Comment on "correlates of overweight and obesity among urban adolescents in Bihar, India".

Dear Editor,

We read the article by Ghosh et al., “correlates of overweight and obesity among urban adolescents in Bihar, India” with interest.[1] The authors have done a commendable job of highlighting an issue of public health importance in adolescents of Bihar. However, some issues need to be addressed.

First, the reference for sample size calculation (prevalence = 20%) is a review article which quotes overweight and obesity in Indian studies ranging from 4.7% to 29%.[2] An original and nationally representative study or a meta-analysis is preferable in calculating a sample size.[3] Moreover, authors mention the lack of data regarding overweight/obesity in National Family Health Survey (NFHS). It is important to point out that NFHS-3 does report overweight and obesity in the age group of 15–19 years which is 3.5% at national level. For Bihar, it is 1.3% in females and 0.7% in males of 15–19 years of age.[4]

Authors have used reference data from the Center for Disease Control and Prevention 2000 dataset for body mass index cut-offs. It would have been preferable to use standardized World Health Organization cut-offs for the age group of 5–19 years which are applicable for developed as well as developing countries.[5] Moreover, the population is classified in dichotomous categories (overweight and not-overweight) which groups together participants who are normal and thin. According to NFHS-3, the age group of 15–19 has the highest prevalence of thinness, 52% in females and 61.6% in males in this age group in Bihar.[4] It will be interesting to see the burden of thinness in the 79% reported as not overweight in this study (where participants of 15 years of age are in majority). In addition, the methodology used for the determination of socio-economic status is unclear, and physical activity due to household chores remains undocumented (which is significant in India).

Finally, the analysis shows a significant association between nonconsumption of vegetables and fruits with overweight/obesity. However, socio-economic status is an important confounder in case of intake of vegetables and fruits.

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Conflicts of interest

There are no conflicts of interest.