Underweight and overweight/obesity among middle aged and older adults in India: Prevalence and correlates from a national survey in 2017-2018

Background and Objective : This study aimed to estimate the prevalence and correlates of underweight and overweight/obesity among middle aged and older adults in India.Materials and Methods : The cross-sectional sample consisted of 72,262 individuals (>= 45 years) from the Longitudinal Aging Study in India Wave 1 in 2017-2018. Multinomial logistic regression was used to estimate the factors associated with underweight and overweight/obesity relative to normal weight.Results : The prevalence of normal weight (18.5-22.9 kg/m2) was 36.7%, underweight (<18.5 kg/m2) 20.8%, overweight (23.0-24.9 kg/m2) 14.2%, Class I obesity (25.0-29.9 kg/m2) 20.8%, and Class II obesity (>= 30.0 kg/m2) 7.4%. In adjusted multinomial logistic regression, the factors positively associated with underweight were older age (>= 70 years) (adjusted relative risk ratio [ARRR]: 1.94, confidence interval [CI]: 1.75-2.14), food insecurity (ARRR: 1.19, CI: 1.07-1.33), poor or fair self-rated health status (ARRR: 1.14, CI: 1.05-1.33), and current tobacco use (ARRR: 1.42, CI: 1.31-1.53). The factors negatively associated with underweight were higher education (>= 10 years) (ARRR: 0.67, CI: 0.48-0.92), high subjective socioeconomic status (ARRR: 0.78, CI: 0.67-0.92), urban residence (ARRR: 0.72, CI: 0.61-0.84), high life satisfaction (ARRR: 0.83, CI: 0.75-0.91), hypertension (ARRR: 0.64, CI: 0.58-0.69), diabetes (ARRR: 0.50, CI: 0.42-0.59), and heart disease or stroke (ARRR: 0.74, CI: 0.61-0.89). The factors positively associated with overweight/obesity were higher education (>= 10 years) (ARRR: 2.09, CI: 1.87-2.33), high subjective socioeconomic status (ARRR: 1.44, CI: 1.31-1.59), urban residence (ARRR: 1.94, CI: 1.79-2.11), high life satisfaction (ARRR: 1.12, CI: 1.04-1.20), hypertension (ARRR: 1.89, CI: 1.76-2.02), type 2 diabetes (ARRR: 1.80, CI: 1.59-2.04), and raised cholesterol (ARRR: 2.75, CI: 2.11-3.58). The factors negatively associated with overweight/obesity were older age (>= 70 years) (ARRR: 0.44, CI: 0.39-0.49), male sex (ARRR: 0.59, CI: 0.54-0.64), food insecurity (ARRR: 0.85, CI: 0.76-0.94), vigorous physical activity (>once/week) (ARRR: 0.91, CI: 0.84-0.99), current tobacco use (ARRR: 0.69, CI: 0.64-0.74), and heavy episodic alcohol use (ARRR: 0.70, CI: 0.58-0.85).Conclusion : One in five middle-aged and older adults in India were underweight and more than two in five were overweight/obese, confirming a dual burden of malnutrition in India.