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Malnutrition remains major threat to Indian women, even though mean BMI is rising

BMJ 2013; 346 doi: http://dx.doi.org/10.1136/bmj.f689 (Published 01 February 2013) Cite this as: BMJ 2013;346:f689
  1. Soumyadeep Bhaumik
  1. 1Kolkata

Women in India face the twin problems of obesity and undernutrition, whereby the “fat are becoming fatter” while the “thin continue to remain thin,” a study published last month in PLOS Medicine shows.1

Researchers from the University of Toronto and Harvard School of Public Health found that as India underwent massive social, economic, and demographic changes the mean body mass index of Indian women rose. However, the obese and overweight, like their counterparts in other low and middle income nations, have been gaining weight more rapidly than the severely undernourished.

The study found that in 2005 a quarter (24.8%) of Indian women were underweight, down from 30.7% in 1998. Over that period the proportion of women who were obese rose from 2.4% to 3.6% and of overweight women from 9.5% to 13.7%. The mean BMI of women rose from 20.6 to 21.4.

One of the authors, S V Subramanian, professor of population health and geography at Harvard University, said, “In India the prevalence of obesity is relatively low, and underweight remains higher in 2005 [than in other countries], especially given the overall increases in levels of economic growth during that period. The findings imply that obesity will likely increase at a faster pace than underweight will decrease.”

The researchers looked at changes in BMI of women in 37 low and middle income countries and found that trends in India were in line with those of the other 36 nations analysed. The 0.79 unit increase in mean BMI from 1998 to 2005 in India was similar to that in Nicaragua (0.72) and Guatemala (0.86) but lower than in Benin (1.25), Haiti (1.45), and Bangladesh (1.46). “However, the annual rate of change was similar between India (0.11) and Bangladesh (0.13),” said Subramanian.

The overall trend within these countries was for increased dispersal within the BMI distribution: more people at the low and high ends and fewer in the “normal” range.

Subramanian said, “This has implications, for example, in mortality, where there is increased risk at either very low or very high values of BMI.

“But the key issue is that obesity is a problem of the rich, at least currently. We may create unintended inequities if public policy pays either equal attention to obesity—or even more (since the group that is affected is more advantaged and vocal)—than the problem of undernutrition (with the populations in this groups being marginalised, poor, and less vocal). So, a very balanced prioritised approach is necessary.”

Notes

Cite this as: BMJ 2013;346:f689

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