Spatiotemporal change in wealth-based inequalities in overweight/obesity among women of reproductive age in India, 2015–2021

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Background Overweight/obesity poses significant global health concerns, especially affecting women. This study aimed to measure changes in wealth-based inequality in overweight/obesity among women of reproductive age (WRA) across states of India from 2015 to 2021 and identify the contributing factors to this inequality. Methods The study used 582,851 and 587,435 women aged 15–49 from National Family Health Survey (NFHS)-4 (2015-16) and NFHS-5 (2019-21), respectively. Erreygers Concentration Index (ECI) was employed to measure the change in inequality over time. Further, ECI is decomposed to unravel the contributing factors to this inequality. Results Overweight/obesity increased among WRA from 20.3 % (NFHS-4) to 23.7 % (NFHS-5). However, wealth-based inequality in overweight/obesity among WRA has reduced marginally (ECI: 0.25 in NFHS-4, ECI: 0.23 in NFHS-5). Throughout the time the ECI indicated a pro-rich inequality in the overweight/obesity in India and its states. Among the 28 states, 8 have witnessed a significant increase in inequality, whereas 16 states have experienced significant reduction in inequality. For instance, Punjab witnessed the most significant increase (ECI: 0.10 in NFHS-4, ECI: 0.18 in NFHS-5) in inequality, while Maharashtra (ECI: 0.24 in NFHS-4, ECI: 0.16 in NFHS-5) saw the most significant reductions in inequality. The decomposition analysis results revealed women's education, mass media exposure, and place of residence were major contributors, contributing more than 80 % to wealth-based inequality in overweight/obesity. Conclusion The study highlights the growing prevalence of overweight/obesity among WRA in India, emphasizing that wealth-related inequalities represent a significant public health concern both at the national and state levels in India.

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