Intraindividual double burden of malnutrition among women (15–49 years) in South Asia

The individual double burden of malnutrition (IDBM) is an underexplored public health problem. In this paper, we did secondary analyses of DHS data in three South Asian countries - India, Myanmar, and Nepal to study the prevalence of the coexistence of anemia and overweight/obesity among women.

Brief methodology

We analyzed the recent standard DHS of India (2019–2021), Myanmar (2015–2016), and Nepal (2016). DHS are nationally representative household surveys that provide data for a wide range of monitoring and impact evaluation indicators in the areas of population, health, and nutrition. The prevalence of IDBM was estimated and the association of variables such as women’s age, education status, occupation status, number of children, place of residence, and wealth quintile with IDBM was found with Pearson chi-square test and binary logistic regression analysis.


The prevalence of IDBM among women was 12.4%, 9.6%, and 6.6% respectively for India, Myanmar, and Nepal. The results show that the co-existence of anemia and overweight/obesity is no more an emerging phenomenon given that a substantial number of women are already living with it. The results also indicate a wide disparity in the occurrence within countries understudy, particularly in India. In nine out of 36 states/union territories of India, the prevalence of IDBM was more than 15%, and in eight, more than 10%. This indicates the higher variability in the prevalence of IDBM within the country. Women belonging to developed states (as per the human development index) and Union Territories had a higher prevalence of IDBM (Puducherry - 25.8%, Chandigarh - 25.7%, Punjab - 22.6%, Tamil Nadu - 20.3%) than those from less developed states (Nagaland - 3.9%, Meghalaya - 5.6%, Rajasthan - 6%, Jharkhand - 6.8%). In Myanmar, the highest prevalence is reported in the Yangon
region (15.3%), followed by Taninthayi (13.3%) and Sagaing regions (12.8%), and the least in the Chin region (4%). Among the three countries, Nepal had the least prevalence of IDBM (7%). The highest prevalence is reported in Province 1 (9.0%) and the least in Province 6 (2.5%).

Among the independent variables considered,  age and wealth showed consistent patterns in all three countries. The prevalence of IDBM increased as age advanced and as moved from poorest to richest wealth quintiles. The increase in burden may be attributed to the changing trends of nutrition transition which has led to increased consumption of fat, salt, sugar, and processed food consumption across the continent of Asia. While rich women can afford to access expensive junk foods that have added fat, salt, and sugar content, poor women are forced to consume cheap diets with limited nutrients [11]. This indicates the inequity in the occurrence of IDBM. Place of residence and education were also found associated with IDBM in India and Myanmar as women from urban areas and those who are educated had a high prevalence of IDBM.  

The prevalence of anemia among women was found to be relatively higher than that of overweight/obesity across all the countries. This observation seems to somewhat negate the
hepcidin-mediated hypothesis, which suggests that obesity leads to anemia in which it was expected that overweight/obese prevalence should have been higher than anemia. However, we cannot conclusively establish temporality as this analysis is based on a cross-sectional survey.


There is a high prevalence of IDBM in South Asian women and it varies substantially across different sociodemographic and economic predictors. Sufficient evidence from prospective studies is needed to establish causal association and also to implement need-based prevention and curative strategies.

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