Although malnourishment among women and children is widespread in India, increasing numbers of girls and women are overweight too, especially among urban, educated and wealthier families, a new global study has found. The proportion of overweight and obese women almost doubled in 17 years to 2016, it said.

The study, Trends and Correlates of Overweight among Pre-School Age Children, Adolescent Girls, and Adult Women in South Asia, was published in the global journal Nutrients in August.

In 17 years from 1999 to 2016, the proportion of children younger than five years who were overweight fell from 2.9% to 2.1%. During the same period, however, the proportion of adolescent girls aged between 15 and 19 years, and women, aged between 20 and 49 years, who were overweight more than doubled from 1.6% to 4.9% and 11.4% to 24%, respectively. The prevalence of obesity among women in this age group more than doubled from 2.4% to 6%.

The study examined preschool, adolescent and adult women in six countries of South Asia – Afghanistan, Bangladesh, India, Pakistan, Maldives and Nepal. All countries studied followed a similar trend in the prevalence of excess body weight and obesity, researchers who worked on the study from Yale University, Tufts University and UNICEF found.

The proportion of overweight girls and women increased over time in Nepal, India and Bangladesh. These countries, while still tackling undernutrition among vast sections of their population, are seeing rising over-nutrition in other segments, even among women and girls living in rural areas and uneducated and poorer households, the study found.

“Globally, the rise in adolescent overweight and obesity is larger than the decline in underweight (sic),” the researchers wrote. “It has been estimated that if post-2000 trends continue unabated, the prevalence of child and adolescent obesity will surpass the prevalence rate of underweight by the year 2022.”

However, India had the lowest prevalence – just 24% – of excess body weight among women in South Asia. The Maldives at 46% and Pakistan at 41% reported levels that are significantly above the global estimate of 38%.

The study also suggested that the proportion of obese and overweight people increases faster among the less educated and the poor, which has clear policy implications.

India’s double burden

Despite these changes, the proportion of undernourished children, adolescents and women remain high. In 2016, for example, 37.4% of children under five were stunted, 41.8% of adolescent girls and 18.8% of women were underweight, as per the same study.

India is not on track to achieve any of the World Health Organization’s nine nutrition goals – to reduce the prevalence of under-five stunting which is having a short height for age, under-five wasting which is having low body weight for height and under-five excess body weight; to reduce the prevalence of anaemia among women of reproductive age; reduce obesity and diabetes among women and men and increase exclusive breastfeeding. The targets for 2025 are likely to be missed, as IndiaSpend reported in December.

However, there is evidence that undernutrition and excess body weight increasingly co-exist in the same countries, communities and even families, the paper said.

Earlier, the National Institute for Nutrition, which comes under the Indian Council for Medical Research, had found high prevalence of obesity in adults in a 2016 study – 44% of women were obese and 11% underweight in urban India.

“The current nutrition strategy acknowledges the challenge but doesn’t include actions,” said Purnima Menon, senior research fellow, International Food and Policy Research Institute, a food policy think-tank. Poshan Abhiyan, the national programme to improve nutrition outcomes, has five goals and they only deal with undernutrition and anaemia and do not mention overnutrition.

“The policy actions and actors that deal with the problems [overnutrition and undernutrition] have typically been different groups of people but there is an increasing recognition of the two groups coming together more strongly,” Menon added.

India is currently home to 49% of the world’s diabetic patients, with an estimated 72 million cases in 2017, a figure expected to almost double to 134 million by 2025, IndiaSpend reported in April 2018.

Economic losses in India due to cardiovascular disease have been estimated at $2.25 trillion from 2012 to 2030, according to this 2016 Food and Nutrition bulletin.

The researchers suggested that since public policy continues to focus largely on tackling undernutrition through improved infant feeding practices even as the prevalence of overnutrition increases, these practices must be monitored.

While breastfeeding has protective effects against obesity, other feeding styles such as indulgent or restrictive feeding can affect outcomes.

Source: Nutrients

Obesity among the poor

This study also suggests that the proportion of obese and overweight people increases faster among the less educated and the poor, emphasising that they are already vulnerable to all forms of malnutrition, micronutrient deficiencies and non-communicable diseases.

As incomes rise, more sedentary jobs and diets high in carbohydrates, edible oils, sweeteners and animal-source foods increase and research has linked these to non-communicable diseases.

“A common protective factor for both undernutrition and overweight/obesity is better quality–diverse diets,” said Menon of the International Food Policy Research Institute. What we need is to find a range of double-duty actions – interventions, programmes and policies that have the potential to simultaneously reduce the risk or burden of both undernutrition along with overweight, obesity and diet-related non-communicable diseases, she said.

“To address the growing concerns of overweight and obesity in South Asia, a critical examination of the food environment, access to good quality diets and the effectiveness of food-based programming in relation to all forms of malnutrition is urgently needed,” the researchers wrote.

Overweight families

In South Asia, especially India, children of mothers who were overweight had higher chances of being overweight themselves than children whose mothers were not overweight. This relation remained constant through 1999, 2001 and 2016 district health surveys, though the likelihood reduced over time.

Children who consumed the least diverse diets – diverse diets include at least five of the eight food groups in each meal – had a higher likelihood of being overweight, said the study.

Adolescent girls in India who had lived in urban areas had a higher likelihood of being overweight as compared to counterparts in other countries, the study said.

More Indian women were overweight in 2016 than in 1999, especially those who lived in urban areas, were educated and from richer households, the researchers found.

Slim education

In South Asia, the wealthier you are and the more educated, the higher your likelihood of being overweight and obese, as opposed to the West where lower socio-economic groups have more likelihood of being obese.

The researchers pointed out that while formal education does not promote being overweight, it does nothing to improve knowledge regarding optimal health and nutrition practices. “South Asia’s education systems are in effect passive bystanders to the unfolding of a hugely significant nutrition and health crisis; they must do more to inform, educate and promote improved dietary choices, physical activity and healthy behaviours,” said the paper.

This article first appeared on HealthCheck, a publication of the journalism non-profit IndiaSpend.