*3.2.4 Physical activity*

The Wardha study showed a good correlation between physical inactivity and childhood obesity. On univariate analysis, the odds ratio (OR) of obesity in school children was 2.064 if they played outdoors for less than 30 min a day. Step-down multiple logistic regression analysis showed OR for the same children

**223**

*Obesity in School Children in India*

cal activity [38].

*3.2.5 TV watching*

*3.2.6 Psychosocial factors*

ing both difficult to treat [44].

*3.2.7 Familial factors*

*DOI: http://dx.doi.org/10.5772/intechopen.89602*

overfeed themselves continues into adolescence also.

to be 2.133 (95% CI: 1.373–3.301) [17]. In the study from Oceania, sedentary behaviour defined as sitting for ≥3 h/d increased the odds of being overweight/ obese OR1.17 (95% CI 1.03–1.34, p < 0.05) [11]. More frequent participations in sports correlated well with greater accretion of fat free mass. This finding was independent of ethnicity, individual, family, community and socio-economic factors. Walking or cycling to school also resulted in a lower fat mass index [37]. Kunwar et al. studied the prevalence of obesity in school children in a military station in North-Eastern India and concluded that the prevalence of obesity in garrison schools was lower due to the greater emphasis laid on games and physi-

Sedentary lifestyle is associated with higher adiposity. Every additional hour of TV-time per day increases the prevalence of obesity in children by 2% [23]. Govindan et al. found that watching TV for >2 h/d was significantly associated with obesity (boys OR 1.19, p < 0.01, girls OR1.19, p < 0.01) [39]. The National Institutes of Health, US also consider TV-time of >2 h as a definite risk for obesity [40]. TV watching (passive screen time) is unhealthier than active screen time (computer and video games) [41]. Hours of TV watching also directly correlate with increased intake of foods frequently advertised on TV like sweets, sweetened beverages, cookies, chocolates, sweetened cereals and salted snacks [42]. This habit of watching TV or playing games on mobile phones starts at an earlier age. During preschool period, most mothers have a tendency to feed children by distracting them. They let them watch cartoons on television or play games on mobile phones. This makes their job of feeding easier as the children do not resist feeding. In the process, they tend to overeat, being too distracted to signal the feeders that they are full. This tendency to

Pengpid and Peltzer looked for impact of loneliness, lack of close friends, anxiety and worrying, suicidal ideation and bullying on occurrence of overweight/ obesity in school-going children in Oceania. The OR for being overweight with lack of close friends was 0.72 (95% CI 0.56–0.92, p < 0.01) and with suicidal ideation OR was 1.42 (95% CI 1.21–1.66, p < 0.001). The association with other factors was not significant on multivariate regression analysis [11]. The lifetime risk for anxiety disorders is higher for obese adolescents in comparison to non-obese ones [43]. There is a bi-directional relationship between eating disorders and depression mak-

The family has a significant role to play in the development of childhood obesity. The influence starts even before the child is born. The first reported causal association of intra-uterine undernutrition resulting in obesity in the offspring later in life was from the observation of children born to women who were pregnant during the Dutch famine [45]. Intra-uterine malnutrition may lead to a higher susceptibility to excess weight gain due to increased fat stores, short stature and a preference for foods high in fats [46]. This is the 'mismatch' effect alluded to earlier. A phenomenon known as 'mirror imaging' between the mother and her baby is observed in India. The baby's birth size is predicted by the mother's size before pregnancy. Despite this, birth weight has been found to be a poor indicator of adiposity in the

#### *Obesity in School Children in India DOI: http://dx.doi.org/10.5772/intechopen.89602*

to be 2.133 (95% CI: 1.373–3.301) [17]. In the study from Oceania, sedentary behaviour defined as sitting for ≥3 h/d increased the odds of being overweight/ obese OR1.17 (95% CI 1.03–1.34, p < 0.05) [11]. More frequent participations in sports correlated well with greater accretion of fat free mass. This finding was independent of ethnicity, individual, family, community and socio-economic factors. Walking or cycling to school also resulted in a lower fat mass index [37]. Kunwar et al. studied the prevalence of obesity in school children in a military station in North-Eastern India and concluded that the prevalence of obesity in garrison schools was lower due to the greater emphasis laid on games and physical activity [38].
