Obesity in Low- and Middle-Income Countries: Sex-Specific Sociocultural Determinants in High-Risk Rural Punjab, India

Obesity is a critical public health challenge in South Asia, yet region-specific data remain limited. This study examines the prevalence and sex-specific sociodemographic, economic, and behavioral determinants of obesity in rural Punjab, India.

A population-based cross-sectional study of 2349 adults in Mansa district, Punjab, assessed general obesity using BMI and central obesity by WC, WHR, and WHtR. Structured interviews captured sociodemographic, economic, and behavioral data. Sex-stratified logistic regression models estimated AORs for obesity.

General obesity was high (69.6%), with central obesity more pronounced (WC: 76%; WHtR: 85.8%; WHR: 93.4%). Females had significantly higher obesity risk (WC and WHR) than males. In males, obesity risk peaked at ages 40-49 (BMI, WC, and WHtR) and 50-59 (WHR), while females' risk increased from 50 years (WC) and ≥ 60 years (WHR and WHtR). Education and income showed sex-specific associations: primary education increased females' risk (WC), and senior secondary and higher increased males' risk (BMI) compared with those with no formal education but decreased at higher education levels in females. Higher income increased obesity risk in males (BMI, WC, and WHtR). Belonging to the Jatt Sikh community and sedentary behavior increased obesity risk in both sexes.

The higher central obesity among women reflects gendered vulnerabilities shaped by socioeconomic and educational disparities. The coexistence of high central obesity and sedentary behavior in a transitioning rural context highlights the shifting sociocultural landscape of obesity in LMICs. Age-related decrease in general but persistent central obesity warrants longitudinal biocultural investigations.