{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T16:41:13Z","timestamp":1789144873821,"version":"build-2803163510"},"reference-count":38,"publisher":"BMJ","issue":"12","license":[{"start":{"date-parts":[[2021,12,1]],"date-time":"2021-12-01T00:00:00Z","timestamp":1638316800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2021,10,22]]},"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Overweight\/obesity increased dramatically among Indian women since 2000. We evaluated the independent contributions of economic and nutrition context to the changing distribution of overweight\/obesity among women from 1998 to 2016 across India.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Individual-level data from 473\u2009912 ever married Indian women aged 18\u201349 in the National Family Health Surveys (1998\u20131999, 2005\u20132006, 2015\u20132016) were merged with year-matched state-level economic and nutrition context indicators. Cross-classified generalised linear mixed models were estimated to quantify associations of contextual characteristics with overweight\/obesity (body mass index \u226525\u2009kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      ) across survey rounds.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Between 1998 and 2016, age-standardised prevalence of overweight\/obesity increased from 13.9% to 27.5% nationally at an annual growth rate of 0.8%. After accounting for a woman\u2019s age, parity and social class, the adjusted OR (aOR) for overweight\/obesity was 2.02 times higher for every unit of state log per capita gross domestic product (GDP) (95% credible interval (CrI) 2.00 to 2.03). Yet, the association of state GDP with overweight\/obesity generally decreased over survey round. Women in states with higher per capita daily oil (aOR 1.02 per gram; 95% CrI 1.01 to 1.03) and sugar (aOR 1.05 per gram; 95% CrI 1.04 to 1.05) consumption were more likely to be overweight\/obese, while women in states with higher cereal consumption were less likely to be overweight\/obese (aOR 0.93 per 10\u2009gram; 95% CrI 0.93 to 0.93).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Indicators of state economic development and nutrition transition were independently associated with a woman\u2019s likelihood of being overweight\/obese. The impact of state wealth waned over survey round, suggesting that risks for overweight\/obesity may be increasingly shaped by individual factors as economic development expands in India.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2021-050598","type":"journal-article","created":{"date-parts":[[2021,12,9]],"date-time":"2021-12-09T11:42:32Z","timestamp":1639050152000},"page":"e050598","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":6,"title":["Contribution of economic and nutritional context to overweight\/obesity dynamics in Indian women from 1998 to 2016: a multilevel analysis of national survey data"],"prefix":"10.1136","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0299-3619","authenticated-orcid":false,"given":"Jeswin","family":"Baby","sequence":"first","affiliation":[{"name":"Division of Epidemiology and Biostatistics, St John\u2019s Research Institute, Bangalore, Karnataka, India"},{"name":"Department of Statistical Sciences, Kannur University, Kannur, Kerala, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jithin Sam","family":"Varghese","sequence":"additional","affiliation":[{"name":"Nutrition and Health Sciences Doctoral Program, Laney School of Graduate Studies, Emory University, Atlanta, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shruthi","family":"Cyriac","sequence":"additional","affiliation":[{"name":"Nutrition and Health Sciences Doctoral Program, Laney School of Graduate Studies, Emory University, Atlanta, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8621-5405","authenticated-orcid":false,"given":"K M Venkat","family":"Narayan","sequence":"additional","affiliation":[{"name":"Department of Global Health and Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anura V","family":"Kurpad","sequence":"additional","affiliation":[{"name":"Department of Physiology, St John's Medical College, Bangalore, Karnataka, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1786-6076","authenticated-orcid":false,"given":"Tinku","family":"Thomas","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, St John's Medical College, Bangalore, Karnataka, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shivani","family":"Patel","sequence":"additional","affiliation":[{"name":"Department of Global Health and Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2021,12,9]]},"reference":[{"key":"2025120600190629000_11.12.e050598.1","doi-asserted-by":"publisher","DOI":"10.1016\/s0140-6736(20)30752-2"},{"key":"2025120600190629000_11.12.e050598.2","doi-asserted-by":"crossref","first-page":"2692","DOI":"10.1093\/jn\/131.10.2692","article-title":"The nutrition transition is underway in India","volume":"131","author":"Griffiths","year":"2001","journal-title":"J Nutr"},{"key":"2025120600190629000_11.12.e050598.3","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1002968"},{"key":"2025120600190629000_11.12.e050598.4","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2018-023935"},{"key":"2025120600190629000_11.12.e050598.5","doi-asserted-by":"publisher","DOI":"10.1016\/j.annepidem.2015.02.009"},{"key":"2025120600190629000_11.12.e050598.6","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2004-1808"},{"key":"2025120600190629000_11.12.e050598.7","doi-asserted-by":"publisher","DOI":"10.3945\/ajcn.112.036350"},{"key":"2025120600190629000_11.12.e050598.8","doi-asserted-by":"crossref","first-page":"364","DOI":"10.1093\/jn\/nxz251","article-title":"A double edged sword? Improvements in economic conditions over a decade in India led to declines in undernutrition as well as increases in overweight among adolescents and women","volume":"150","author":"Young","year":"2020","journal-title":"J Nutr"},{"key":"2025120600190629000_11.12.e050598.9","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1186\/s41256-019-0117-z","article-title":"Prevalence and factors associated with underweight, overweight and obesity among women of reproductive age in India","volume":"4","author":"Al Kibria","year":"2019","journal-title":"Glob Health Res Policy"},{"key":"2025120600190629000_11.12.e050598.10","doi-asserted-by":"publisher","DOI":"10.3945\/jn.109.112029"},{"key":"2025120600190629000_11.12.e050598.11","doi-asserted-by":"crossref","DOI":"10.1186\/s12889-019-7155-9","article-title":"Do trends in the prevalence of overweight by socio-economic position differ between India's most and least economically developed states?","volume":"19","author":"Luhar","year":"2019","journal-title":"BMC Public Health"},{"key":"2025120600190629000_11.12.e050598.12","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pmed.1002581","article-title":"Geographic and sociodemographic variation of cardiovascular disease risk in India: a cross-sectional study of 797,540 adults","volume":"15","author":"Geldsetzer","year":"2018","journal-title":"PLoS Med"},{"key":"2025120600190629000_11.12.e050598.13","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2019.0411","article-title":"Socioeconomic gradients and distribution of diabetes, hypertension, and obesity in India","volume":"2","author":"Corsi","year":"2019","journal-title":"JAMA Netw Open"},{"key":"2025120600190629000_11.12.e050598.14","doi-asserted-by":"publisher","DOI":"10.1111\/mcn.12036"},{"key":"2025120600190629000_11.12.e050598.15","unstructured":"Pingali P , Khwaja Y . 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Nutrient requirements for Indians: recommended daily allowances and estimated average requirements 2020."},{"key":"2025120600190629000_11.12.e050598.37","unstructured":"Working Group Constituted by Ministry of Women and Child Development . Report of working group on addressing consumption of foods high in fat, salt and sugar (HFSS) and promotion of healthy snacks in schools of India 2015."},{"key":"2025120600190629000_11.12.e050598.38","doi-asserted-by":"publisher","DOI":"10.1007\/s00125-020-05330-1"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2021-050598","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,6]],"date-time":"2025-12-06T08:19:14Z","timestamp":1765009154000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2021-050598"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,12]]},"references-count":38,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2021,12,9]]},"published-print":{"date-parts":[[2021,12]]}},"alternative-id":["10.1136\/bmjopen-2021-050598"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2021-050598","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,12]]}}}