Overweight and obesity among under-five children in South Asia

ABSTRACT In parallel with high prevalence of undernutrition, the low-middle-income countries like those in South Asia are experiencing an increasing burden of overweight and obesity among under-five children. The present study aims to measure the prevalence of overweight and obesity and their sociodemographic correlates among under-five children in selected South Asian countries. Methods Cross-sectional data on 132,231 mother-child pairs were extracted from Demographic and Health Surveys conducted in Bangladesh (2014), India (2015–16), Maldives (2016–17), Nepal (2016) and Pakistan (2017–18). Singleton children aged 6 to 59 months regardless of breastfeeding status were included in the analysis. Childhood overweight (>2 SD) and obesity (>3 SD) were measured by BMI z-Scores using WHO guidelines for reference population. Generalised linear models (binomial family) were used to analyse the risk ratios of having overweight/obesity. Results The overall prevalence of overweight and obese children was 1.91% and 0.89%, respectively, with the prevalence being highest in Maldives (3.9% and 1.5%, respectively) and lowest in Nepal (1.2% and 0.2%, respectively). Child’s dietary diversity, maternal BMI and education, and household wealth status were significantly associated with childhood overweight/obesity. Having adequate dietary diversity increased the risk of overweight/obesity by 27% [RR = 1.27, 95%CI = 1.13,1.42]. Children whose mothers had normal [RR = 1.81, 95%CI = 1.62,2.03], overweight [RR = 1.99, 95%CI = 1.71,2.31] and obesity [RR = 1.88, 95%CI = 1.48,2.40] had higher risks of having overweight/obesity. Children from households that ranked higher in the wealth quintile also had a higher risk of having overweight/obesity. Conclusion The prevalence of overweight and obesity among under-five children in South Asian countries is relatively low compared with that in high-income countries. There exists important sociodemographic pattern in the distribution of childhood overweight/obesity across the countries, signifying the role of socio-cultural factors in the epidemiology of overnutrition in this population.