Neck Circumference, a Screening Tool for Obesity in Newly Pubescent Children-A Case Study

“Childhood Obesity and its co-morbidities is considered as a prime health hitch that lay up consideration among the public health society. Obesity and above the over weight has bagged the fifth position in the global risk for mortality. The obesity shows a very early onset in life which has laid the utmost importance in the prevention of it among the children. Neck circumference is being Conclusion: The present study showed that the weight increase in school children and need to aware the parents.


INTRODUCTION
Above the over weight is defined as body mass index between 25 and 29.9 kilogram per meter square and obesity is defined as BMI of 30 kilogram per meter square or higher. Obesity is a pathological condition in which excess body fat accumulated, leading adverse effects on health and life expectancy [1]. It is a chronic disorder with complex interaction between genetic and environmental factors. It characterized by high cholesterol, fatty acid levels; imbalance in metabolic energy; insulin desensitization; lethargy, gallstones; high blood pressure; shortness of breath; emotional and social problems; and excessive adipose mass accumulation with hyperplasia and hypertrophy [2]. Pathological obesity is associated with several secondary commodities like heart disease, type 2 diabetes, breathing difficulties during sleep, cancer and osteoarthritis.
It is most commonly caused by a combination of excessive dietary calories, lack of physical activity, and genetic susceptibility. Evidence to support this view is that some obesity people eat little yet gain weight due to slow metabolic rate. The primary treatment for obesity are dieting and physical exercise. To addition to this, or in case of failure, anti-obesity drugs may be taken to reduce appetite or impede fat absorption [3]. In serious cases, surgery is carryout or an intragastric balloon is placed to lower stomach volume and/or bowel length, precede to earlier satiation and make less ability to absorb nutrients from food [4].
Obesity can be associated with several risk factors such as cardiovascular and metabolic disturbances. There are numerous methods for assessing above the over weight and obesity. Some techniques are applicable at primary care facilities, such as measurements of weight, height, hip circumference, calculations of waist-hip ratio and BMI. It is important to develop a quick method of for the assessment of obesity in primary care clinic. The purpose of the study to determine whether neck circumference is useful alone for assessing obesity [5].
The restraint of BMI as a risk evaluation tool is also conceded, and there is continuing interest in alternative or complementary indices linking body adiposity and disease risk. For example, some studies suggest that abdominal circumference is better correlated than BMI with the risk of type 2 diabetes [6]. Although it is well established that visceral adiposity plays a central role in the metabolic disorders associated with obesity, the dearth of a pragratis method to assess visceral fat in routine examinations precludes its use as a screening tool for the public [7][8][9]. Forkhead box O (FOXO) transcription factors are the main factors that contribute the direct and indirect pathways for glucose homeostasis. The recent studies showed that it actively hyperglycemia in chronic insulin resistance in obesity patients [10]. Developing simple and authentic methods to assess body fat compartments should be an important prime concern of obesity research.

Objective
Above the over weight in children is described by using body mass index along with BMI, waist-hip ratio, mid-upper arm circumference, waist thigh ratio indices of body fatness is needed to determine obesity.
The aim of the study to determine whether neck circumference is useful alone for assessing obesity, Children who were to 11 to 18 yrs and undergoing schooling where the subject of the study, trained CRRI collected the anthropometric data from school-going children. We calculated and correlated the neck circumference and other indexes of obesity and we analyzed the optimal neck circumference cutoff for identifying children with high BMI.

METHODOLOGY
A cross-sectional study was conducted during the period of August 2019-September 2019 in the private schools, of Pondicherry. Participants were of age 11-18 years comprising both males and females as the separate groups. Considering approximately 50 private schools in Puducherry , 9 schools were chosen by systematic random sampling method. 35 samples from each school were selected using simple random sampling method using the lottery method with the help of attendance registry maintained in the schools to arrive at the sampling frame. A total of 280 children, among which 150 were males and 129 were females. A pretested questionnaire was used as a study stool for the data collection. The validity of the tool was assessed by consultation with expert opinion. Anthropometry measurements were taken by Doctors through proper modes.
Neck circumference was measured using a plastic tape it was measured in a standing position while the child's head was held erect with eyes looking forward, shoulders in a relaxed position, Waist circumference measurements were measured using tape. Measured at the top of the hip bone, then brought the tape and measured all the way around the body, level with the belly button. Made sure it wasn't too tight and that it's straight, even at the back. asked the children not to hold their breath while measuring, measured the number on the tape right after they exhale. Hip circumference was measured at the maximum circumference of the Gluteal region.
Participants were also examined regarding height, weight, and BMI.

Height (cm):
Standing height was measured using an audiometer and height road. It was measured in cm; the participants were made to stand in an erect position.

Weight (kg):
Standard weight monitoring device was used that was placed on a hard flat surface and checked for zero balance.
BMI: BMI was calculated by dividing weight in kg with the square of height in the meter as per the formula kg/M2.
The Data was entered in excel sheets and analysed using SPSS software version 21 [11].

RESULTS
In a total of 279 children, Table 1 Table 1).

DISCUSSION
The present study conducted on children aged 11-17years had shown a notable relation between neck circumference and anthropometric measurement of obesity in both boys and girls.
Childhood obesity has become a paramount worry. Many studies had manifest expand unfavourable health issue of childhood obesity both short term besides long term consequences. Controlling the epidemic of childhood obesity, awareness prior precaution and treatment of childhood obesity are important priorities that need adequate diagnostic measures. Both patients and health practitioner must have tools with low cost, quick and easy to use for screening and monitoring [12][13].
The first person to suggest that different body morphology and type of fat distribution which is associated with health risk of obesity is Vague J.Hatipoglu et al also suggested neck circumference can be used for screening children with above the over weight and obesity and correlated positively between neck circumference and BMI, waist circumference. Nafiu et al conducted a study on 1102 children aged between 6-18yrs had shown that neck circumference correlated with age, BMI and waist circumference in both boys and girls and neck circumference cut off value were given according to age, optimal neck circumference cutoff indicative of high BMI in boys ranged from 28.5-39 cm, in girls 327-34.6 cm respectively. Similar results were also found in other studies by Roberta et al and Mozaffer et al. The present study results which conducted on 279 students aged between 11 to 17 years has shown that neck circumference correlated with BMI , weight , hip circumference ,waist circumference in both boys and girls .Optimal NC cut off values indicative of high BMI in boys ranged from 33.16-37.68 cm, in girls 30.92-34.77 cm respectively. Neck circumference is reliable and easy to measure compare to other indiexes of adiposity.

CONCLUSION
The present study findings in children are consistent with other studies, therefore we conclude that above the over weight/obesity children could be screened through neck circumference, through which we could identify the pre obesity children and carry out the needed management since there in increased level of obesity related health conditions among the children and the adolescents.

CONSENT AND ETHICAL APPROVAL
As per international standard or university standard guideline Patient's consent and ethical approval has been collected and preserved by the authors.