Prevalence and associated risk factors of overweight and obesity among adolescent population of India: a scoping review

Abstract

Background

Adolescent obesity and overweight is a global epidemic, resulting in severe health problems such as dyslipidemia, hypertension, diabetes, and coronary heart disease. With the rising prevalence of overweight and obesity among Indian adolescents, it is crucial to examine the existing status of research/evidence and the gaps in research. Therefore, the present scoping review was conducted to map the evidence on the prevalence of adolescent obesity/overweight in India and associated major risk factors.

Methods

The study followed Arksey and O’Malley’s (2005) scoping review framework and Joanna Briggs Institute Reviewers Manual (2015) recommendations. We undertook the literature search in electronically available databases using specific mesh terms.

Results

We identified 93 studies that met the standard inclusion criteria. The prevalence of overweight ranged from 1.25 to 35.8% (male: 2.6–28.1%; female: 2.7–44.5%), while obesity ranged from 0.3 to 24.6% (male: 1–19.7%; female: 0.3–32.8%). Research activity peaked between 2011 and 2020, with the highest number of publications in 2015 (n = 13). Most studies were conducted in southern states (31%), followed by eastern (16%), western (15%), and northern (12.9%) regions. A significant proportion were urban-based (70.9%) and institution-based (77.4%). Among major key risk factors, insufficient physical activity was examined in 36.5% of studies, high-calorie dietary habits in 44% of the studies, higher socioeconomic status was reported in 36.5% of studies. Additionally, 26.8% of studies explored the impact of factors like urban living, private school attendance and increased screen time as associated factors of weight gain among adolescents. Other identified factors included 12.9% reporting using vehicles for school transportation, 8.6% noting shorter sleep duration, and 17.2% recognizing a family-history of overweight and obesity as contributing factors.

Conclusion

The review provides a comprehensive overview of adolescent obesity and overweight in the Indian context while highlighting critical research gaps for future exploration. Most studies are cross-sectional and quantitative, underscoring the need for longitudinal and qualitative research. There is a lack of studies on gender-specific risk factors, community-based perspectives, and vulnerable populations such as slum-dwelling adolescents and school dropouts. Addressing these gaps will be essential for generating robust evidence to inform and implement effective, evidence-based policies and interventions.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40795-025-01088-0.

Introduction

The rising prevalence of overweight and obesity among children and adolescents is a major public health concern worldwide. Overweight and obesity were just 8% and 2% respectively in the age group of 5–19 years of children in 1990, which have significantly risen to 20% and 8% respectively by 2022 [1]. As per the estimates of the World Health Organisation, there were 390 million overweight children in 2022 only [2]. The prevalence of obesity roughly tripled between 1975 and 2022. Each year, 2.8 million individuals die from being overweight or obese [3]. Overweight and obesity, once considered public health concerns in high-income countries, are rapidly becoming serious health problems across age groups including children and adolescents in low- and middle-income countries (LMICs) including India [4]. There is a rising trend and it is expected to rise mostly adolescents from 10 to 20% among boys and 8–18% among girls worldwide from 2020 to 2035 associated with various health risk behaviours like sedentary lifestyle, excess junk food consumption, low physical activities and neglected self-care causing overweight/obesity extensively [5].

India has the world’s largest adolescent population with 253 million adolescents comprising one-fifth of its total population [6]. The recent reports highlight that the prevalence and associated risks of overweight/obesity are intensifying among Indian adolescents [7, 8]. India in the last couple of decades transitioned from a high adolescent undernutrition-burdened state to a scenario with rapidly rising adolescence-associated incidences of overweight and obesity [9]. A recent nationwide nutritional survey report indicated overweight/obesity burden among adolescents is more than 5% [10]. A similar upward-rising trend was also reported in the National Family and Health Survey (NFHS) 2019-21 during its five-year evaluation period, compared to NFHS-2015-16. Recent empirical studies among adolescents have reported the prevalence of overweight (Kar and Khandewal, 2015, 14.5%; Prasad R et al., 2016, 9.7%; Mohan et al., 2019, 9.5%; Pathak et al., 2018, 22.2%; Pedapudi et al., 2020, 21.7%; Singh et al., 2020, 9.9%; Seema. et al., 2021, 17.1%) and obesity (Pathak.et.al., 2018, 18.3%; Pedapudi. et al., 2020, 6.1%; Singh et al., 2020, 14%; Seema. et al., 2021, 6.8%) at a higher level; all these scenarios make it imminent concerns for adolescent health in India [8, 11–16].

Furthermore, there has been a significant change in the sociocultural landscape in Indian households in recent decades, with large-scale preference and adaptation to Western culture and lifestyle, including dietary practices. So, such perspectives of childhood and adolescent obesity both from traditional and emerging contexts bring important explanations and therefore need to be studied. Talking about obesity, economic historian Fernandez Armesto wrote- Obesity is a “cultural revolution with an obvious economic root” [17]. Trends around parents’ long working hours associated with busyness in daily life, the value of convenience and child-centric parenting have been identified as important emerging modern cultural contributors of childhood obesity in some of the developing countries [18]. The western food cultures, mostly driven by a preference for high-fat associated foods are available largely as fast and junk food culture in India [19, 20]. These foods are also considered status symbols in several contexts in different low economic settings [20]. With increased access to digital culture around use of mobiles, television and other electronic gadgets, childhood physical activity levels are significantly falling [21]. Both adiposity and obesity can cause various non-communicable diseases among adolescents [22, 23]. Here it may be mentioned that excess weight gain during adolescence leads to many associated chronic diseases in later stages of life like hypertension, dyslipidemia, cardiovascular disease, fatty liver, type 2 diabetes, endocrine insulin resistance, premature puberty, polycystic ovarian syndrome in girls; hypogonadism in boys and gallbladder stones, stroke, and several other with long-term consequences [24].

Here it may be mentioned that there is a rising stress factors [25, 26] among Indian adolescents and now significantly evident [27]. Our recent experience around adolescent health indicated that adolescents of first-generation urban living families and those with recently/newly achieved economic upliftment are more vulnerable to acquiring obesity and overweight. On the other hand, rural households are quickly adopting urban lifestyles due to increased mobility, better transport communication facilities and access to technology showing a high inquisitiveness [19]. Such an urban-rural continuum indicates a conversance trend [28]. Also, some other important aspects like age, gender, family characteristics, and parents’ lifestyles are important [29].

With the above background, we realise that there is an important need to look into the status of research and evidence around adolescent overweight/obesity with respect to traditional and emerging major risk factors; it is also pertinent to identify and analyse the major research gaps in the available evidence and clarify further [30]. We realise that there is a major gap regarding comprehensive discussion on the pattern and trends in published literature/primary studies reporting prevalence and major risk factors of obesity and overweight among adolescents in different parts of India looking into the risk factors, gaps in research evidence and scopes for further research [31, 32].

In the above context, we initiated this scoping review intending to map the evidence around adolescent obesity and overweight burden in India; the review also aims to systematically synthesize the pattern and trends of research practices in existing literature reporting adolescent obesity and overweight in India. We also aim to analyse the major research gaps in the available evidence. It will help to define the future courses of the research, priority areas as well as related research plans and programs.

Objectives of the study

The present study has the following objectives:

• To map the research evidence on the prevalence of overweight and obesity among the adolescent population in India.

• To examine the available literature and describe the evidence on the associated risk factors of adolescent obesity and overweight in India.

Methods

The study adhered to the Preferred Reporting Items for Systematic Review and Meta-analysis: Extension for Scoping Review (PRISMA-ScR) as mentioned in the protocol which has been published (supplementary file 1) [33]. Also, for the current scoping review, we utilized Arksey & O’Malley’s [34] scoping review framework and the Joanna Briggs Institute Reviewers’ Manual [35]. This review encompassed five main stages: (1) Defining the research questions; (2) Identifying relevant studies; (3) Choosing studies for inclusion in the review; (4) Organizing the data; and (5) Compiling, summarizing, and presenting the findings.

Identifying the research question

We used the Population, Concept and Context (PCC) strategy for framing the following research questions:

• What is the status of research and associated evidence on adolescent overweight and obesity in India?

• What is the status of research and associated evidence on the associated risk factors of adolescent overweight and obesity in India?

Search strategy for identification of relevant studies

We conducted a thorough search across various databases, including Google Scholar, EMBASE, Web of Science, SCOPUS, and PubMed to identify relevant literature. Specific mesh terms such as “prevalence”, “overweight”, “obesity”, “obese”, “malnutrition”, “nutritional status”, “BMI”, “adolescents”, “teenage”, “youth” and “India” were used. We used Boolean operators (AND, OR, NOT) to combine and use these search terms. Additionally, we searched government reports like NFHS (2019-20) and CNNS (2016-18), as well as short communications and reference lists for grey literature. We have attached the details of the search strategy employed for the PubMed database (Supplementary File 2).

Eligibility criteria

Inclusion criteria

• Population: We included the studies undertaken among Indian adolescents ranging between 10 and 19 years.

• Concept: Evidence around the prevalence of adolescent overweight/obesity in India and the associated primary and secondary risk factors. All such studies have estimated the status of overweight and obesity among adolescents quantitatively using valid and acceptable scales; the WHO scale for measuring growth standards, CDC (Centre for Disease Control and Prevention) scale for measuring growth standards, the Indian Academy of Paediatrics (IAP) growth charts, Growth standard scale of International Obesity Task Force (IOTF), etc.).

  • According to WHO, the BMI-based cut-offs for overweight and obesity are ≥ 25.0 kg/m2 and ≥ 30.0 kg/m2 respectively [36].
  • CDC defines the BMI Cutoff with ≥ 25–30 kg/m2 as overweight and a BMI ≥ 30 kg/m2 as obesity [37].
  • As per IAP (Indian Academy of Pediatrics) the BMI cut-off for overweight and obesity are 23 to < 27 kg/m2 and ≥ 27 kg/m2 respectively [38].
  • As per the revised IAP growth cutoff for children and adolescents of 5–18 years for overweight and obesity are ≥ 23 to < 27 kg/m2 and ≥ 27 kg/m2 respectively [39].
  • As per IOTF (International Obesity Task Force) BMI (kg/m²) cutoff point for overweight is ≥ 25(kg/m²), for obesity is ≥ 30(kg/m²) and for severe obesity is ≥ 40(kg/m²) [40].
  • The age- and sex-specific BMI cutoffs of ≥ 25 kg/m² for overweight and ≥ 30 kg/m² for obesity to different age groups [41].

• Context: The review included studies conducted among Indian adolescents in various settings, including urban and rural areas, hospitals, schools, colleges, and communities.

• Review period: Studies conducted from 2000 to 2024.

• Language of published literature: We included studies published and available in English only.

Exclusion criteria

• Studies with abstracts showing inconsistencies between titles and content, and those not mentioning the PCC, were excluded.

• Studies conducted before the year 2000 or focusing on populations outside of India were excluded.

• Studies with age groups outside the adolescent age group, i.e. <10 and > 19 years were excluded.

• Studies without appropriate original data were excluded to prevent duplication of data.

• Interventional studies leading to overweight/ obesity as the secondary outcomes and studies involving pregnant women were also excluded.

Selection of the studies, data charting and summarizing, and reporting the results

To ensure the study’s exclusion from the review, we conducted a systematic screening and selection process. The titles of articles and abstract details were evaluated, and the identical studies were eliminated by the investigators, with reviewers conducting a cross-check. The exclusion and inclusion criteria were used to select the appropriate literature. The same eligibility criteria were applied by the reviewers (A.P., S.J.) to screen the full text of the studies. In cases of disagreement among the reviewers, resolutions were reached by consulting the third reviewer (J.P). The flow diagram in Fig. 1 illustrates the entire selection and screening process. We followed the guidelines of the Preferred Reporting Items for Systematic Review and Meta-Analysis Scoping Reviews (PRISMA-ScR) [42].

Fig. 1.

PRISMA flow chart (literature search result)

According to the study objectives, data were extracted and organized around details such as the author’s name, study year, location, study type, sample size, participants’ residence, growth standard, age group, gender, data collection methods, the prevalence of overweight and obesity among adolescents, and factors associated with adolescent overweight and obesity. The analysis adopted thematic content analysis for the included studies. Data relevant to the themes were manually extracted, and the findings were collated, summarized, and reported focusing on the prevalence and the associated risk factors of overweight and obesity.

Ethics and dissemination

Ethical approval isn’t necessary for scoping reviews since they involve organizing and presenting existing information systematically.

Results

The initial literature search identified 3.779 articles. After removing 1,220 duplicate articles and screening the title and abstract using the defined criteria, a total of 376 articles are included. Additionally, 38 studies were left out as they couldn’t be retrieved. Further exclusions led to the removal of 245 articles for the following reasons: age group not between 10 and 19 (n = 12); age group other than 10-19years (n = 108); studies conducted outside India (n = 56); published before 2000 (n = 18); not in English (n = 21); studies no relevant data (n = 18); enable to access (n = 6); and preprints (n = 6). This left us with a final selection of 93 articles for analysis in this scoping review. We have presented the entire screening and selection process in the PRISMA flowchart (Fig. 1) along with providing the detail characteristics of the selected studies. (Table 1).

Table 1.

Characteristics of the included studies

Characteristics of the selected studies	No. of studies	%
Year of publication
2000–2010	8	8.6
2011–2020	60	64.5
2021–2024	25	26.8
Study design
Quantitative and Cross-sectional study	93	100
Gender
Female	8	8.6
Both male and female	85	91.3
Studied adolescent age-groups
Only Early adolescent	24	25.8
Only Late adolescent	9	9.6
Mixed age group (Both early and late)	60	64.5
Place of study
School and college based	72	77.4
Community-based	13	13.9
Hospital based	2	2.1
Region
Eastern region	15	16.1
Central region	9	9.6
Western region	14	15.0
Northern region	12	12.9
Southern region	29	31.1
North-eastern region	8	8.6
Multicentral region	6	6.4
Study setting
Rural	7	7.5
Urban	62	70.9
Both rural and urban	22	23.6
Tribal	2	2.1
Sample size
< 250	8	8.6
251–500	19	20.4
501–1000	21	22.5
1001–2500	31	33.3
2500–5000	4	4.3
> 5000	10	10.7
Article type
Original article	83	89.2
Short communication	6	6.4
Brief epidemiologic report	1	1.0
Letter to editor	1	1.0
National sample survey report	2	2.1
Growth standard
WHO	45	48.3
CDC	12	12.9
IAP	11	11.8
IOTF	8	8.6
NHANES	1	1.0
Cole et al. (2000) cutoff	2	2.1
Khadilkar et al. (2015) cutoff	3	3.2
Used two and more cutoff	12	12.9
Prevalence of overweight	91	97.8
Prevalence of obesity	81	87.0
Mentioned risk factors for overweight and obesity	79	84.9

BMI = Body Mass Index, CDC = Centers for Disease Control and Prevention, IAP = Indian Academy of Pediatrics, IOTF = International Obesity Task Force, WHO = World Health Organisation, NHANES = National Health and Nutrition Examination Survey

Characteristics of the included studies

From the ninety-three eligible papers, all relevant details including the names of the authors, study year, location, study type, sample size, participants’ residence, growth standard, age group, gender, data collection methods, reported associated risk factors, and prevalence percentage were extracted (Supplementary File 4). We observed a trend of noticeable increase in research around adiposity/obesity between 2011 and 2020, and further, with a total of 25 articles published from 2021 to 2024 (Fig. 2) (Supplementary File 3).

Fig. 2.

Year wise number of publications in India reporting adolescent overweight/obesity

Geographical distribution

The findings of the study revealed that the majority of studies were conducted in the southern states (n = 29; 31.1%), followed by the eastern (n = 15; 16.1%), western (n = 14; 15%), and northern regions (n = 12; 12.9%). A significant proportion of studies were reported from urban settings (n = 62;70.9%). Most of the evidence was institution-based, primarily in schools or colleges (n = 72; 77.4%), while only a few studies were community-based (n = 13; 13.9%).

Target population

Regarding inclusion of both girls and boys in studies, eighty-five publications or 89.2% of total studies provided gender-stratified analysis (n = 85), and the rest of the studies reported data on adolescent girls only. Regarding the studied age range, only early and only late adolescent age group were covered in 24 (25.8%) and 9 (n = 9; 9.6%) respectively, while 60 (64.5%) assessed the entire adolescent age group (10–19 years). In most studies, samples ranged between 1000 and 2500 (n = 31; 33.3%). A total of 1,021,929 adolescent participants were included in this review.

Obesity indicators

We observed that all the studies matching the inclusion criteria were cross-sectional (100%) and quantitative (100%) in their study design, of which eighty-three studies (89.2%) were original research, six studies (6.4%) were short communication, two studies (2.1%) were national-level sample surveys and one study (1%) was a brief epidemiological report and one letter to the editor(1%). Our findings show a significant variation in the adoption of growth measurement standards in the selected studies; a major percentage of studies (48.3%) have adopted the WHO growth standard (n = 45). Other references that were considered were the IOTF growth charts (n = 8; 8.6%), the CDC growth charts (n = 12; 12.9%), IAP growth charts (n = 11, 11.8%), Cole et al., 2000 cutoff (n = 2; 2.1%), Khadilkar et al., 2015 cutoff (n = 3, 3.2%). Twelve publications (n = 12, 12.9%) referred to multiple growth standards (Table 1).

Prevalence of overweight and obesity among Indian adolescents

Among the ninety-three selected studies, the prevalences of overweight and obesity were reported in ninety-one studies (97.8%) and eighty-one studies (87%) respectively (Table 2). The prevalence of overweight in these studies ranged from 1.25 to 35.8%, while obesity prevalence ranged from 0.3 to 24.6%. Studies on prevalence of overwaight (23 (24.7%) studies among males and 17(18.2%) studies among females) and obesity (13 (13.9%) studies among males and 19(20.4%) studies among females) were observed to report separately. Specifically, the prevalence of overweight and obesity among females ranged from 2.7 to 44.5%, and 0.3–32.8% respectively. In comparison, overweight prevalence varied from 2.6 to 28.1% among male adolescents with obesity ranging from 1 to 19.7%. Age-group based differences in prevalence were examined in fourteen studies (15%), reporting higher rates of overweight and obesity among early adolescents ranging 2.5–28.3% and 1.8–14.1% respectively compared to older adolescents ranging 3.6–23.5% and 0.8–11.2% respectively. However, four studies (4.2%) found a higher overall prevalence among older adolescents [43–46]. Maiti et al. (2013) reported an increase in overweight prevalence with age [43], while Chhatwal et al. (2004) and Mandal et al. (2012) observed a significant decrease in obesity with age [44, 45] (Table 2).

Table 2.

Variability in studies while covering obesity-associated risk factors in India

Risk factors	Characteristics
	Number of studies reporting the risk factors	Area of residence reporting for the risk factors	Study settings reporting the risk factors	Range of sample size for the risk factors	Geographical variation in reporting the risk factors	Gender-wise prevalence of Obesity/ Overweight (%) for the risk factors
Lack of physical activity	34 (36.5%)	Urban (25; 73.5%)	School-based (26; 76.4%)	99- 6,67,750	Southern (9 studies), Eastern (9 studies), Northern (4 studies), Western (4 studies), Central (4 studies), Multicentric (3 studies)	Obesity: Male (1-19.1%); Female (0.8-14.7%) Overweight: Male (5-17.6%); Female (4.9-23.4%)
Poor dietary behaviour	41 (44%)	Urban (31; 75.6%)	School-based (35; 85.3%)	100- 6,67,750	Southern (13 studies), Eastern (9 studies), Western (5 studies), Northern (3 studies), Central (6 studies), North-eastern (3 studies), Multicentric (2 studies)	Obesity: Male (1-10.8%); Female (0.5-6.4%) Overweight: Male (3.5-19.2%); Female (4.8-23.4%)
Area of residence and school type	25 (26.8%)	Urban and Rural (14; 56%)	School-based (23; 92%)	99 − 26,495	Northern (5 studies), Southern (8 Studies), Western (4 studies), Multicentric (2 studies), Central (2 studies), Eastern (2 studies), North-eastern (2 studies)	Obesity: Male (1-13.3%); Female (0.8-14.7%) Overweight: Male (6.1-15.7%); Female (6.1- 13.7%)
High socioeconomic status	34 (36.5%)	Urban (24; 70.5%)	School-based (32; 94.1%)	100-8,055	Southern (11 studies), Northern (7 studies), North-eastern (2 Studies), Central (5 studies), Western (3 studies), Eastern (6 studies)	Obesity: Male (1-13.3%); Female (1.6-14.7%) Overweight: Male (6.1-17.8%); Female (5.6-18.4%)
High screen time	25 (26.8%)	Urban (22; 88%)	School-based (21; 84%)	100-6,67,750	Southern (7 studies), North-Eastern (2 studies), Northern (3 studies), Western (3 studies), Eastern (6 studies), Central (3 studies), Multicentric (1 study)	Obesity: Male (1-10.8%); Female (0.5-5.3%) Overweight: Male (3.5-19.2%); Female (4.8-13.4%)
Mode of transportation	12 (12.9%)	Urban (10; 83.3%)	School-based (10; 83.3%)	260 − 12,410	Eastern (5 studies), Southern (2 studies), Northern (2 studies), Western (1 studies), Central (1 studies), North-Eastern (1 studies)	Obesity: Male (1-6.7%); Female (1.5-6.4%) Overweight: Male (6.1-15.1%); Female (8.2-13.3%)
Limited sleep duration	8 (8.6%)	Urban (6; 75%)	School-based (7; 87.5%)	327 − 12,410	Eastern (1 studies), Southern (2 studies), Western (3 studies), Central (1 studies), North-Eastern (1 studies)	Obesity: Male (4-13.3%); Female (4.8-14.7%) Overweight: Male (10.3-12.9%); Female (9-10.3%)
High birth weight	2 (2.1%)	Urban (1; 100%), Urban and Rural (1;)	School-based (2; 100%)	1266, 4700	Southern (Tamil Nadu) Central (Uttarakhand)	Obesity: Male (3.6%); Female (2.7%); Overweight: Male (17.8%); Female (15.8%)
Family history of overweight and obesity	16 (17.2%)	Urban (9; 56.2%)	School-based (13; 81.2%)	187 − 12,410	Eastern (2 studies), Southern (5 studies), Northern (1 studies), Western (5 studies), Central (2 studies), North-Eastern (1 studies)	Obesity: Male (2.3-7.3%); Female (4.9-6.1%) Overweight: Male (5.1-12.9%); Female (4.9-18.7%)

These selected risk factors have been discussed in detail in the following section.

Lack of physical activity

Insufficient physical activity was identified as a major risk factor for overweight and obesity in 36.5%. Across the studies, the lack of physical activities was attributed to prevalence of overweight and obesity ranging from 3 to 28.3% and 1.3–23.7% respectively. More than 76% of the studies were school-based, focusing on adolescents from an urban area (73.5%). Several of such studies were conducted in states like Tamil Nadu, Karnataka, and Telangana in the southern part of India. The majority of studies reported that engaging in two to three hours of daily physical activity could significantly reduce the risk of overweight and obesity among adolescents. High socio-economic status, fewer outdoor games, urban lifestyle, sedentary activity and more leisure hours were observed as major influencing factors [7, 47–50]. Importantly, adolescents pointed out their school homework as the main reason for them for low physical activities [51].

Poor dietary behaviour

Diet plays a crucial role in becoming overweight or obese among adolescents. Forty-one studies (44%) analyzed dietary behaviors and highlighted a positive association between poor dietary practices and overweight/obesity. Consumption of energy-dense foods such as fast food, chocolates, and cold drinks was highlighted in most studies as a major risk factor for increased adiposity [47–48, 52]. The prevalence of overweight due to poor diet in the selected studies ranged from 3 to 28.5%, while obesity prevalence ranged from 0.7 to 18.3% with predominance among males. Most studies were reported from the southern region of India (31.7%), largely school-based (85.3%) and urban-centric (75.6%). Two studies (4.8%) indicated that non-vegetarian adolescents were more likely to have a high BMI [8, 53, 54]. Studies reported skipping meals, skipping breakfast, taking meals in the canteen, less fruit and vegetable consumption, snacking in between meals, are the major factors associated with poor dietary behavior, a major factor for overweight and obesity among adolescents.

Area of residence and school type

The area of residence and type of school attended were significant factors for increased adiposity among adolescents. Out of all included studies, twenty-five studies (26.8%) examined the role of residential areas in causing overweight and obesity prevalence. The overall prevalence of overweight and obesity among adolescents in these studies was reported at 5.8- 34.9% and 0.3-18.3%, respectively, with higher prevalence among urban living adolescents [14, 50, 52, 55]. Most of the studies were school-based (92%) and conducted in the southern states (32%) of India. These findings underscore the role of urbanization and school environments in shaping dietary habits and physical activity levels for adolescent health.

High socioeconomic status

Evidence suggests a significant association between socioeconomic status (SES) and the increased risk of overweight and obesity among adolescents. Thirty-four studies (36.5%) have reported adolescents from higher socioeconomic backgrounds having higher BMI. Among the studies reporting high economic status, the prevalence of overweight ranged from 2.2 to 26.9%, while obesity prevalence ranged from 1.3 to 23.7%. Interestingly, overweight and obesity prevalence was higher among male adolescents, while most of these studies were southern states-based (32.3%), urban-centric (70.5%) and from school facilities (94.1%). Higher parental education, which often leads to better financial status and access to modern foods, has been linked to an increased risk of adiposity. Studies (8.8%) highlighted this correlation, with educated parents, especially mothers’ education, being associated with having children at risk of higher BMI. The education and occupation of both mother and father were found to independently influence the body adiposity composition in adolescents [54]. High socioeconomic status associated with family structure also impacts adiposity. A nuclear family structure tends to provide increased access to energy-dense foods and is associated with a higher risk of overweight and obesity. Traditionally, smaller family sizes, with fewer siblings, have been associated with more food adequacy for children, potentially leading to increased caloric intake. The preference for one or two children in nuclear families, combined with access to modern foods, exacerbates the risk for adiposity. In line with this, a study by Bhargava et al. (2016) found that adolescents with lower birth order in families tended to have higher BMI [52]. Furthermore, a study indicated that single children in a family had the highest risk of developing overweight and obesity [56].

High screen time

Screen time has emerged as a significant risk factor for overweight and obesity among adolescents in the present analysis. A total of twenty-five articles (26.8%) examined higher screen time and adolescent overweight and obesity. The prevalence of overweight was reported to range from 3 to 28.3%, while the prevalence of obesity ranged from 0.7 to 23.7%. These findings were predominantly reported from the Southern regions of India (28%), focusing on urban-dwelling (88%) adolescents. Most of these studies were school-based (84%), highlighting the urban school environment as a critical setting for these observations. The overall prevalence rate shows that overweight is high among female adolescents and obesity is high among male adolescents. Television watching and video gaming were identified as the two primary contributors to prolonged screen time and subsequent weight gain. Studies observed a notable pattern of adolescents engaging in eating while watching television, further exacerbating the risk of weight gain. Majority of studies reported that watching TV for more than 2 to 3 h per day was significantly correlated with an increased likelihood of being overweight or obese [7, 8, 55, 57–59].

Mode of transportation

The mode of transportation to school has been identified as a significant factor influencing physical activity levels and, consequently, overweight and obesity. Adolescents who walk or cycle to school exhibit higher activity levels compared to those who rely on private or public transportation. This relationship was highlighted in twelve studies (12.9%), which consistently identified the mode of transportation, specifically bus transportation as a significant risk factor associated with increased adiposity [50, 55] while walking or cycling to school had significantly lower adiposity (60–62). Reported prevalence rates of overweight ranged from 5.8 to 28.3%, while obesity prevalence ranged from 1.3 to 17.8%. Most of these findings were derived from school-based studies (83.3%) with an urban orientation (83.3%), with a notable concentration of research conducted in eastern India (41.6%). The prevalence of overweight and obesity is similar for both genders.

Limited sleep duration

A total of eight studies (8.6%) reported on the association between less sleep duration among adolescents and overweight and obesity. The prevalence of overweight was reported to range between 6.4% and 17.1%, and obesity ranged between 1.2 − 14%. The overweight rate was higher among males. The reviewed studies predominantly focused on adolescents from urban areas (75%) in southern (25%) and western (37.5%) India, particularly younger adolescents. The majority of the data were collected from school-based studies. Sleep duration, particularly shorter sleep durations, emerged as a critical risk factor for adiposity. However, adolescents with a sleep duration of 8 to 9 h or more had a significantly lower risk of overweight and obesity [16, 56, 62–64].

Other risk factors

Among several other risk factors, two studies (2.1%) highlighted high birth weight as a significant predictor of overweight and obesity later in life. Three studies also demonstrated that adolescents with higher obesity levels had a significantly increased rate of elevated blood pressure [13, 65, 66]. Additionally, the review revealed that the prevalence of overweight and obesity was higher in southern and northern regions of India, particularly among adolescents with a family history of diabetes and hypertension [15]. Moreover, sixteen studies (17.2%) emphasized that a family history of overweight and obesity, posed a significant risk for obesity in subsequent generations [67]. The prevalence of overweight and obesity was observed to be highest among Muslim adolescents (51.1%), in comparison to Hindus (38.8%) [68]. Adolescents demonstrated only an average level of knowledge regarding the prevention and control of overweight and obesity [69]. Additionally, the prevalence of overweight and obesity was notably higher among adolescents from the general category compared to those from scheduled castes, scheduled tribes, and backward communities [55]. However, few studies also reported the prevalence among children from low socioeconomic status, particularly among the girls [60, 61].

Discussion

This scoping review aimed to discuss the status of research evidence around the overweight/obesity burden among adolescents, as well as the major associated risk factors during the period of 2000 to 2024. Out of the studies reviewed, ninety-three studies met the criteria for inclusion and were analyzed and synthesized. Various characteristics emerged from the research studies around adolescent overweight/ obesity by considering aspects like study year, study design, location, study type, sample size, participants’ residence, growth standard, age group, gender, data collection methods, the prevalence of overweight and obesity among adolescents, etc. Risk factors like physical activities, living areas, school settings, rural/urban lifestyle, food and diet practices, physical activity, screen time, sleep duration, and the modes of school transportation etc. were examined in the selected studies. Similarly, the particular scales used for the assessment of adiposity were also looked into. As per the findings of the analysis, major research reporting was observed during post-2015, with 100% cross-sectional and quantitative design, prioritizing urban settings (62studies or 70%), school-going/institutional facilities (72 studies or 77.4%) with the adaptation of varied growth standards such as of CDC, IAP, IOTF and NHA-NES, cut off given by Khadilkar et al. (2015) and Cole et al. (2000) (49 studies or 52.6%). On the other hand, the majority of the studies included two genders (85 studies or 91.4%), standard sample size as ≥ 250 numbers (in 85 studies or 91.4%), both early and late age groups (60 studies or 64.5%), regional variation (South region, 29studies or 31.1%; East region, 15 studies or 16.1%; West region, 14 studies or 15%; North region, 12 studies or 12.9%; Central region, 9studies or 9.6%; N-E region, 8 studies or 8.6%) and WHO growth standard (44 studies;47.4%). On major risk factors, the findings highlight that physical activity level was examined in 34 studies (36.5%), diet factor in 41 studies (44%), high Socio-Economic status in 34 studies (36.5%), high screen time in 25 studies (26.8%) Mode of transportation in 12 studies (12.9%) less sleep duration in 8 studies (8.6%) high birth weight in 2 studies (2.1%) and family history in 16 studies (17.2%).

The findings showed association of increased adiposity among adolescents with attending urban and private schools, high socioeconomic status, urban residence, parental high education, high income based occupation, having less physical activity, adopting urban lifestyle, particularly food habits with energy-dense or high-caloric foods and non-vegetarian diets, high screen time, eating while watching television, lesser sleep duration, adopting the sitting/resting modes of transportation to school/college (by buses, motorcycles, or cars) and within the younger (10–14) age group [70–79, 86, 87]. In the context of family types, nuclear families with single children or younger siblings are more prone to higher BMI while children’s birth order, birth weights, and family histories of diabetes and hypertension influenced increased overweight/obesity among them [80–85]. However, some studies reported higher sleep duration related to higher BMI with behavioral confounding factors like eating habits, screen time, substance abuse, and mental health [88].

Major research gaps

Through the analysis of various evidence in the present study, we can say that although there has been much evidence available in the field, most of the studies focused on similar or traditional risk factors, leading to various prevailing gaps in assessing multiple perspectives (Table 3).

Table 3.

Identified research gaps regarding overweight/obesity research among Indian adolescents

Research Gaps in Study Design and Methodology
• All the studies are cross-sectional study designs (100%) without any longitudinal or any other details exploration.
• The major studies are school/college-based settings (77%) with limited community-based study settings (14%).
• All the studies followed the quantitative (100%) sample design with a lack of qualitative in-depth explanations of risk factors.

Research Gaps in Study Population
• Prioritized urban-centric population selection (71%), in comparison to rural (7.5%) and tribal (2.1%) populations.
• More focus on the early adolescent group (26%) with a limited focus on late adolescents (9 studies).
• No data on vulnerable populations like slum-dwelling adolescents, dropout children and those who have never gone to school, orphans, etc.
• Fewer community-based studies (14%) so the limited explanation of community-associated risk factors.
• Fewer studies from north (12.9%), eastern (16.1%), central (9.6%), western (15%) and north-eastern zones (8.6%).
• Several states without any evidence on the prevalence or risk factors

Research Gaps in Selection of Variables/Risk Factors
• Most of the studies included the common risk factors with descriptive analysis.
• Limited research in emerging and new risk factors like parents’ long working hours associated busy-ness in daily life, the value of convenience and child-centric parenting, binge eating, increased screen time, etc.
• Limited explanations of influence of various socio-cultural aspects on adiposity risk.
• Major literature gaps on evidence around:
• Gender-specific risk factors around obesity and overweight.
• Knowledge, perception, understanding and practices regarding the risk factors of overweight and obesity among the adolescents.
• Perspective of food choices, changing patterns of food habits, role and association of social media on adolescent overweight and obesity.
• Lack of qualitative exploration of perception, attitude, peer pressure influences, social media influence, family cultural influence, diet and lifestyle understanding among the adolescents.
• Association of maternal BMI during pregnancy and exclusive breastfeeding during infancy with adolescent overweight and obesity.
• Interactions between birth weight, childhood sedentary lifestyle, consumption of high-calorie foods during childhood, parental factors, and adolescent overweight and obesity risks.

Research Gaps in Publication Practices and Statistical Analysis
• The empirical studies around adiposity/obesity appear to be more incidental, sporadic, and inconsistent.
• Limited statistical analysis across studies, leading to redundancy in results and poor interpretation, providing limited insights.

Research Gaps in Overweight/Obesity Measurement/Standardization
• Significant variability in BMI cut-offs and growth measurement standards (Fig. 3):
• WHO Growth Standards, CDC Growth Charts, Indian Academy of Paediatrics (IAP), and International Obesity Task Force (IOTF) charts were used.
• Diverse cut-offs for overweight/obesity, e.g., WHO (≥ 25.0/≥30.0), IAP (≥ 23.0/≥27.0), and Diverse cut-offs for overweight/obesity, e.g., WHO (≥ 25.0/≥30.0), IAP (≥ 23.0/≥27.0), CDC (≥ 25.0–30.0/≥30.0), IAP (23 -<27/≥ 27).
• Limited comparability and standard reporting practices across studies due to these variations.
• Lack of standardized criteria impedes evidence-based decision-making.

Fig. 3.

Bibliography of the selected studies presenting pattern of research undertaken by various researchers, institute-wise affiliation, and publishing journals on adolescent overweight/ obesity in India (Supplementary File 3)

It is imperative to mention that addressing these research gaps by ensuring a more comprehensive research and analysis plan will immensely help to understand overweight/obesity among Indian adolescents. It is also worth noting that India currently lacks targeted policies aimed at raising awareness and assisting adolescents in addressing obesity and overweight issues. So, this evidence synthesis and gap analysis can guide future research policies around evidence synthesis as well as implementation research for controlling overweight and obesity among Indian adolescents.

Emerging perspectives for future research policy and practices

Based on the present analysis of evidence, we suggest the following prioritization in the future course of research, policy and evidence synthesis.

• i.Studies involving longitudinal assessment of overweight/obesity to understand the trends of various risks as well as contextual emerging factors.
• ii.Research around food behavior, dietary practices and associated influencing factors.
• iii.Qualitative studies for in-depth explanation of factors and pathways of acquiring overweight/obesity among adolescents.
• iv.Recognizing and examining the role of new and emerging risks around overweight/obesity from all spheres of life, including socio-cultural, ecological, biological and environmental aspects for a comprehensive understanding.
• v.Commissioning overweight/obesity studies involving vulnerable populations like tribal, scheduled caste, and dropout children by shedding the traditional wisdom that these sections are affected by undernutrition only.
• vi.Greater standardization of measurement criteria and preferably an India-specific guideline for nutritional assessment, including obesity and overweight to facilitate meaningful cross-study comparisons and evidence-based decision-making.
• vii.Undertaking more implementation researches and improving upon the existing intervention models.

Strengths and limitations

To our knowledge, this review is the first scoping review to examine the status of research regarding obesity and overweight, along with associated risk factors, among Indian adolescents. The review includes the latest available studies (by the time of submission) which encompasses a substantial number of studies from different geographic areas in India to ensure representation. The study suggests future scopes for research in the areas of adolescent obesity/overweight. However, the study has some limitations as it only includes the studies available electronically and those published in English. Additionally, the review focuses on a specific time frame based on the available evidence. Some variables, like region with limited data, do not represent the issue’s actual status and remain unexplored in several contexts. Expanding research coverage would provide a more accurate and detailed status. India, being a linguistically highly diverse and region-wise strongly affiliated country, studies in local languages could have been more informative. Scoping reviews do not evaluate the quality of the studies, so specific observations need to be assessed thoroughly while looking for effectiveness and causality.

Conclusion

Overweight and obesity have become significant health risks among adolescents due to multiple contributing factors. This review evaluates the literature on Indian adolescent overweight and obesity, highlighting the limited research in this critical health domain. Despite its growing importance, the field has several aspects underexplored, necessitating future investigations with broader geographical coverage and diverse research methodologies. Additionally, the findings on risk factors from this scoping review highlight the need for interventions aimed at improving knowledge and perception about lifestyle factors, including less explored and emerging risk factors like proper sleep duration, and screen time management, ensuring a more holistic and effective approach to tackling adolescent overweight and obesity in India.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Abbreviations

WHO

World Health Organisation

LMICs

Low- and Middle-Income Countries

NFHS

National Family and Health Survey

PRISMA-ScR

Preferred Reporting Items for Systematic Review and Meta-analysis: Extension for Scoping Review

PCC

Population, Concept and Context

CDC

Centre for Disease Control and Prevention

IAP

Indian Academy of Paediatrics

IOTF

International Obesity Task Force

BMI

Body Mass Index

NHA-NES

National Health and Nutrition Examination Survey

Author contributions

S.K.A. conceptualized the study, contributed to the methodology, was involved in preparing the original draft, reviewed and edited the manuscript, and was involved in fund acquisition. A.P., S.J. and S.S.B. were involved in investigating the manuscript. A.P. and S.J. were involved writing of the original draft preparation of the manuscript. J.P. was involved in methodology and original draft preparation. P.K.P., S.P. and H.K. were involved in reviewing and editing the manuscript.

Funding

This scoping review received no specific grant from any funding agency in the public, commercial or not-for-profit sectors. However, we acknowledge that the manpower in the research grant received from the Indian Council of Medical Research (ICMR), New Delhi vide letter number Tribal/122/2020-ECD-II was utilized for the present scoping review covering one of the aspects for which the grant was received.

Data availability

Data is provided within the manuscript or supplementary information files.

Declarations

Ethical approval

This scoping review does not require ethical approval; it involves a systematic combination and presentation of available resources.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.