LAUSR

Abstract The dramatic increase in overweight/obesity prevalence in India and the concomitant increase in nutrition-related non-communicable diseases present critical health policy challenges. This paper analyses two successive nationally representative household datasets – the 2015–16 and 2005–06 National Family Health Survey rounds – to discern the extent of shifts in overweight/obesity prevalence underway in India and the implications for informing policy. Unique features of the study are the focus given to analysing overweight/obesity across different sub-populations, based on gender, rurality and socio-economic status, and the diverse pattern of the prevalence across individual states over time. A fixed effects model using state-time interactions is used to analyse state-level variations and time-dependent effects across particular sub-populations. Despite the considerable increase in the prevalence of overweight/obesity over the past decade and a degree of convergence across population cohorts, the results show that this has been accompanied by considerable variation and divergence between states. Our findings reveal that a select few economically advanced states, most noticeably for wealthy urban female cohorts, experienced negative time-dependent effects where the predicted rates of overweight/obesity declined over the decade. However, some less developed and more populous states experienced positive time-dependent effects such that by 2015–16 they had attained overweight/obesity rates that had overtaken those of richer states. Also, interestingly, beyond a particular threshold education exhibits a negative relationship in the likelihood of overweight/obesity for females but not for males. Policymakers need to understand the driving factors underpinning the state-level differences and the changing patterns across cohorts over time, and to formulate regionally–based policies that specifically target these differences rather than pursue a single policy approach. Moreover, India’s health system needs to be re-orientated to manage burgeoning chronic disease conditions and to address the burden placed on the poor given that such health expenditure is mostly privately incurred.