Body mass index is an useful indicator to the status of adult health

It shows the current nutritional status and is an effective predictor of morbidity and mortality rates.

Women with low BMI (< 18.5) leads to chronic energy deficiency (CED) which ultimately leads to higher rate of mortality, low birth weight etc

In India, 29 % women have a BMI less than 18.5 (NFHS-3)

On the other hand, in the twentieth century, BMI is increasing, resulting to a good proportion of people suffering from obesity.

It is regarded that due to increase of urbanization, availability of processed and fast foods and dependence on Television for leisure, people are fast adopting less physical activities and consuming ‘energy-dense, nutrient-poor’ diets leads to overweight and obese (WHO, 2003; Bell et al. 2002; Popkin, 2002; 2001; Popkin et al. 2001 and Drewnowski & Popkin, 1997).

Obesity has a great effect on mortality because it is associated with hypertension, diabetes, gallstones, gout and some type of cancers.

• Second National Family Health Survey (NFHS-2) data, conducted in 1998-99 by International Institute for Population Sciences and to see the temporal trend, NFHS-3 (2005-6) have been considered.

• Sample size 81,712 (NFHS-2) and 1,18,781 (NFHS-3).

• Ever married reproductive aged (15-49 years) women along with their husbands of all states in India.

Besides BMI, the other variables are: Women’s Age

Women’s Education Drinking Water Toilet Facilities Electricity Religion and Caste Husband’s Educational Level Husband’s Occupation Women’s Occupation

Standard of Living Index (SLI)

Variables taken:

Clarification of each variables

Clarification of each variables

Methodology

Results

India

Malnourished31%

Normal57%

Obese3%Overw eight

9%

Malnourished29%

Normal55%

Overw eight12%

Obese4%

NFHS-2 NFHS-3

Results

Percentage distribution of CED among women in different zones of India

NFHS-2 NFHS-3

Results

Percentage distribution of normal women in different zones of India

Results

Percentage distribution of obese & Overweight among women in different zones of India

NFHS-2 NFHS-3

ResultsPercentage distribution of CED and Obesity in different zones of India by rural/urban differences (NFHS-2)

Results

Low prevalence of CED (< 20 %) among women are found in the following states of India during NFHS-2 & NFHS-3

Results

High prevalence of CED (> 35 %) are found among women in the following states of India during NFHS-2 & NFHS-3

Results

Temporal trends of CED in India between NFHS-2 & NFHS-3

ResultsLow prevalence of overweight & obesity (<10 %) among women are found in the following states of India during NFHS-2 & NFHS-3

NFHS-2 NFHS-3

Results

High prevalence of overweight & obesity (>20 %) among women are found in the following states of India during NFHS-2 & NFHS-3

NFHS-2 NFHS-3

Results

Temporal trends of overweight & obese in India between NFHS-2 & NFHS-3

Features of Socio-economic development:

A) Education

A) Education

Illiterate Women

(Zone-wise)

Features of Socio-economic development:

Features of Socio-economic development:

 Maximum occurrence of different occupational categories among women in different states of India

Categories of work

Unemployed Punjab (91.1 %)

Professional Manipur (21.6 %)

Agriculture Arunachal Pradesh (50.0%)

Manual Manipur (17.4 %)

B) Occupation

Household development indicators (highest occurrence,followed in descending order):

Drinking water Toilet facility Electricity

Open Closed Not available Available Not available Available

(State-wise)

Kerala

(73.9 %)

Punjab

(99.2 %)

Bihar

(83.0 %)

Mizoram

(97.8 %)

Bihar

(82.3 %)

New Delhi

(98.3 %)

Nagaland

(52.5 %)

New Delhi

(98.9 %)

Orissa

(82.0 %)

New Delhi

(94.3 %)

West Bengal

(59.5 %)

Himachal Pradesh

(98.1 %)

Manipur

(51.5 %)

West Bengal

(91.1 %)

Madhya Pradesh

(76.4 %)

Manipur

((92.9 %)

Orissa

(58.8 %)

Punjab

(97.0 %)

(Zone-wise)

North-east

(34.8 %)

West

(84.3 %)

Central

(74.6 %)

North-east

(77.7 %)

East

(67.3 %)

West

(88.3 %)

Central

(25.1 %)

North

(83.1)

East

(72.4 %)

West

(53.8 %)

Central

(42.7 %)

North

(85.5 %)

Relationship of CED and Obesity with some socioeconomic variables: India

Variables CED Overweight/ Obese NAge-group 15-24 35.9 3.5 20578 25-34 32.0 10.5 30960 35-49 27.1 19.1 30184Place of residence Rural 36.0 6.5 56333 Urban 20.4 24.1 25399Women’s education Illiterate 38.5 5.7 40098 Primary 31.5 11.2 14158 Secondary 23.0 18.1 19924 Higher 13.2 30.4 7532

Variables CED Overweight/ Obese N________________________________________________________________Husband’s education Illiterate 41.0 4.6 21140 Primary 35.7 8.0 15040 Secondary 28.5 13.1 30210 Higher 18.6 23.5 15322

Drinking water Open 34.3 6.20 18022 Closed 30.3 13.6

Toilet facility NA 40.4 4.4 45680 Pit+Flush 19.5 21.5 36032

Variables CED Overweight/ Obese N___

Electricity: No 41.3 2.6 26406 Yes 26.3 16.3 55306

Religion_Caste ST 38.8 7.0 14016 SC 32.9 4.6 10040 Hindu 30.1 13.4 44831 Muslim 29.3 13.6 9205 Others 15.3 29.2 3620

Variables CED Overweight/ Obese N___

Husband’s Occupation Professional 20.7 21.4 23512 Unemployed 29.8 13.3 21140

Manual 32.3 11.0 26459 Agriculture 38.8 4.9 29266

Women’s occupation Professional 16.6 25.4 4552 Unemployed 28.4 14.2 52007 Manual 35.7 9.4 6392 Agriculture 40.9 3.2 18761 SLI Low 44.0 2.7 22741 Medium 31.6 9.1 39275 High 15.5 28.2 19696

Relationship of CED and Obesity with some socioeconomic variables: India, Rural

Variables CED Overweight/Obese N___Age-group 15-24 37.4 2.1 15649 25-34 36.9 5.6 21038 35-49 34.0 10.8 19646Women’s education Illiterate 40.2 3.9 33409 Primary 34.2 8.0 10026 Secondary 28.0 10.8 10802 Higher 19.2 16.5 2096

Variables CED Overweight/Obese N____

Husband’s education Illiterate 42.4 3.2 18123 Primary 38.0 5.5 11463 Secondary 32.4 8.2 19896 Higher 26.4 11.4 6851

Drinking water Open 35.4 5.2 16042 Closed 36.3 6.9 40291

Toilet facility NA 40.6 4.0 41551 Pit+Flush 23.1 13.2 14782

Electricity: No 41.3 2.5 24634 Yes 31.9 9.5 31699

Variables CED Overweight/Obese N___

Husband’s Occupation Professional 26.8 11.6

10886 Unemployed 34.5 7.9 1596 Manual 36.8 6.1 16068

Agriculture 39.3 4.6 27783

Religion_Caste ST 42.6 3.7

10421 SC 35.2 3.2

8337 Hindu 35.7 6.8

29808 Muslim 33.6 7.8 5630 Others 18.1 23.1 2137

Variables CED Overweight/ Obese N___

Women’s occupation Professional 23.3 15.3 1801

Unemployed 33.4 7.9 32675Manual 40.0 5.5 3993Agriculture 41.3 3.1 17864

SLI Low 44.4 2.2 19963 Medium 34.4 6.0 27980 High 21.6 18.0 8390

Relationship of CED and Obesity with some socioeconomic variables: India, Urban

Variables CED Overweight/ Obese N___

Age-group 15-24 31.2 8.1 4929 25-34 21.7 21.2 9912 35-49 14.1 34.4 10538

Women’s education Illiterate 29.8 14.3 6689 Primary 24.9 18.8 4132 Secondary 17.0 26.7 9122 Higher 10.9 35.7 5436

Variables CED Overweight/Obese N__

Husband’s Occupation Professional 15.4 29.9 12626

Unemployed 21.4 23.2 879 Manual 25.3 18.7 10391

Agriculture 27.9 11.9 1483

Religion_Caste ST 27.8 16.4 3595 SC 21.7 12.0 1703 Hindu 18.8 26.3 15023 Muslim 22.5 22.8 3575 Others 11.3 38.0 1483

Variables CED Overweight/Obese N___

Women’s occupation Professional 12.3 32.0 2751 Unemployed 20.0 24.8 19332 Manual 28.5 15.9 2399 Agriculture 32.9 6.7 897 SLI Low 41.1 5.8 2778 Medium 24.7 16.9 11295 High 11.0 35.7 11306

Regression analysis of women’s BMI on socio-economic variables:

Independent variables BMI ________________________________________

Rural Urban (R + U)_______________________________________________________________Women’s age 37.15*** 26.77*** 7.361***Women’s educational level 17.38*** 33.90*** 28.676***Drinking water -6.713 47.02*** 9.751***Toilet facility 81.000*** 63.45*** 97.728***Electricity 37.48*** 53.28*** 40.896***Religion _caste 14.56*** 23.63*** 15.331***Husband’s education level 4.883*** 7.922** 5.791***Husband’s occupation 13.29*** 14.17*** 18.705***Women’s occupation 18.19*** 33.55*** 22.7222***Standard of living index 31.42*** 39.08*** 50.578***_________________________________________________________________________<0.01 = 1% level ***

Findings:

Socio-economic variables Body mass index

Findings

70 to 85 % normal health women are found in most of the North-eastern states (both NFHSs).

Highest percentage of chronic energy deficient (CED) women are found from east to west through its central part.

Thus, it appears that the middle belt of India is mostly affected region of CED.

North-east zones of India are in a better position in respect of BMI than the other zones of India.

The facts which support the precondition of this findings are:

1. The highest percentage of women are working in North-eastern states. For ex. Manipur (70 %), Nagaland (64%) and Arunachal Pradesh (60 %) which gives the financial support for the betterment of their families.

2. Self employment is the most important employment (28 %) among women in Manipur which indicates the better standard of living among them.

3. Percentage of educated women is highest in North-eastern states.

4. The main inhabitant of North-east zone are tribes. But religiously, In Mizoram. Nagaland and Maghalaya, 82 to 96 % and in Manipur, 37% are Christian and Christianity may be one of the reason for enhancement of education.

5. Toilet facility is also highest in North –east India which reflects the awareness and indicates the resultant of education.

6. Literacy gap between male and female is least in Mizoram and Meghalaya.

Central and Eastern part of India where percentage of illiterate women (mainly in Bihar and Jharkhand) and toilet facilities are least.

Ethnicity is also the regulatory factor for CED because Madhya Pradesh is one of the state of Central India which is mainly inhabited by Tribes. East India is possessing 30 % SC people, Bihar is concentrated of 50% OBC. So this zones are mainly inhabitation of low caste and tribal people which reflects the causes of lowest literacy and less awareness.

It is also evident that in Bihar, impact of mass media like TV, Radio are very low.

Kerala and Goa have high percentage of obese women, associated with higher literacy rate :

Proportion who do not belongs to SC, ST and OBC are higher in Goa (87 %) and Delhi (66 %)

Regular exposure to TV is highest in Delhi (90 %).

Rural–urban differences

a) nearly fifty percent or more women are malnourished in rural areas.

b) nearly six times more overweight & obese women are found in urban than rural areas.

It may be due the effect of urbanization, processed and fast food, dependence on TV, Radio etc. less physical activity

and consuming ‘energy-dense, nutrient –poor’ diets .

Summary of the study:

According to BMI indicator, most of the states of north-eastern zone are normal health women

Temporal trend indicates that 6.45 % undernourished have decreased and 33% Overweight & obesity have increased among women between NFHS-2 and NFHS-3

Bihar, Orissa and Central India are least privileged in respect of adult female nutritional status which ultimately focus the poor health of women.

On the other hand, New Delhi, Kerala, Punjab, Goa, are taking upper rung of overweight & obesity due to over nutrition.

Nutritional deficiency is acute among the women in rural areas, illiterate, younger women and also from low standard of living households.

Women health status is associated with many socio-economic indicators.

Education and awareness are the two most important catalyst for socio-economic changes.

The best example is the North east zone of India because North-east zone can boast of having the lowest percentage of illiterate mother and highest percentage of toilet facility though this zone is not privileged so far as electricity connection or high standard of living.

Conclusion