Obesity goes up in India, fertility rate dips: National Family Health Survey

The prevalence of overweight or obesity has increased in India with almost the same percentage of men and women being obese, according to the National Family Health Survey (NFHS – 5), 2019–21.

As per the fifth round of NFHS, released by the Ministry of Health and Family Welfare (MoHFW), 19% of women and 16% of men aged 15-49 are thin and 24% of women and 23% of men are obese. At the national level, obesity has increased from 21% to 24% among women and 19% to 23% among men from the last NFHS (2015-16).

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According to the report, 57% of women and 48% of men have a waist-to-hip ratio (WHR) which puts them at a substantially increased risk of metabolic complications. In anaemia among adults, 57% of women and 25% of men aged 15-49 have anaemia.

The 2019-21 NFHS collected anthropometric data on the height and weight of women aged 15-49 and men aged 15-54 years. These data were used to calculate several measures of nutritional status such as women’s height and body mass index (BMI).

Proportion of thin women decreases with age

“About 19% of women aged 15-49 are thin, 24% are overweight or obese, and 57% have a BMI in the normal range. Twelve percent of women aged 15-49 years have a height below 145 cm,” it said.

The proportion of thin women aged 15-49 declined from 23% in 2015-16 to 19% in 2019-21; at the same time, the proportion of overweight or obese women increased from 21% to 24%. Overall, there has been a slight increase in the mean BMI from 21.9 in 2015-16 to 22.4 in 2019-21. The proportion of women whose height was below 145 cm was the almost the same in 2015-16 (11.1) and 2019-21 (11.5), it added.

The proportion of thin women decreases with age, from 40% for women aged 15-19 to 9% for women aged 40-49, whereas the proportion of overweight or obese women increases steadily, from 5% of women aged 15-49 to 37% of women age 40-49, according to the survey.

The proportion of thin women is higher in rural areas (21%) than in urban areas (13%) and the reverse is observed for the prevalence of overweight or obesity (33% in urban areas and 20% in rural areas).

There is a steady decrease in the proportion of thin women as household wealth increases (from 28% in the lowest wealth quintile to 10% in the highest wealth quintile), which is accompanied by a steady increase in the proportion of overweight or obese women (from 10% in the lowest wealth quintile to 39% in the highest wealth quintile).

The highest proportion of thin women is observed in Jharkhand and Bihar (26% each), followed by Gujarat and Dadra & Nagar Haveli and Daman & Diu (25% each). The highest proportion of overweight or obese women is found in Puducherry (46%), Chandigarh (44%), Delhi, Tamil Nadu, and Punjab (41% each), and Kerala and Andaman & Nicobar Islands (38% each)

Sixteen percent of men aged 15-49 are thin, 23% are overweight or obese, and 61 percent have a BMI in the normal range. The mean body mass index for men (22.4) is the same as that of women (22.4).

The proportion of thin men decreases with age, from 41% of men aged 15-19 to 8% of men age 40-49, whereas the proportion of overweight or obese men increases from 7% of men aged 15-19 to 32% of men aged 40-49. The proportion of thin men is higher in rural areas (18%) than in urban areas (13%), whereas 30% of men are overweight or obese in urban areas, compared with 19% in rural areas, the survey shows.

There is steady decrease in the proportion of thin men with increasing household wealth (from 24% in the lowest wealth quintile to 9% in the highest wealth quintile), and a steady increase in the proportion of overweight or obese men (from 10% in the lowest wealth quintile to 37% in the highest wealth quintile).

The proportion of thin men is highest in Bihar (22%), followed by Madhya Pradesh and Gujarat (21% each). The highest proportion of overweight or obese men is observed in Andaman & Nicobar Island (45%), followed by Puducherry (43%) and Lakshadweep (41%).

Waist and hip circumference measurements

As per World Health Organization (WHO) guidelines, waist circumference (WC), waist-to-hip ratio (WHR) and waist-to-height ratio (WHtR) have been found to be appropriate measurements of abdominal obesity.

For the first time, NFHS-5 included waist and hip circumference measurements provided by using Gulick tapes for both eligible women and men for measurements of abdominal obesity. For the first time, the 2019-21 NFHS measured the waist circumference and hip circumference of women and men aged 15-49 years.

The proportion of adults with an increased risk of WHR increases with age, from 46% for women aged 15-19 to 65% for women aged 40-49, and from 28% for men aged 15-19 to 60% for men aged 40-49.

The proportion of women having a substantially increased risk of WHR is higher in urban areas than rural areas for both women (60% in urban areas than 55% in rural areas) and men (50% in urban areas than 46% in rural areas).

The proportion of women having a substantially increased risk of WHR is highest in Jammu & Kashmir (88%) and lowest in Madhya Pradesh (40%). For men, it is highest in Chandigarh (67%) and lowest in Meghalaya (25%).

Fertility rate

Meanwhile, the total fertility rate is 2.0 children per woman, which declined from 2.2 children in 2015-16 and is currently below the replacement level of fertility of 2.1 children per woman, the survey has found.

The median birth interval is 33 months since the preceding birth and the median age at first birth among women aged 25-49 is 21.2 years. Seven per cent of women aged 15-19 have begun childbearing, which is just a 1% decline from 2015-16. About one-fourth (23%) of currently married women aged 15-49 want to have another child. The wanted fertility rate is 1.6 children per woman and ranges from 0.9 children in Sikkim to 2.7 children in Meghalaya, the survey said.

The first NFHS was conducted in 1992-93 and covered all states except Sikkim. NFHS-5 fieldwork for India was conducted in two phases — Phase-I from 17 June 2019 to 30 January 2020 covering 17 states and 5 UTs and Phase-II from 2 January 2020 to 30 April 2021 covering 11 states and 3 UTs — by 17 Field Agencies and gathered information from 636,699 households, 724,115 women, and 101,839 men. NFHS-5 provides information for 707 districts, 28 states, and 8 union territories.

The National Family Health Survey (NFHS) is a large-scale, multi-round survey conducted in a representative sample of households throughout India.