Overweight and obesity in India: policy issues from an exploratory multi-level analysis

This article analyses a nationally representative household dataset-the National Family Health Survey (NFHS-3) conducted in 2005 to 2006-to examine factors influencing the prevalence of overweight/obesity in India. The dataset was disaggregated into four sub-population groups-urban and rural females and males-and multi-level logit regression models were used to estimate the impact of particular covariates on the likelihood of overweight/obesity. The multi-level modelling approach aimed to identify individual and macro-level contextual factors influencing this health outcome. In contrast to most studies on low-income developing countries, the findings reveal that education for females beyond a particular level of educational attainment exhibits a negative relationship with the likelihood of overweight/obesity. This relationship was not observed for males. Muslim females and all Sikh sub-populations have a higher likelihood of overweight/obesity suggesting the importance of socio-cultural influences. The results also show that the relationship between wealth and the probability of overweight/obesity is stronger for males than females highlighting the differential impact of increasing socio-economic status on gender. Multi-level analysis reveals that states exerted an independent influence on the likelihood of overweight/obesity beyond individual-level covariates, reflecting the importance of spatially related contextual factors on overweight/obesity. While this study does not disentangle macro-level 'obesogenic' environmental factors from socio-cultural network influences, the results highlight the need to refrain from adopting a 'one size fits all' policy approach in addressing the overweight/obesity epidemic facing India. Instead, policy implementation requires a more nuanced and targeted approach to incorporate the growing recognition of socio-cultural and spatial contextual factors impacting on healthy behaviours.