Systematic Review

Search Strategy

• Data Sources: Data was collected by carrying out a systematic literature reviews on electronic sources as well as a manual search on the internet. The manual search was done in web of science, CDC, WHO, Obesity Society, Obesity Action Coalition, Obesity Help, World Obesity Federation, CINAHL, WHOLIS Bibliography Database, and BIOSIS.
• Search Terms/Key Words: To help in facilitating the process, the search was done using relevant and closely related terminologies. A proper choice of the search word was necessary because it could help in narrowing down the search results to be obtained from the sources. Searches were done differently for each source. For example, for the MEDLINE search, the following keywords were used: childhood obesity, childhood, obesity, prevalence, India, New Delhi, children, child, adolescence, school-going children, physical exercise, and overweight. For the rest of the databases, analogous searches were conducted. Although English was the most preferred language, considerations were made on other alternative languages such as Gujarat (Redsell, Edmonds, Swift, Siriwardena, Weng, Nathan & Glazebrook, 2016). Here, key terminologies like obesity, childhood obesity in India, and prevalence in New Delhi were used.

Inclusion/Exclusion Criteria

Before the review process, a comprehensive inclusion and exclusion criteria was developed. This was done by considering if the literature was actually observational, experimental or based on human beings-not animals. These factors would help in determining the kind of literature to include and exclude from the search.

• Inclusion Criteria: For a source to be included, it had to fit into the regional and periodical criteria identified for it. Meaning, the literature has to be published in a country that falls in one of the categories under study. At the same time, inclusion had to be based on the fact that the literature was seeking to discuss about the prevalence of caries amongst the children. Moreover, the inclusion criterion was to be determined by the organization of the study done. To be included, the literature must have broadened the study to cover caries-free individuals and caries-positive. The pediatric population studied should have had oral bacterial infection and oral hygiene issues to be addressed. The past or present trends of childhood obesity were studied. Such studies had to touch on issues such as causes of childhood obesity, overweight in children, prevalence of obesity in India and New Delhi (Gupta, Shah, Nayyar & Misra, 2013). As a result of this criterion, a total of 240 publications mainly from 180 independent populations were actually included. However, these publications, most of which were cross sectional, kept on varying depending on the age range of the children who had been studied. Only publications that met all the set criteria by possessing the required qualities would be included in the study.
• Exclusion: Not all the literature was included in the search. There are some publications that could not meet the set criteria, thus getting excluded from the entire process. Several factors were used in determining the exclusion of publications from this study (Bergmeier, Skouteris, Horwood, Hooley & Richardson, 2014). Most importantly, it should be noted that publications that were excluded from the study were dissertations, practice guidelines, commentaries, abstracts, review articles, conference proceedings, and position statements. It was decided that these literature should be excluded from the search because they do not meet the guiding criteria. The other category of publications excluded from the search was determined by the contents of the study itself. As already hinted, inclusion was based on the nature of study conducted. This justifies why the publications dealing with global trends in childhood obesity and those discussing about obesity in adults were excluded from the list of possible publications (Pearce, Taylor & Langley-Evans, 2013). The criteria also specified that the intervention studies that were not related to obesity in other countries had to be excluded. A strict observance of these criteria necessitated the need for excluding certain literature even if they were also dealing in different aspects of obesity.

Flow Chart  

Evidence on the Topic

• Obesity has become a serious issue of concern in India and other developing countries across the globe
• The number of children with obesity in the world increased. In 2013, the prevalence of childhood obesity stood at 28% and 22.6% for the boys and girls respectively (Praveen & Tandon, 2016).
• This reflects the figures in India in which the prevalence of childhood obesity has been increasing over the last decade
• In 2010, the prevalence of childhood obesity in India was at 19.3%
• The prevalence of childhood obesity amongst the kids in private schools increased in New Delhi from 9.6% to 17.8% between 1981 and 2002, an increase that was linked to the change in lifestyles adopted by the Indian children in the past years (Vaidya, 2014).
• The prevalence of childhood obesity amongst girls in New Delhi steadily rose from 5.5% in 1997 to 6.7% in 2003
• Very few studies have been conducted on the prevalence of childhood obesity in many states across India (Chaffee, Feldens, Rodrigues & Vítolo, 2015). Therefore, they only constituted a small percentage of publications.
• The sources of the published literature were not constant, but kept on changing each and every time.
• Although New Delhi had never produced any publication by the year 2010, it emerged as the state with the highest number of publications thereafter.
• Different study designs were used. However, cross-sectional design was prominently utilized as it accounted for the 65% of all the designs. Meaning, it was the most preferred design to be used in the study.
• Intervention design included only 9 publications that were mainly taken from 7 autonomous studies. Intervention design had to be used for the independent studies available for studies.
• The percentage of peer reviewed publications stood at 84% during the entire period. Peer reviewed publications are preferred because of their credibility, authority, validity and reliability (Gupta, Goel, Shah & Misra, 2012).
• All studies were dealing with children. However, the study population kept on varying from time to time depending on the caries status, as well as the age of the children under study. The changes had to be made to make the studies more diverse to capture a broader population size.
• Recently, most of the publications were adjusted towards the putative confounding variables
• Across all the 6 WHO regions, studies were conducted and published on the populations with high and low obesity burden. While doing all these, publications were made to represent children of all ages (Jansen, Roza, Jaddoe, Mackenbach, Raat, Hofman & Tiemeier, 2012). Whereas some studies concentrated on children at closer range age limits, others were more accommodative and included children whose age bracket fall between infancy and school-age.
• One challenge experienced during the studies is that it was quite difficult to estimate regional or nationwide prevalence of obesity since most of the studies did not choose a proportionate representative sample population.

Conclusion from the Evidence

• Over the years, the number of publications that study childhood obesity in India has been increasing
• The number of publications studying childhood obesity disease has been expanding
• The expansion rate on these publications has been skewed (Praveen & Tandon, 2016). It has not been uniformly done for all the states across India.
• The prevalence of childhood obesity in India is increasing
• Childhood obesity is rising both in the low and high income families

Study Objectives from the Evidence

• The objective of the search was to analyze epidemiological literature dealing with childhood obesity disease (Neves, Ribeiro, Tenuta, Leitão, Monteiro-Neto, Nunes & Cury, 2016).
• The other objective was to explain the changing trends in epidemiologic literature that studies childhood obesity in India

Further Research

• Intervention and longitudinal studies should be conducted to help in providing much stronger evidence for informing policies and practice
• The burden of childhood obesity should be addressed by integrating multidisciplinary knowledge (Narayanappa, Rajani & Mahendrappa, 2013).
• Several studies should be conducted to find out the prevalence of childhood obesity in New Delhi and all the other states 

References

Bergmeier, H., Skouteris, H., Horwood, S., Hooley, M., & Richardson, B. (2014). Associations between child temperament, maternal feeding practices and child body mass index during the preschool years: A systematic review of the literature. Obesity Reviews, 15(1), 9-18.

Gupta, N., Shah, P., Nayyar, S., & Misra, A. (2013). Childhood obesity and the metabolic syndrome in developing countries. The Indian Journal of Pediatrics, 80(1), 28-37.

Gupta, N., Goel, K., Shah, P., & Misra, A. (2012). Childhood obesity in developing countries: epidemiology, determinants, and prevention. Endocrine reviews, 33(1), 48-70.

Jansen, P. W., Roza, S. J., Jaddoe, V. W., Mackenbach, J. D., Raat, H., Hofman, A. & Tiemeier,(2012). Children’s eating behavior, feeding practices of parents and weight problems in early childhood: results from the population-based Generation R Study. International Journal of Behavioral Nutrition and Physical Activity, 9(1), 1.

Narayanappa, D., Rajani, H. S., & Mahendrappa, K. B. (2013). Prevalence of Overweight and Obesity among Urban School Going Children in Mysore, India. Executive Editor,4(4), 27.

Neves, P. A., Ribeiro, C. C. C., Tenuta, L. M. A., Leitão, T. J., Monteiro-Neto, V., Nunes, A. M.M., & Cury, J. A. (2016). Breastfeeding, Dental Biofilm Acidogenicity, and Early

Childhood Caries. Caries research, 50(3), 319-324.

Pearce, J., Taylor, M. A., & Langley-Evans, S. C. (2013). Timing of the introduction of complementary feeding and risk of childhood obesity: a systematic review. International journal of obesity, 37(10), 1295-1306.

Praveen, P. A., & Tandon, N. (2016). Childhood obesity and type 2 diabetes in India. WHO South-East Asia J Public Health, 5(1), 17-21.

Redsell, S. A., Edmonds, B., Swift, J. A., Siriwardena, A. N., Weng, S., Nathan, D., & Glazebrook, C. (2016). Systematic review of randomised controlled trials of interventions that aim to reduce the risk, either directly or indirectly, of overweight and obesity in infancy and early childhood. Maternal & child nutrition, 12(1), 24-38.

Vaidya, A. D. (2014). The formidable challenge of underweight, overweight and obese children in India. Journal of Obesity and Metabolic Research, 1(1), 4.

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