A single-center study exploring urbanization-related changes in children’s eating behaviors, central obesity and parental food choices

Rampant urbanization as an environmental factor may cause a shift in children’s eating behaviors, raising the prevalence of pediatric obesity. While smart and sustainable urbanization is central to the One Health approach, evidence linking urbanization to pediatric obesity—particularly in the Indian context—remains limited. Therefore, this study examined urbanization-related lifestyle factors, influence of urban food environment on children’s eating behaviours, and parental food choices as a correlate of central obesity in children. In this single-center cross-sectional observational study, 163 parents and schoolchildren aged 8–15 from Karimnagar, Telangana, India, were recruited using convenience sampling. A 29-item structured, self-reported questionnaire with 5 sections: socio-demographics, anthropometry, dietary data, urban lifestyle factors, influence of urban food environment on child’s eating behavior and parental food choices was developed and validated. Anthropometric measurements were collected by a researcher using standard methods, and central obesity was defined as a waist-to-height ratio (WHtR) ≥ 0.5. Multivariate regression analysis was performed and p-values < 0.05 indicated significance. Overall, 61.3% of children had central adiposity (WHtR > 0.5), with a higher prevalence among males (67%). Notably, 55% of children with normal BMI also had central adiposity. Secondly, most participants reported perceived urbanization-related lifestyle changes, including increased sedentary behavior (45.5%), > 2 h of screen time (45.5%), access to gadgets (85.1%), altered eating habits (89%), attraction towards food stalls (86.4%), and unhealthy choices during leisure time among children (69.5%). Parental food ordering driven by food vouchers and coupons (OR: 5.58, p = 0.017), outside food consumption (OR: 2.64, p = 0.003), and fried food intake (OR: 1.16, p = 0.028) was significantly associated with increased risk of central obesity. Whereas, daily consumption of pulses & legumes, green leafy vegetables, eggs & poultry, fish & seafood were associated with lowered odds of central obesity ( p adj <0.05 for all). In conclusion, this exploratory study highlighted the need for larger studies with diverse urban school settings including government schools, and qualitative inquiry to identify urbanization-related determinants to inform nutrition education, and policies that promote healthy food environment and sustainable urbanization considering its health impact.