Factors Contributing to the Change in Overweight/Obesity Prevalence Among Indian Adults: A multivariate decomposition analysis of data from the National Family Health Surveys

INTRODUCTION: Concerns over the escalating burden of non-communicable diseases call for the redressal of behavioral risk factors like increased body mass index. Most studies have failed to quantify the contribution of socio-demographic characteristics in a linear trend. The present study aims to estimate the current prevalence of overweight and obesity in Indian adults and the contribution of different socio-demographic factors to the increasing prevalence. METHODS: We carried out a secondary data analysis of two National Family Health Survey (NFHS) rounds. The final sample includes 558,122 women and 84,477 men from round 4, and 574,099 women and 74,761 men were included from round 5, using a multi-stage stratified random sampling approach. Overweight/obesity was our primary dependent variable. Weighted bivariate analysis was used to ascertain the prevalence, and the adjusted odds ratios were computed to ascertain the potential predictors. The contribution of different factors towards rising burden over two time points was estimated using multivariate decomposition analysis for non-linear response models. RESULTS: Overall weighted prevalence of overweight and obesity in males and females per NFHS-5 was 44.02% and 41.16%, respectively, compared to 37.71% and 36.14% in NFHS-4. Decomposition analyses depict that the proportion of obesity increased by 6.37% and 5.10% points among men and women, respectively, over the two rounds. Compositional differences of participants (endowment) attributed to 16.54 and 49.90% differences, and the difference in coefficient or effect accounted for 83.46 and 50.10%, respectively, of the increase in the prevalence. The most significant factors contributing to increased prevalence were age, improving socio-economic status, smoking, unclean cooking fuel, and diabetes. CONCLUSIONS: The incremental rise in such a short period, mainly attributed to the effect of socio-demographic variables, is concerning. Policy interventions should prioritize health advocacy programs and aggressively target behavioral modifications while preparing the health systems to manage the people living with obesity.