking account of sampling
strategy

Not
clear

NA

(

e

) Describe any sensitivity analyses

No

NA

Results

Participants

13*

(a) Report numbers of individuals at each
stage of study—eg numbers potentially
eligible, examined for eligibility, confirmed
eligible, included in the study, completing
follow-up, and analysed

Yes

161

Sample size
mentioned

(b) Give reasons for non-participation at
each stage

NA

(c) Consider use of a flow diagram

No

NA

No diagram

Descriptive data

14*

(a) Give characteristics of study participants
(eg demographic, clinical, social) and
information on exposures and potential
confounders

Yes

161

No
information on
exposures and
potential
confounders

(b) Indicate number of participants with
missing data for each variable of interest

NA

Outcome data

15*

Report numbers of outcome events or
summary measures

Yes

161

Prevalence
mentioned

Main results

16

(

a

) Give unadjusted estimates and, if

applicable, confounder-adjusted estimates
and their precision (eg, 95% confidence
interval). Make clear which confounders
were adjusted for and why they were
included

No

NA

(

b

) Report category boundaries when

continuous variables were categorized

Yes

161

Mentioned

(

c

) If relevant, consider translating estimates

of relative risk into absolute risk for a
meaningful time period

NA

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Other analyses

17

Report other analyses done—eg analyses of
subgroups and interactions, and sensitivity
analyses

NA

Discussion

Key results

18

Summarise key results with reference to
study objectives

Yes

162-163

Mentioned

Limitations

19

Discuss the limitations of the study, taking
into account sources of potential bias or
imprecision. Discuss both the direction and
magnitude of any potential bias

No

NA

Interpretation

20

Give a cautious overall interpretation of
results considering objectives, limitations,
multiplicity of analyses, results from similar
studies, and other relevant evidence

Yes

161-162

Mentioned

Generalisability

21

Discuss the generalisability (external
validity) of the study results

Yes

162-163

Implications

Other information

Funding

22

Give the source of funding and the role of
the funders for the present study and, if
applicable, for the original study on which
the present article is based

No

163

No funding

Study 10: A cross-sectional study on the prevalence of overweight and
obesity in affluent school children of central Kerala

Item

No

Recommendation

Yes/No/

Not
clear

Page
number

Comments

Title and
abstract

1

(

a

) Indicate the study’s design with a

commonly used term in the title or the
abstract

Yes

4284

Clearly
mentioned

(

b

) Provide in the abstract an informative

and balanced summary of what was done
and what was found

Yes

4284

Clearly
mentioned

Introduction

Background/
rationale

2

Explain the scientific background and
rationale for the investigation being reported

Yes

4284-

4285

Clearly
mentioned

Objectives

3

State-specific objectives, including any
prespecified hypotheses

Yes

4284

and

4285

Not specified
about
hypothesis

Methods

Study design

4

Present key elements of study design early
in the paper

Yes

4285

Mentioned

Setting

5

Describe the setting, locations, and relevant
dates, including periods of recruitment,
exposure, follow-up, and data collection

Yes

4285

Mentioned
applicable
details

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Participants

6

(

a

) Give the eligibility criteria and the

sources and methods of selection of
participants

Yes

4285

Not fully
mentioned

Variables

7

Clearly define all outcomes, exposures,
predictors, potential confounders, and effect
modifiers. Give diagnostic criteria, if
applicable

Not
clear

4285

Outcome
variables
measurement
mentioned

Data sources/
measurement

8*

For each variable of interest, give sources

of data and details of methods of assessment
(measurement). Describe comparability of
assessment methods if there is more than
one group

Yes

4285

Mentioned

Bias

9

Describe any efforts to address potential
sources of bias

Yes

4285

Sampling;
universal

Study size

10

Explain how the study size was arrived at

No

4285

Mentioned

Quantitative
variables

11

Explain how quantitative variables were
handled in the analyses. If applicable,
describe which groupings were chosen and
why

Yes

4285

Grouping not
mentioned
clearly

Statistical
methods

12

(

a

) Describe all statistical methods,

including those used to control for
confounding

Yes

4285

Not mentioned
about
confounding

(

b

) Describe any methods used to examine

subgroups and interactions

Yes

4286

Chi-square done

(

c

) Explain how missing data were

addressed

NA

Not mentioned

(

d

) If applicable, describe analytical

methods taking account of sampling
strategy

Not
clear

NA

(

e

) Describe any sensitivity analyses

No

NA

Results

Participants

13*

(a) Report numbers of individuals at each
stage of study—eg numbers potentially
eligible, examined for eligibility, confirmed
eligible, included in the study, completing
follow-up, and analysed

Yes

4285

Sample size
mentioned

(b) Give reasons for non-participation at
each stage

NA

(c) Consider use of a flow diagram

No

NA

No diagram

Descriptive data

14*

(a) Give characteristics of study participants
(eg demographic, clinical, social) and
information on exposures and potential
confounders

Yes

4285

No
information on
exposures and
potential
confounders

(b) Indicate number of participants with
missing data for each variable of interest

NA

Outcome data

15*

Report numbers of outcome events or
summary measures

Yes

4285

Prevalence
mentioned

Main results

16

(

a

) Give unadjusted estimates and, if

applicable, confounder-adjusted estimates
and their precision (eg, 95% confidence
interval). Make clear which confounders

No

NA

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were adjusted for and why they were
included
(

b

) Report category boundaries when

continuous variables were categorized

Not
clear

NA

(

c

) If relevant, consider translating estimates

of relative risk into absolute risk for a
meaningful time period

NA

Other analyses

17

Report other analyses done—eg analyses of
subgroups and interactions, and sensitivity
analyses

Not
clear

NA

Discussion

Key results

18

Summarise key results with reference to
study objectives

Yes

4286

Mentioned

Limitations

19

Discuss the limitations of the study,
considering sources of potential bias or
imprecision. Discuss both direction and
magnitude of any potential bias

No

4286

NA

Interpretation

20

Give a cautious overall interpretation of
results considering objectives, limitations,
multiplicity of analyses, results from similar
studies, and other relevant evidence

Yes

4286

Mentioned

Generalisability

21

Discuss the generalisability (external
validity) of the study results

Yes

4286-4287 Implications

Other information

Funding

22

Give the source of funding and the role of
the funders for the present study and, if
applicable, for the original study on which
the present article is based

No

4287

No funding

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Appendix 2: Data Extraction Table

Childhood Obesity in Urban and Rural India: A

Systematic Review and Meta-Analyses of Prevalence

Studies

Authors/ye
ar

Aim/objectives

Study
design

Study
setting

Urb
an/
rura
l
area

Sa
mp
le
siz
e

Sampl

ing

Study

popula

tion

(age

group)

Data
collection
details

(Jain et al.,
2016)

To study the
obesity among
children of aged
5-18 years in
Jaipur,
Rajasthan.

Cross
sectional
study

Jaipur,
Rajastha
n

Urba
n

10
00

Simple

rando

m

sampli

ng

Childre

n

( 5-18
years)

Semi-
structured
questionn
aire,
(BMI)
was
calculated

(Ghonge et
al., 2015)

To find out
prevalence of
obesity and
overweight
among school
children.

Cross
sectional
study

Pune,
Maharas
htra

Urba
n

12
81

Rando

m

sampli

ng

Childre

n

(10 and

15

years)

Pre-
designed,
pre-
tested,
semi-
structured
performa,
BMI were
calculated

(Pradhan et
al., 2022)

Estimating the
prevalence of
obesity among
rural and urban
adolescent
school children
and to assess the
risk
factors
associated with
adolescent
obesity.

Cross
sectional
study

Ganjam,

Odisha

Urba
n
and

Rura
l

18
0

Syste

matic

rando

m

sampli

ng

Adoles

cents

(high

school)

Pre-
designed
and pre-
tested
questionn
aire,
(BMI)
was
calculated

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(Rani and
Sathiyaseka
ran, 2013)

To address the
prevalence of
behavioural risk
factors for
obesity among
randomly
selected urban
adolescent
students from
both private
and government
schools in
Chennai, Tamil
Nadu.

Cross
sectional
study

Chennai

,

Tamil

Nadu

Urba
n

18
42

Simple

rando

m

sampli

ng

Adoles

cents

(12-18

years)

Age-
appropriat
e
modified
GSHS
self-
administe
red
questionn
aire,
standardiz
ed
Internatio
nal
Physical
Activity
Questionn
aire (short
form),(B
MI) was
calculated

(Pathak et
al., 2018)

To compare the
prevalence
of obesity
among urban and
rural school
going children of
adolescent age in
district of
Vadodara and
also to study
various
predisposing
factors.

Cross
sectional
study

Vadodar

a,

Gujarat

Urba
n
and

Rura
l

18
8

No

details

School

going

childre

n of

adolesc

ent

age

group

(10 to

18

years

of age)

(BMI)
was
calculated
,
standardiz
ed
questionn
aire

(Vidhya et
al., 2023)

To assess the
prevalence
of obesity
among rural
school children
of 6-12 years of
age and to
determine
factors
associated with
obesity

Cross
sectional
study

Trichy
district,
Tamil
Nadu

Rura
l

10
0

Multis

tage

cluster
sampli

ng

Childre

n

aged

6-12

years

(BMI)
was
calculated
,
Semi
structured
questionn
aire.

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(Danasekar
an and

Ranganatha
n, 2

To assess the
prevalence of
overweight and
obesity among
the school in the
age group of 14-
17 years in
Kanchipuram
district of Tamil
Nadu.

Cross
sectional
study

Kanchip
uram,
Tamil
Nadu

Rura
l

93
4

Simple

rando

m

sampli

ng

Childre

n aged

14-17

years

(BMI)
was
calculated
,
questionn
aire

(Shanmuga
m et al.,
2016)

To study the
prevalence of
overweight and
obesity among
school children
in a rural school
in Coimbatore
using
the WHO
standard
reference for age
5–19 years.

Cross
sectional
study

Coimbat
ore,
Tamil
Nadu

Rura
l

89
0

No

details

School
childre

n aged

5–15

years

(BMI)
was
calculated
,
questionn
aire

(Kumar et
al., 2019)

To assess the
prevalence of
overweight and
obesity amongst
school children
of Bangalore and
to study the
association of
age and gender
with overweight
and obesity
amongst school
children of
Bangalore.

Cross
sectional
study

Bangalo
re,
Karnata
ka

Rura
l

11
27

No

details

School
childre

n aged

6 to 16

years

(BMI)
was
calculated
BMI
charts
based on
NCHS
(National
Centre for
Health
Statistics)
, CDC
USA
(United
States of
America)
standards,
questionn
aire

(Viswambh
aran and
Abraham,
2021)

To assess the
prevalence of
obesity among
affluent school
children in

Cross
sectional
study

Thrissur
, Kerala

Urba
n

11
04

Univer

sal

sampli

ng

metho

Private

school

childre

n (4

Semi-
structured
questionn
aire,
BMI was

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VOLUME 06 ISSUE11

60

Thrissur

d

and 18

years)

calculated

Appendix 3: Quality Appraisal II

Childhood Obesity in Urban and Rural India: A Systematic

Review and Meta-Analyses of Prevalence Studies

Authors/yea
r

Analysis
details

Ethics
informati
on

Funding
informat
ion

Confli
ct
of
intere
st
presen
t or
not

Total

prev

alenc

e

Rura

l

prev

alenc

e

Urba

n

prev

alenc

e

Gend
er
based

preva
lence

Risk factors

(Jain et al.,
2016)

Software:

No details

Methods:

Descriptives
,
Chi-square
test

Consent
attained:

Yes

IRB
approval
attained:

No details

No
funding

No

5.60

%

NA

5.60

%

Male
:

17.9
%

Fema
le:

15.9
%

Less
physical
activity,
High-
income
family, Male
gender, Junk
food,
chocolate,
and eating
outside the
home, more
nonvegetaria
n diet, lesser
physical
activity

(Ghonge et
al., 2015)

Software:

Microsoft
Excel and
Open- Epi
Software
(Version
2.3).

Methods:

Descriptives
,

Consent
attained:

Yes

IRB
approval
attained:

Yes

No
funding

No

5.62

%

NA

5.62

%

Male
:

4.62
%

Fema
le:

6.8%

Age groups
(15 years
age group
both in
Government
schools and
private
schools),
children of
Private

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61

Chi-square
test

schools have
higher
prevalence

(Pradhan et
al., 2022)

Software:

SPSS
ver.16.0

Methods:

Proportions,
chi-square
test, mean,
and standard
deviations,
unpaired t-
test

Consent
attained:

Yes

IRB
approval
attained:

Yes

No
funding

No

5.00

%

3.33

%

6.66

%

More
in
males

Urban
school
students,
older
students,
hours of
television
and/or
smartphone
and laptop
use,
Consumptio
n of
carbonated
drinks, and
irregular
breakfast,
Tiffin
from
canteen,
physical
activities
like outdoor
games and
mode of
conveyance
to school

(Rani and
Sathiyasekara
n, 2013)

Software:

SPSS ver
15.0

Methods:

Descriptives
, Pearson’s
chi-squared
test, logistic
regression
models

Consent
attained:

Yes

IRB
approval
attained:

Yes

Ramacha
ndra
Universit
y

No

5.20

%

NA

5.20

%

More
in
femal
es

Younger age
group,
female sex, a
high level of
father’s and
mother’s
education,
and the type
of school
they were
attending,
type of
school, and
fast-food

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62

consumption
, private
schools,

(Pathak et al.,
2018)

Software:

SPSS ver 23

Methods:

Descriptives
,
Independent
sample test
(Kruskal-
Wallis test),
Spearman’s
rho, Odds
ratio, Mann-
Whitney U
test, chi-
square test

Consent
attained:

Yes

IRB
approval
attained:

Yes

No
funding

No

17.60

%

2.20

%

31.30

%

Male
:

20.2
%

Fema
le:

15.4
%

Higher
parental
Annual
income,
frequency of
restaurant
and school
canteen food
consumption
and lesser
frequency of
physical
training
sessions
conducted in
schools.

(Vidhya et
al., 2023)

Software:

SPSS

Methods:

Descriptives
,
Chi-square
test

Consent
attained:

No details

IRB
approval
attained:

Yes

No
funding

No

6.00

%

6.00

%

NA

Male
:

4.0%

Fema
le:

2.0%

Number of
family
members

(Danasekaran
and

Ranganathan,
2

Software:

SPSS

Methods:

Descriptives

Consent
attained:

Yes

IRB
approval
attained:

Yes

No
funding

No

4.40

%

4.40

%

NA

Male
:

4.58
%

Fema
le:

4.20
%

Not covered

(Shanmugam
et al., 2016)

Software:

SPSS ver 19

Methods:

Descriptives
,
Chi-square
tests

Consent
attained:

Yes

IRB
approval
attained:

Yes

No
funding

No

4.72

%

4.72

%

NA

Male
:

6.43
%

Fema
le:

2.96

No
significant
findings

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63

%

(Kumar et al.,
2019)

Software:

SPSS ver 24

Methods:

Descriptives
,
Chi-square
tests

Consent
attained:

Yes

IRB
approval
attained:

Yes

No
funding

No

4.08

%.

4.08

%.

NA

Male
:

2.04
%.

Fema
le:

2.04
%.

No
significant
findings

(Viswambhar
an and
Abraham,
2021)

Software:

SPSS ver 20

Methods

Proportions,
means and
standard
deviations,
Bivariate
analysis

Consent
attained:

Yes

IRB
approval
attained:

Yes

No
funding

No

7.30

%

NA

7.30

%

Male
:

8.3%

Fema
le:

5.9%

Increase in
age and
male gender

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