Abstract
Nepal’s dual burden of undernutrition and over nutrition warrants further exploration of the population level differences in nutritional status. The study aimed to explore, for the first time in Nepal, potential geographic and socioeconomic variation in underweight and overweight and/or obesity prevalence in the country, adjusted for cluster and sample weight. Data came from 14,937 participants, including 6,172 men and 8,765 women, 15 years or older who participated in the 2016 Nepal Demography and Health Survey (NDHS). Single-level and multilevel multi-nominal logistic regression models and Lorenz curves were used to explore the inequalities in weight status. Urban residents had higher odds of being overweight and/or obese (OR: 1.89, 95% CI: 1.62–2.20) and lower odds of being underweight (OR: 0.81, 95% CI: 0.70–0.93) than rural residents. Participants from Provinces 2, and 7 were less likely to be overweight/obese and more likely to be underweight (referent: province-1). Participants from higher wealth quintile households were associated with higher odds of being overweight and/or obese (P-trend < 0.001) and lower odds of being underweight (P-trend < 0.001). Urban females at the highest wealth quintile were more vulnerable to overweight and/or obesity as 49% of them were overweight and/or obese and nearly 39% at the lowest wealth quintile were underweight.
Highlights
The dual burden of underweight and overweight and/or obesity is an emerging challenge for many low- and middle-income countries (LMICs), including Nepal[3,4,5]
Previous studies using Nepal Demography and Health Survey (NDHS) 201613,14 showed variation in underweight and overweight and/or obesity by individual level factors, i.e., women compared to men, urban residents compared to rural residents, and wealthy individuals were more likely to be overweight and/or obese
Individual characteristics play an important role in manifesting health outcomes, including weight status, recent evidence suggest that health is determined by population level characteristics such as residence, neighborhood’s walkability, availability of food and so on
Summary
The dual burden of underweight and overweight and/or obesity is an emerging challenge for many low- and middle-income countries (LMICs), including Nepal[3,4,5]. Nepal’s population, estimated at 26.5 million as of 2011, is projected to rise to 30.4 million by 20218 This escalating population growth coupled with less impressive economic growth in Nepal raises a grave concern in the context of ensuring safe and sufficient food supply to the growing population and the problem of chronic undernutrition may be further aggravated. Previous studies using Nepal Demography and Health Survey (NDHS) 201613,14 showed variation in underweight and overweight and/or obesity by individual level factors, i.e., women compared to men, urban residents compared to rural residents, and wealthy individuals were more likely to be overweight and/or obese. Previous studies have extensively focused on individual characteristics associated with weight status among Nepalese population[13,14] and less is known about the geographic variations in overweight/obesity burden as well as how much of the variation is explained by individual and geographic factors.
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