Abstract
In common with many other low- and middle-income countries (LMICs), rural to urban migrants in India are at increased risk of obesity, but it is unclear whether this is due to increased energy intake, reduced energy expenditure, or both. Knowing this and the relative contribution of specific dietary and physical activity behaviours to greater adiposity among urban migrants could inform policies for control of the obesity epidemic in India and other urbanising LMICs. In the Indian Migration Study, we previously found that urban migrants had greater prevalence of obesity and diabetes compared with their nonmigrant rural-dwelling siblings. In this study, we investigated the relative contribution of energy intake and expenditure and specific diet and activity behaviours to greater adiposity among urban migrants in India. The Indian Migration Study was conducted between 2005 and 2007. Factory workers and their spouses from four cities in north, central, and south of India, together with their rural-dwelling siblings, were surveyed. Self-reported data on diet and physical activity was collected using validated questionnaires, and adiposity was estimated from thickness of skinfolds. The association of differences in dietary intake, physical activity, and adiposity between siblings was examined using multivariable linear regression. Data on 2,464 participants (median age 43 years) comprised of 1,232 sibling pairs (urban migrant and their rural-dwelling sibling) of the same sex (31% female) were analysed. Compared with the rural siblings, urban migrants had 18% greater adiposity, 12% (360 calories/day) more energy intake, and 18% (11 kilojoules/kg/day) less energy expenditure (P < 0.001 for all). Energy intake and expenditure were independently associated with increased adiposity of urban siblings, accounting for 4% and 6.5% of adiposity difference between siblings, respectively. Difference in dietary fat/oil (10 g/day), time spent engaged in moderate or vigorous activity (69 minutes/day), and watching television (30 minutes/day) were associated with difference in adiposity between siblings, but no clear association was observed for intake of fruits and vegetables, sugary foods and sweets, cereals, animal and dairy products, and sedentary time. The limitations of this study include a cross-sectional design, systematic differences in premigration characteristics of migrants and nonmigrants, low response rate, and measurement error in estimating diet and activity from questionnaires. We found that increased energy intake and reduced energy expenditure contributed equally to greater adiposity among urban migrants in India. Policies aimed at controlling the rising prevalence of obesity in India and potentially other urbanising LMICs need to be multicomponent, target both energy intake and expenditure, and focus particularly on behaviours such as dietary fat/oil intake, time spent on watching television, and time spent engaged in moderate or vigorous intensity physical activity.
Highlights
India has experienced a rapid increase in the prevalence of obesity due to increasing adiposity over the last two decades, which is attributed to lifestyle changes associated with urbanisation, rural to urban migration and globalisation [1,2,3]
We found that increased energy intake and reduced energy expenditure contributed to greater adiposity among urban migrants in India
Policies aimed at controlling the rising prevalence of obesity in India and potentially other urbanising low-and middle-income country (LMIC) need to be multicomponent, target both energy intake and expenditure, and focus on behaviours such as dietary fat/oil intake, time spent on watching television, and time spent engaged in moderate or vigorous intensity physical activity
Summary
India has experienced a rapid increase in the prevalence of obesity due to increasing adiposity over the last two decades, which is attributed to lifestyle changes associated with urbanisation, rural to urban migration and globalisation [1,2,3]. A few cross-sectional studies (conducted in China, Peru, and Guatemala) have compared urban migrants to rural populations from the area of their birth; they found lower levels of physical activity and more energy intake among urban migrants, suggesting that a decline in physical activity was the primary contributor to increased adiposity among urban migrants [11,12,13] In such comparisons, the role of unmeasured confounding due to differences in premigration characteristics of urban migrants, such as genetics, childhood home environment (including parental behaviours), and behaviours in adolescence should not be ignored [14,15,16].
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