Lifestyle Influences on Total Body Composition in Overweight Children from South India

Abstract

Background:

India is witnessing a dual burden of malnutrition, with rising childhood obesity coexisting with undernutrition. Conventional measures like BMI are limited in accurately assessing adiposity, especially in growing children. Dual-energy X-ray absorptiometry (DEXA) offers a more precise evaluation of fat distribution and body composition. This study assessed DEXA-derived adiposity metrics and their associations with behavioral factors in overweight South Indian children aged 5–12 years.

Methods:

A prospective cross-sectional study was conducted at a tertiary care center in South India over 12 months. Forty-three overweight children were recruited based on Indian Academy of Paediatrics BMI percentiles. DEXA scans measured Total Body Fat Percentage (TBFP), Fat-Free Mass Index (FFMI), and Android:Gynoid (A:G) fat ratio. Behavioral data on screen time, physical activity, and processed food intake were collected using structured questionnaires. Statistical analyses included chi-square tests and Pearson’s correlations.

Results:

Mean TBFP was 23.3% (SD = 3.6), with a mean A:G ratio of 1.06, indicating central adiposity. Screen time and processed food intake were significantly associated with higher TBFP (p = 0.006 and p = 0.007, respectively), while physical activity showed no significant association. Moderate positive correlation was found between processed food frequency and TBFP (r = 0.339, p = 0.050).

Conclusion:

DEXA-based evaluation revealed elevated central adiposity in overweight children, which may be underestimated by BMI. Dietary behaviors and screen time were stronger predictors of adiposity than physical activity. These findings underscore the need for targeted behavioral interventions and the integration of advanced body composition assessments in pediatric obesity screening.