Unhealthy Weight in Indian Families: The Role of the Family Environment in the Context of the Nutrition Transition
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India faces a dual burden of increasing obesity and persistent underweight as it experiences the nutrition transition—the dietary and lifestyle changes that accompany globalization, economic development, and technological change. Yet, the nutrition transition is not solely a top-down process; rather, global forces converge with local practices at multiple levels of the social ecology. The family environment, a key site for the transmission of local customs and norms, remains largely unexplored in India. We examined the extent to which opposite-gender siblings and mother–child pairs were concordant or discordant in body weight, and whether domains of the family environment, specifically, food practices, food-related gender norms, and household resources, were associated with patterns of unhealthy weight within and between families. Multilevel dyadic analysis and logistic regression were conducted using survey data from a representative sample of 400 families in a Southern Indian city. We identified substantial clustering of weight among opposite-gender sibling pairs (ICC = 0.43) and mother–child pairs, as well as important patterns of discordance, including 11% of families experiencing a dual burden of underweight and overweight. Household resources, including mother’s education and income, were salient in explaining the distribution of body weight within and between families. Importantly, less examined domains of the family environment were also relevant, including food practices (e.g., grocery shopping frequency), and food-related gender norms (e.g., mother’s control of food served at home). Continued exploration of how global and local practices converge in households will be necessary to develop programming that effectively addresses India’s dual burden of unhealthy weight.
KeywordsIndia Overweight Underweight Family environment Nutrition transition Gender
This work was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development [Award Number 3D43HD065249-03S1]. We thank Dr. G. V. Krishnaveni for her contributions as a project consultant, Dr. A. V. Bharathi, for training the field staff in diet and anthropometry measurements, and Dr. M. C. Yadavannavar for coordinating data collection and survey supervision. The authors would also like to thank Dr. Nida Shaikh and Rebecca Jones for their helpful feedback during the writing of the manuscript.
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