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Do burdens of underweight and overweight coexist among lower socioeconomic groups in India?^1,2,3,4

¹ From the Department of Society, Human Development and Health, Harvard School of Public Health, Boston, MA (SVS); the Department of Health Policy, Harvard University, Boston, MA (JMP): and the Pennsylvania State University College of Medicine, Hershey, PA (KTK).

² This study was reviewed by the Harvard School of Public Health Institutional Review Board and was considered exempt from full review because it was based on an anonymous public use data set with no identifiable information on the survey participants.

³ SVS was supported by the National Institutes of Health Career Development Award (NHLBI K25 HL081275).

⁴ Address correspondence to SV Subramanian, Department of Society, Human Development and Health, Harvard School of Public Health, 677 Huntington Avenue, Kresge Building, 7th floor, Boston, MA 02115. E-mail: svsubram{at}hsph.harvard.edu.

Background: The coexistence of underweight and overweight in rapidly developing economies is well recognized. However, less is known about the socioeconomic patterning of underweight and overweight as economies move through the epidemiologic transition.

Objective: The objective was to assess whether burdens of underweight and overweight coexist among lower socioeconomic groups in India.

Design: Repeated cross-sectional analyses were conducted in nationally representative samples of 76,514 and 80,054 women aged 15–49 y drawn from the 1998–1999 and 2005–2006 Indian National Family Health Survey, respectively. Body mass index (in kg/m²) was used to measure weight status. We also calculated a ratio of the number of underweight women (<18.5) divided by the number of overweight women (>24.9). Indicators of socioeconomic status (SES) included wealth and education.

Results: Although the ratio of underweight to overweight women decreased from 3.3 in 1998–1999 to 2.2 in 2005–2006, there were still considerably more underweight women than overweight women. It was only in the top wealth quintile and in groups with higher education that there was a slight excess of overweight women as compared with underweight women. There was a strong positive relation between SES and body mass index at both time points and across urban and rural areas. A positive relation between SES and body mass index was also observed for men in 2005–2006.

Conclusions: The distribution of underweight and overweight in India remains socially segregated. Despite rapid economic growth, India has yet to experience a situation in which underweight and overweight coexist in the low-SES groups.