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Health Policy Plan. 2016 Jun;31(5):582-91. doi: 10.1093/heapol/czv105. Epub 2015 Nov 13.

Overweight and obesity in India: policy issues from an exploratory multi-level analysis.

Author information

1
Crawford School of Public Policy, Australian National University, Canberra, Australia; and Institute of Development Studies Kolkata, Kolkata, India.
2
UniSA Business School, University of South Australia, Way Lee Building, City West Campus, 37-44 North Terrace, Adelaide, 5001, South Australia ronald.donato@unisa.edu.au.

Abstract

This article analyses a nationally representative household dataset-the National Family Health Survey (NFHS-3) conducted in 2005 to 2006-to examine factors influencing the prevalence of overweight/obesity in India. The dataset was disaggregated into four sub-population groups-urban and rural females and males-and multi-level logit regression models were used to estimate the impact of particular covariates on the likelihood of overweight/obesity. The multi-level modelling approach aimed to identify individual and macro-level contextual factors influencing this health outcome. In contrast to most studies on low-income developing countries, the findings reveal that education for females beyond a particular level of educational attainment exhibits a negative relationship with the likelihood of overweight/obesity. This relationship was not observed for males. Muslim females and all Sikh sub-populations have a higher likelihood of overweight/obesity suggesting the importance of socio-cultural influences. The results also show that the relationship between wealth and the probability of overweight/obesity is stronger for males than females highlighting the differential impact of increasing socio-economic status on gender. Multi-level analysis reveals that states exerted an independent influence on the likelihood of overweight/obesity beyond individual-level covariates, reflecting the importance of spatially related contextual factors on overweight/obesity. While this study does not disentangle macro-level 'obesogenic' environmental factors from socio-cultural network influences, the results highlight the need to refrain from adopting a 'one size fits all' policy approach in addressing the overweight/obesity epidemic facing India. Instead, policy implementation requires a more nuanced and targeted approach to incorporate the growing recognition of socio-cultural and spatial contextual factors impacting on healthy behaviours.

KEYWORDS:

India; multi-level; overweight-obesity; policy issues

PMID:
26567124
DOI:
10.1093/heapol/czv105
[Indexed for MEDLINE]

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