Examination of the Association between Socioeconomic Status and Overweight and Obesity in Bijapur, Karnataka, India Open Access

Abstract

Background: India has been traditionally more affected by undernutrition but recently there has been a rise in rates of overweight and obesity. Rapid urbanization of rural and peri-urban areas as well as the increasing influence of globalization is facilitating the increased consumption of foods that are higher in calories and fat than traditional Indian diets. Rising overweight and obesity has mostly affected higher socioeconomic classes in India's large metropolitan cities.

Purpose: This research examines the association between socioeconomic status and overweight and obesity among school-going adolescents in a peri-urban environment such as Bijapur, Karnataka, India.

Methods: Analysis was conducted on cross-sectional survey data of 398 school-going adolescents. 4 different proxies were used to measure socioeconomic status (total household income, household education, possession wealth, and private school or public school attendance). The outcome was adolescent BMI classified using the International Obesity Task Force (IOTF) adolescent BMI cut points. Chi-square tests were used to determine statistically significant differences in BMI classifications and ordinal multivariate logistic regression modeling was used to estimate the association of socioeconomic status and adolescent BMI.

Results: Prevalence of overweight and obesity increased as socioeconomic status increased. Chi-Square tests showed statistically significant differences across various socioeconomic status indicators in regards to BMI. Ordinal multivariate logistic regression showed that as socioeconomic status increased so did the odds of being in a higher BMI category vs. a lower BMI category.

Conclusions: Our study suggests that there is a positive does-response relationship between socioeconomic status and increasing BMI among school-going adolescents in a peri-urban environment in India.

Table of Contents

CHAPTER I: BACKGROUND AND LITERATURE REVIEW...1

Problem of Childhood Overweight and Obesity in India...2

Globalization and Changing Socioeconomic Dynamics...2

Socioeconomic Status Differences in Food Consumption...4

Sedentary Lifestyle and Lack of Physical Activity...5

Higher Socioeconomic Status and Overweight and Obesity...6

Changing Dynamics of socioeconomic status and adolescent obesity in India...8

Methods of Measuring Overweight and Obesity...9

Methods of Measuring Socioeconomic Status in India...10

Monthly Household Income...11

Occupation...12 Education...13

Possession Wealth...13

Socioeconomic Status Classification Summary...15

Usefulness and Gaps in the Literature...15

Gaps Pertaining to Peri-Urban Areas (Bijapur, Karnataka, India)...16

Thesis Focus and Research Questions...17

CHAPTER II: Methods...18

Study Setting...18

Data Collection...18

Study Participant Selection...19

Weights...19

Main Exposures...20

Development of Wealth Possession Index Variable...21

Outcome...21 Variables...23

Data Cleaning and Statistical Analysis...26

Descriptive Statistics and Chi-Square Tests...27

CHAPTER III: Results...29

Unweighted Descriptive Statistics of Exposure Variables and Covariates...29

Weighted Descriptive Statistics of Exposure Variables and Covariates...29

Unweighted Descriptive statistics of Assets within the Wealth Possession Index...30

Weighted Descriptive statistics of Assets within the Wealth Possession Index...30

Descriptive Statistics of Adolescent BMI...30

Chi-Square and Mantel Haenszel Chi-Square Tests of Exposure and Covariates...31

Multivariate Logistic Regression...32

Unadjusted Odds Ratios of Exposure Variables...32

Adjusted Odds Ratios...33

Collapsed Socioeconomic Status Indicators-Ordinal Multivariate Logistic Regression...34

CHAPTER IV: Discussion...37

Socioeconomic Status and Increasing Adolescent BMI...37

Broader Societal Implications...39 Strengths...41 Limitations...42 Future Directions...42 References...44 Appendix...48 Tables...50

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Subfield / Discipline	Global Epidemiology - MPH & MSPH
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Keyword	Adolescent Overweight Socioeconomic Status BMI Obesity
Committee Chair / Thesis Advisor	Kramer, Michael R, Emory University
Committee Members	Argeseanu, Solveig, Emory University
Partnering Agencies	University, college or educational institution (other than Emory)

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