Local Community Environment Drive India's Obesity Epidemic: A Multilevel Analysis of Geographic Variations Using...

Area of Science:

• Public Health
• Epidemiology
• Geographic Health Determinants

Background:

• Rising obesity rates in low- and middle-income countries necessitate understanding geographic influences.
• Limited evidence exists on the specific geographic determinants of obesity in these regions.
• Asian-specific Body Mass Index (BMI) thresholds are crucial for accurate assessment.

Purpose of the Study:

• To examine the contribution of geographic contexts to overweight/obesity among Indian adults.
• To identify the most relevant geographic level for public health interventions.
• To apply Asian-specific BMI thresholds for a more accurate prevalence estimation.

Main Methods:

• Utilized cross-sectional data from the National Family Health Survey (NFHS-5) (2019-21).
• Analyzed data from approximately 750,000 adults (15-49 years) across 707 Indian districts.
• Employed multilevel logistic regression models, adjusting for demographic and socioeconomic factors, at state, district, and Primary Sampling Unit (PSU) levels.

Main Results:

• Using Asian-specific BMI criteria, 38.0% of women and 40.1% of men were overweight/obese.
• Primary Sampling Unit (PSU)-level factors explained the largest geographic variation (51.1% women, 62.4% men).
• State-specific analyses indicated community-level variation predominated, exceeding 90% in some states.

Conclusions:

• Overweight/obesity disparities in India are primarily driven by local community factors (PSUs).
• Asian-specific BMI criteria reveal a substantially higher burden of overweight/obesity compared to conventional thresholds.
• Community-focused interventions are recommended for effective obesity prevention in India and similar transitioning economies.