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International Journal of Medical Science and Current Research (IJMSCR)

Available online at: www.ijmscr.com
Volume3, Issue 5, Page No: 374-380
September-October 2020

A Study of Prevalence of Obesity and Hypertension among Children and Adolescents in

North-West Rajasthan

Dr.Kampra Gupta 1, Dr.Shivam Sethi 2, Dr.Ritvik Agrawal 3 , Dr.R.P.Agrawal4

1, 2, 3
Senior Resident, 4 Senior Professor
1
Department of Radiotherapy, Sardar Patel Medical College, Bikaner, Rajasthan, India
2, 3, 4
Department of Medicine, Sardar Patel Medical College, Bikaner, Rajasthan, India

*Corresponding Author:
Dr. Shivam Sethi
Department of Medicine, Sardar Patel Medical College, Bikaner, Rajasthan, India

Type of Publication: Original Research Paper

Conflicts of Interest: Nil
ABSTRACT
Background: A rising trend is seen in both obesity and hypertension in children. Both lead to increased risk of
cardiovascular disease in adulthood, causing greater morbidity and mortality in productive years of adult life.
Thus, screening of children for hypertension becomes important, especially those who are obese or overweight
as primordial and primary risk reduction strategies can be applied to reduce cardiovascular disease development
in youth.
Method: This study was conducted on 1000 school going children and adolescent of Bikaner city, Rajasthan.
The study was approved by the Hospital’s Institutional Review Board and consent was obtained from the school
management, parents and the students prior to study. All the anthropometric measurements were taken in school
premises and the participants were examined thoroughly.
Result: In our study, we found the prevalence of overweight to be 13.8% and that of obesity 7.2%. We found
that 145 (14.5%) candidates had elevated blood pressure, 147 (14.7%) were hypertensive out of which 107
(10.7%) had hypertension stage 1 while 40 (4.0%) had hypertension stage 2.
Conclusion: Based on observations of our study, it is recommended that strategies for obesity prevention,
weight reduction, promotion of healthy lifestyles and regular monitoring are necessary during childhood and
adolescence else the implications of this global phenomenon on future generations will be serious.

Keywords: childhood obesity, hypertension in childhood, adolescents

INTRODUCTION
Obesity has emerged as a major global health
problem. It is a serious health risk and associated
with multiple co-morbidities such as type 2 diabetes
mellitus, dyslipidemia, polycystic ovarian disease,
hypertension, metabolic syndrome etc. which are
increasingly becoming common among children and
adolescents1-3.
The epidemic of childhood obesity is a significant
health burden worldwide4-6 and its implications are
countries like India, where a significant proportion of
the population belongs to younger age group9. Rising
prevalence of obesity in India may be attributed to
various factors, like sedentary life-style, unhealthy
food habits, cultural practices and increasing
affluence of middle class population1-3, 10.
The International Association for the Study of
Obesity (IASO) and International Obesity Task Force
(IOTF) have estimated that 200 million school
374

being seen in developing countries also7, 8. The children are either overweight or obese11.
problem attains a greater magnitude in developing

International Journal of Medical Science and Current Research | September-October 2020 | Vol 3 | Issue 5
Dr. Shivam Sethi et al International Journal of Medical Science and Current Research (IJMSCR)
Rapid changes in the prevalence of childhood obesity
in recent decades within a relatively stable population
indicate that genetic factors are not the primary
cause. Therefore, changes in the nature of the
environment towards a more obesogenic society are
the most likely cause for the rise in prevalence12.
70% Children with obesity have at least one
cardiovascular risk factor, and 39% have ≥2. These
risk factors, along with obesity, are associated with
heart disease in childhood and more importantly,
track into increased risk of atherosclerosis and left
ventricular hypertrophy in adulthood.13
AIMS AND OBJECTIVES
1. To study the prevalence of overweight and
obesity in children and adolescents in North-
West Rajasthan
2. To study the prevalence of hypertension in
children and adolescents in North-West
Rajasthan.
3. To study prevalence of hypertension in
accordance to BMI
MATERIAL & METHODS
This study was conducted in the Department
of Medicine, S.P. Medical College and associated
group of Hospitals, Bikaner. A sample size of 1000
apparently healthy children and adolescents from 10-
18 years of age of both genders were taken from
various schools of Bikaner district.
 INCLUSION CRITERIA
A. Age - 10-18 years
B. Diagnostic criteria for overweight and
obesity-
Revised IAP growth chart for BMI is
used14 and values equivalent to adult
BMI 23kg/m2 and 27kg/m2 were taken
as overweight and obesity cut-off.
 EXCLUSION CRITERIA
A. Subject with thyroid dysfunction
B. Secondary causes of obesity
C. Any acute or chronic illness
D. Subjects not willing to participate in the
study or not giving consent
Volume 3, Issue 5; September-October 2020; Page No.374-380
© 2020 IJMSCR. All Rights Reserved
 Blood pressure was measured using mercury
sphygmomanometer in right arm in sitting
position by ascultatory method. The
individual was made comfortable and seated
at least for five minutes in the chair before
measurement. Those participants who had
raised blood pressure were checked again half
an hour apart and the average of two reading
was taken.
According to recent guidelines by American
College of Cardiology and American Heart
Association 2017, participants having systolic
blood pressure (SBP) <120mmHg and
diastolic blood pressure (DBP) <80mm Hg
were considered as normal, those with SBP
between 120-129 mmHg and DBP <80mmHg
were considered as having elevated blood
pressure, those having SBP between 130-139
mmHg or DBP between 80-89mmHg as stage
1 hypertensive while those with SBP≥ 140
mmHg or DBP≥ 90 mmHg as stage 2
hypertensive.
 Body weight was measured to the nearest
0.1kg using a digital weighing machine with
subjects barefoot.
 Body height was measured using calibrated
stadiometer to the nearest mm with subjects
barefoot.
 Body mass index (BMI) was measured as the
ratio of body weight to body height squared,
expressed as kg/m2.
Revised IAP growth chart for BMI
formulated by Khadilkar et al14 is used.
Values corresponding to 23 and 27 adult
equivalent percentiles were taken as
overweight and obesity cutoff whereas value
corresponding to less than 3 percentile was
considered as underweight.
 Statistical analysis was done using SPSS 17.0
software. Chi Square test was applied. P value
<0.05 was considered as significant.
OBSERVATION AND RESULTS
In our study, we found that 61 candidates (6.1%)
375
were underweight, 138 candidates (13.8%) were
overweight while 72 (7.2%) were obese. Out of 386
female cases, 33 (8.6%) had their BMI in
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Dr. Shivam Sethi et al International Journal of Medical Science and Current Research (IJMSCR)
underweight group, 286 (74.1%) had their BMI
within normal range, 51 (13.2%) cases were
overweight and 16 (4.1%) cases were obese. While,
in males out of total 614 cases, 28 (4.6%) were
underweight, 443 (72.1%) were in normal range, 87
(14.2%) cases were overweight and 56 (9.1%) were
obese. Females had significantly higher prevalence in
underweight group as compared to males (p<0.05),
while in obese adolescents, male has significantly
higher prevalence in comparison to females (p<0.01)
while in normal and overweight children, no
significant difference was found between females and
males (p>0.05) (Table 1).
Out of total 1000 cases, 708 (70.8%) cases had their
BP within normal range, 145 (14.5%) cases had
elevated blood pressure while107 (10.7%) and 40
(4.0%) cases were in hypertension 1 and
hypertension 2 stage respectively (Table 2).
Out of 386 females, 312 (80.8%) had normal blood
pressure, 31 (8%) had elevated blood pressure, 31
(8%) were in HTN1 stage and 12 (3.1%) females
were in HTN2 stage. Out of total 614 males, 396
(64.5%) had normal blood pressure, 114 (18.6%) had
elevated blood pressure, 76 (12.4%) were in HTN1
stage while 28 (4.6%) males were in HTN2 stage.
Males were significantly higher in elevated and
HTN1 group while in HTN 2 group males had higher
prevalence as compared to females but the difference
was found statistically insignificant (p>0.05) (Table
3).
Out of 61 underweight cases, 56 cases (91.8%) had
normal blood pressure, 2 cases (3.3%) had elevated
blood pressure and 3 (4.9%) were hypertensive. Out
of 729 normal BMI cases, 535 (73.4%) had normal
blood pressure, 116 (15.9%) had elevated blood
pressure while 78 cases (10.7%) were hypertensive.
Out of 138 overweight cases, 83 (60.1%) had normal
blood pressure, 19 (13.8%) had elevated blood
pressure while 36 cases (26.1%) were hypertensive.
While out of 72 obese cases, 34 (47.2%) had normal
blood pressure, 8 (11.1%) had elevated blood
pressure and 30 cases (41.7%) were hypertensive
(Table 4).
Volume 3, Issue 5; September-October 2020; Page No.374-380
© 2020 IJMSCR. All Rights Reserved
DISCUSSION
India is a fast growing economy, currently
undergoing major epidemiological, nutritional and
demographic transitions. These transitions tend to
promote obesity in all age groups.
Therefore, identifying obese children at risk for
development of hypertension is of primary
importance in order to interrupt its progression and
its related complications.
In our study, we have tried to find out the prevalence
of overweight, obesity and hypertension among
children and adolescents in north -west Rajasthan.
We found that 61 candidates (6.1%) were in under
nutrition category, out of them 33(54.1%) were
females while 28 (45.9%) were males. 729 cases
(72.9%) were in the normal BMI range. Females had
significantly higher prevalence in underweight group
as compared to males (p<0.05). While, in obese
children, males had significantly higher prevalence in
comparison to females (p<0.01). In normal and
overweight children, no significant difference was
found between females and males (p>0.05). These
findings throw light on the social stigma still
prevalent in our region.
Unfortunately, identifying cut-off point of BMI for
overweight and obesity in children is difficult as they
have less disease related to obesity than adults. Asian
adult populations are more prone to adiposity and
central obesity at a lower BMI than their western
counterparts. As the pattern of growth of population
changes over time so the growth references should be
updated regularly. In our study we have used latest
revised IAP growth charts14 formulated specifically
for 5-18 year old Indian children for defining
overweight and obesity. This will help in showing the
real picture of obesity problem among children in our
community than using WHO defined cut-off point of
25kg/m2 and 30kg/m2 which is for adults.
Our results were comparable to various earlier studies
done across the country. Narayanappa et al15 in 2011
in Mysore city showed the prevalence of overweight
and obesity to be 11% and 5%, respectively. In
Rohtak city, Rohilla et al16 showed the prevalence of
overweight and obesity to be 11.0% and 5.7%
376
respectively, in the age group 10-19 years in 2014.
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Dr. Shivam Sethi et al International Journal of Medical Science and Current Research (IJMSCR)
There are very few studies conducted in Rajasthan.
One of the studies by Jain et al17 in 2012 in Jaipur,
showed the prevalence of overweight to be 12.5%
and that of obesity 5.6%. Another study by
Choudhary et al18 in 2017 in Jaipur, showed the
prevalence of overweight to be 32.65% in males and
34.15% in females. They also found that 33.67%
males and 32.93% females belonged to the obese
category. The high prevalence of obesity and
overweight in their study can be attributed to very
small sample size of 180 candidates.
Continuous rising trend of the problem can be
attributed to sedentary life style, increase
consumption of junk food, decrease physical activity
and more stress of studies.
Prevalence of hypertension
In our study, we analysed the prevalence of
hypertension according to the recent guidelines
published by American College of Cardiology and
American Heart Association in 2017.
We found that 145 (14.5%) candidates had elevated
blood pressure, 147 (14.7%) were hypertensive, out
of which 107 (10.7%) had hypertension stage 1,
while 40 (4.0%) had hypertension stage 2. 708
Candidates (70.8%) had normal blood pressure.
In 2011 Buch et al19 reported the prevalence of
hypertension to be 6.48% among school going
children of Surat. In 2013, study done by Anand et
al20 among adolescents in Delhi showed the
prevalence of pre-hypertension 30.1% while that of
hypertension 7%.
In a large retrospective study in USA by Dr Parker at
el. 21 , including more than 100,000 children (age 3–
11 years) and adolescents (age 12–17 years),, those
with obesity and severe obesity developed higher
systolic blood pressure and diastolic blood pressure ,
when followed over a course of several years.
Our study shows that, not only overweight and obese,
but also normal BMI candidates were at risk of
developing hypertension. The increased prevalence
Volume 3, Issue 5; September-October 2020; Page No.374-380
© 2020 IJMSCR. All Rights Reserved
of hypertension in normal weight as well as obese
can be attributed to lower cut-off values in recent
guidelines and also due to changing lifestyle. We also
found positive correlation between systolic BP
(r=0.198, p<0.001) and diastolic BP (r=0.193,
p<0.001) with BMI. Many other studies have also
shown similar results22, 23, 24. In a study done in 2009-
10 by Kar and Khandelwal25 in adolescent in Sikkim,
a positive linear relationship was found between
systolic and diastolic BP and BMI. Danasekaran et
al26 found the prevalence of hypertension among
obese to be 25% in contrast to 4.4% among those
with normal BMI. This shows that apart from BMI
there are many other factors like family history,
genetic makeup, high sodium diet, lack of exercise
etc. which may contribute to high blood pressure.
CONCLUSION
Prevalence of obesity is increasing in children and
adolescents across the country including north -west
Rajasthan. As obesity is increasing in children and
adolescents of our society, therefore the incidence of
elevated blood pressure and hypertension is also
increasing among children and adolescents. However,
apart from BMI there are many other factors like
family history, genetic makeup, high sodium diet,
lack of exercise etc. which may contribute to high
blood pressure among them.
Based on observations of our study, it is
recommended that strategies for obesity prevention,
weight reduction, promotion of healthy lifestyles and
regular monitoring are necessary during childhood
and adolescence else the implications of this global
phenomenon on future generations will be serious.
LIMITATIONS
As the sample size was small, the prevalence
obtained may not be truly reflective of the
heterogeneity in the population. Larger sample size is
required to obtain a better and more representative
overview of prevalence of obesity and hypertension
in children and adolescents in north-west region of
Rajasthan.
377
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Dr. Shivam Sethi et al International Journal of Medical Science and Current Research (IJMSCR)

Table 1
Prevalence and gender wise distribution of underweight, overweight and obesity among study subjects
Sex BMI Group Total
Under Normal Over weight Obese
weight
No. % No. % No. % No. % No. %
Female 33 54.1 286 39.2 51 37.0 16 22.2 386 38.6
Male 28 45.9 443 60.8 87 63.0 56 77.8 614 61.4
Total 61 100 729 100 138 100 72 100 1000 100
 2
6.5839 0.4531 0.1825 8.7809
P <0.05 >0.05 >0.05 <0.01

Table 2
Prevalence of hypertension among study subjects
Blood pressure Number of subjects Percentage (%)
Normal 708 70.8
Elevated 145 14.5
HTN1 107 10.7
HTN2 40 4.0
Total 1000 100.0

Table 3
Gender wise distribution of blood pressure
Sex Hypertension Group Total
Normal Elevated HTN1 HTN2
No. % No. % No. % No. % No. %
Female 312 80.8 31 8.0 31 8.0 12 3.1 386 38.6
Male 396 64.5 114 18.6 76 12.4 28 4.6 614 61.4
Total 708 70.8 145 14.5 107 10.7 40 4.0 1000 100
2 24.7896 9.8454 0.8570
P <0.001 <0.01 >0.05
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Dr. Shivam Sethi et al International Journal of Medical Science and Current Research (IJMSCR)

Table 4
Distribution of cases according to BMI categories in relation to hypertension
BMI Total Hypertension status
Normal Elevated HTN1 HTN2
No. % No. % No. % No. %
Under 61 56 91.8 2 3.2 3 4.9 0 -
weight
Normal 729 535 73.4 116 15.9 65 8.9 13 1.7
Over 138 83 60.14 19 13.8 25 18.1 11 8
weight
Obese 72 34 47.2 8 11.11 14 19.4 16 22.2
Total 1000 708 70.8 145 14.5 107 10.7 40 4

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