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Adolescent obesity by different growth charts and its efficacy with central adiposity among school-age children in Mumbai

Anita Patil, Priti Patil, Prashant Bhandarkar


Adolescent obesity can be defined using various age- and sex-specific growth
charts. In addition to general obesity, central adiposity is also crucially important. This paper
aims to study the efficacy of central adiposity with general obesity using different growth
charts recommendations. A cross-sectional study was conducted among school-age children in
Mumbai. Anthropometric data were obtained from 1349 adolescents aged 9–15 years. Growth
charts of Indian Academy of Pediatrics (IAP), International Obesity Task Force (IOTF), and
World Health Organization (WHO) were used to classify overweight and obese status among
each of the participants. Central obesity indices such as the waist circumference (WC), the
waist to height ratio (WHtR), and the waist to hip ratio (WHR) were calculated. The efficacy of
each of central obesity indices was checked with overweight and obesity status. The receivers
operating characteristics curves were drawn to check the efficacy of central obesity indices.
According to IAP, IOTF, and WHO chart, the prevalence rates of overweight and obese among
the sampled adolescents were 35.9%, 27.0%, and 25.0%, respectively, while, 26.5%, 26.3%,
and 31% were found to be centrally obese as per WC, WHtR, and WHR, respectively. The
values of area under curve for WC and WHtR were found between 0.857 and 0.942 for all three
methods, while the corresponding values were between 0.611 and 0.689, indicating that WHR
is a less robust indicator. We conclude that the central obesity status appears to be an efficient
measure to identify the general obesity status irrespective of growth chart recommendations.
WHtR and WC are found to be more robust indicators of general obesity.


adolescent obesity; central adiposity; growth chart; India; Mumbai; obesity; overweight; school-age children

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August G P, Caprio S and Fennoy I, et al. (2008). Prevention and treatment of pediatric obesity: An endocrine society clinical

practice guideline based on expert opinion. Journal of Clinical Endocrinology and Metabolism, 93(12): 4576–4599. https://doi.


Casonatto J, Ohara D and Giuliano D, et al. (2011). High blood pressure and abdominal obesity in adolescents. Revista Paulista

de Pediatria, 29(4): 567–571. Available from:

[Last Accessed on 2018 Aug 26].

Cole T J (2000). Establishing a standard definition for child overweight and obesity worldwide: International survey. BMJ, 320: 1240–

Gishti O, Gaillard R and Durmus B, et al. (2015). BMI, total and abdominal fat distribution, and cardiovascular risk factors in schoolage

children. Pediatric Research, 77: 710–718.

Goran M I and Gower B A. (1999). Relation between visceral fat and disease risk in children and’ adolescents. The American Journal

of Clinical Nutrition, 70: 149S–156S.

Chung H, Park S and Park M J, et al. (2016). Waist-to-height ratio as an index for cardiometabolic risk in adolescents: Results from the

-2008 KNHANES. Yonsei Medical Journal, 57(3): 658–663.

Jagadesan S, Harish R and Miranda P, et al. (2014). Prevalence of overweight and obesity among school children and adolescents in Chennai. Indian Pediatrics, 51: 544–549.

Khadilkar A, Ekbote V and Chiplonkar S, et al. (2014). Waist circumference percentiles in 2-18 year old indian children. Journal of

Pediatrics, 164: 1358–1362.

Khadilkar V V and Khadilkar A V (2015). Revised indian academy of pediatrics 2015 growth charts for height, weight and body

mass index for 5-18-year-old Indian children. Indian Journal of Endocrinology and Metabolism, 19(4): 470–476. https://doi.


Lee J M, Davis M M and Woolford S J, et al. (2009). Waist circumference percentile thresholds for identifying adolescents with insulin

resistance in clinical practice. Pediatric Diabetes, 10: 336–342.

Lurbe E, Alvarez V and Liao Y, et al. (1998). The impact of obesity and body fat distribution on ambulatory blood pressure in children

and adolescents. American Journal of Hypertension, 11(4 Pt 1): 418–424.

McCarthy H D and Ashwell M. (2006). A study of central fatness using waist-to-height ratios in UK children and adolescents over

two decades supports the simple message-keep your waist circumference to less than half your height. International Journal of

Obesity, 30: 988–992.

Nyamdorj R, Qiao Q and Lam T H, et al. (2008). BMI compared with central obesity indicators in relation to diabetes and hypertension

in Asians. Obesity (Silver Spring, Md.), 16(7): 1622–1635.

Use office of the Registrar General and Census Commissioner. (2011). Census of India 2011. Available from: http://www.censusindia. [Last Accessed on 2018 Sep 15].

Okafor C, Ofoegbu E and Fasanmade O, et al. (2011). Comparison of the performance of two measures of central adiposity among

apparently healthy Nigerians using the receiver operating characteristic analysis. Indian Journal of Endocrinology and Metabolism,

: 320–326.

de Onis M and Lobstein T. (2010). Defining obesity risk status in the general childhood population: Which cut-offs should we use?

International Journal of Pediatric Obesity, 5(6): 458–460.

Patil A D, Shejul S and Bhandarkar P, et al. (2018). A study of adolescent obesity and hypertension in urban school in Mumbai.

International Journal of Community Medicine and Public Health, 5(2): 790–794.


Pillai R N. (2018). Modelling Studies for a ‘Whole of Society (wos)’ Framework to Monitor Cardio-Metabolic Risk Among Children (6

to 18 years). Ph.D. Dissertation. Universita’ Degli Studi Di Verona. Available from:

uploads/6_D2_Rakesh-Pillai_Thesis_03_Mar_18.pdf. [Last Accessed on 2018 Sep 20].

Pou K M, Massaro J M and Hoffmann U, et al. (2007). Visceral and subcutaneous adipose tissue volumes are cross-sectionally related

to markers of inflammation and oxidative stress: The framingham heart study. Circulation, 116(11): 1234–1241. https://doi.


Sen S D. (2013). Obesity in Kids on the Rise in Mumbai. The Times of India.

Shah N R and Braverman E R. (2012). Measuring adiposity in patients: The utility of body mass index (BMI), percent body fat, and

leptin. PLoS One, 7(4): e33308.

Šimundić A M. (2009). Measures of diagnostic accuracy: Basic definitions. EJIFCC, 19(4): 203–211.

United Nations. (2018). The World Urbanziation Prospects: The 2018 Revision. New York: The United Nations.

Weiss R, Dziura J and Burgert T S, et al. (2004). Obesity and the metabolic syndrome in children and adolescents. The New England

Journal of Medicine, 350: 2362–2374.

World Health Organization. (1999). Definition, Diagnosis and Classification of Diabetes Mellitus and its Complications : Report of a

WHO Consultation. Part 1, Diagnosis and Classification of Diabetes Mellitus. Geneva. Available from:

handle/10665/66040. [Last Accessed on 2018 Aug 28].

World Health Organization. (2000). Obesity: Preventing and Managing the Global Epidemic Report of a WHO Consultation. WHO

Technical Report Series 894. Geneva: World Health Organization. Available from:


World Health Organization. (2009). Child Growth Standards. Geneva: World Health Organization. Available from:

World Health Organization. (2016). The Report of the Commission on Ending Childhood Obesity. Geneva: World Health Organization.

Available from:

Yadav N, Yadav S and Gautam N, et al. (2015). Relation between changing lifestyle and adolescent obesity in India: A community

based study among school children. International Multispecialty Journal of Health (IMJH), 1(10): 15–22. Available from: http:// [Last Accessed on 2018 Sep 20].

Yoo E G. (2016). Waist-to-height ratio as a screening tool for obesity and cardiometabolic risk. Korean Journal of Pediatrics, 59(11):


Zabeen B, Tayyeb S and Naz F, et al. (2015). Prevalence of obesity and central obesity among adolescent girls in a district school in

Bangladesh. Indian Journal of Endocrinology and Metabolism, 19: 649–652.

Zimmet P, Alberti K G M and Kaufman F, et al. (2007). The metabolic syndrome in children and adolescents ? An IDF consensus

report. Pediatric Diabetes, 8: 299–306.

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