The Double Burden of Overweight/Obesity and Anaemia Among Adult Women Living in Low–And Middle-Income Countries: A Secondary Analysis of Demographic and Health Surveys

OBJECTIVES: This study aimed to 1) quantify the magnitude and inequalities of the double burden of malnutrition (DBM), defined as the co-occurrence of overweight/obesity and anaemia, among adult women (20–49 years old) living in LMICs and 2) document trends in its magnitude and distribution over the past two decades. METHODS: We used all available data from the Demographic and Health Surveys (DHS) with anthropometric and haemoglobin level measures (n = 51 LMICs). The DBM magnitude and distribution (i.e., stratified estimates by wealth, education, and area of residence) were calculated using the most recent dataset for every country. Regional and overall pooled estimates were generated using a random-effects model. The trends analysis was conducted by use of 95 DHS datasets from 33 LMICs between 2000 and 2019. We computed DBM trends for all LMICs and by WHO region through multilevel regression models to estimate the average annual rate of change (AARC). RESULTS: The pooled prevalence of concurrent overweight/obesity and anaemia was 12.4% (95% confidence interval (CI): 11.1, 13.7), ranging from 1.7% in Ethiopia to 33.6% in Maldives. The regional pooled prevalence ranged from 11.1% (95% CI: 9.2, 13.0) in the African region to 23.8% (95% CI: 17.0, 30.7) in the Eastern Mediterranean region. Overall, the highest burden of DBM was concentrated among women in the wealthiest quintiles, highest education levels and urban residents; although with some variation across countries and WHO regions. In the past two decades, there was a significant modest increase in DBM prevalence (AARC = 0.17pp; 95% CI: 0.07, 0.27; p-value = 0.001). The DBM increased fastest among women in the three middle wealth quintiles (AARC = 0.19pp (Q2), 0.18pp (Q3 and Q4)), lowest level of education (AARC = 0.16pp), and those living in rural areas (AARC = 0.18pp) and capital cities (AARC = 0.16pp). CONCLUSIONS: The co-occurrence of overweight/obesity and anaemia is common among adult women and emulates the distribution of overweight/obesity in LMICs. A rising trend in DBM might indicate that efforts to reduce anaemia among women living with overweight/obesity need to be revisited. FUNDING SOURCES: National Institute for Health Research (NIHR) Global Health Research Unit on Improving Health in Slums.