Correlates and inequality of underweight and overweight among women of reproductive age: Evidence from the 2016 Nepal Demographic Health Survey

INTRODUCTION: Understanding socio-economic correlates and inequality of underweight and overweight is crucial to develop interventions to prevent adverse health outcomes. MATERIALS AND METHODS: We analysed Nepal Demographic and Health Survey 2016 data from 6,069 women aged 15–49 years. WHO cut-offs for Body Mass Index categorised as: underweight (<18.5 kg/m(2)), normal weight (18.5kg/m(2) to 24.9kg/m(2)) and overweight/ obesity (> = 25.0 kg/m(2)) were used. We used multinomial logistic regression to explore associations of factors with Body Mass Index and concentration indices to estimate socio-economic inequalities. RESULTS: Higher risk of underweight was found in age group 15–19 (RRR 3.08, 95% CI: 2.29–4.15), 20–29 (RRR 1.64, 95% CI: 1.29–2.08) and in lowest (RRR 1.60, 95% CI: 1.03–2.47) and second wealth quintiles (RRR 1.77 (95% CI: 1.18–2.64). Education, occupation, urban/rural residence and food security were not associated with underweight (p>0.05). Lower risk of overweight/obesity was found in age group 15–19 (RRR 0.07, 95% CI: 0.05–0.10), 20–29 (RRR 0.40, 95% CI: 0.32–0.51), in manual occupation (RRR 0.58, 95% CI: 0.46–0.74) and in lower quintiles. Women with primary (RRR 1.91, 95% CI: 1.36–2.67), secondary education (RRR 1.42, 95% CI 1.00, 2.01) were at increased risk of overweight/obesity. Household food security and urban/rural residence were not associated with overweight/obesity (p>0.05). Socioeconomic inequalities were detected, with overweight/obesity strongly concentrated (concentration index: 0.380) amongst the higher quintiles and underweight concentrated (concentration index: -0.052) amongst the poorest. CONCLUSION: Nutrition programmes should target younger and poor women to address undernutrition and higher wealth group women to address overnutrition. Equity based nutrition interventions improving socio-economic status of poor households may benefit undernourished women. Interventions to encourage physical activity as women age and among wealthier women as well as healthy eating for prevention of under- and over-nutrition are needed.