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CORRESPONDENCE
Year : 2011  |  Volume : 133  |  Issue : 1  |  Page : 119-120

Low socio-economic groups are not overweight in India


1 Center for Integrative Approaches to Health Disparities, School of Public Health, University of Michigan, MI, USA
2 Department of Society, Human Development and Health ,Harvard School of Public Health, Boston, MA, USA

Date of Web Publication7-Apr-2011

Correspondence Address:
S V Subramanian
Associate Professor, Harvard School of Public Health, 677, Huntington Avenue, Boston MA 02115
USA
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Source of Support: None, Conflict of Interest: None


PMID: 21321430

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How to cite this article:
Subramanyam MA, Subramanian S V. Low socio-economic groups are not overweight in India. Indian J Med Res 2011;133:119-20

How to cite this URL:
Subramanyam MA, Subramanian S V. Low socio-economic groups are not overweight in India. Indian J Med Res [serial online] 2011 [cited 2020 Feb 28];133:119-20. Available from: http://www.ijmr.org.in/text.asp?2011/133/1/119/76713

Sir,

We commend Jeemon and Reddy [1] for their review article focusing on the need to consider a social determinants perspective for understanding and addressing chronic diseases, including their risk factors such as overweight/obesity, in India. Here we highlight an inaccuracy in their specific claim that "obesity or overweight and hypertension are now associated with lower levels of education and income in India" [1] . The study cited by them does not appear to substantiate their claim with regards to overweight/obesity [2] , and shows that between 1995 and 2002 the increase in obesity and truncal obesity was substantially greater among individuals with higher levels of education. Another study by Reddy et al[3] again shows a clear positive association between overweight and education among men and women. While overweight appeared to be inversely associated with education in "urban" areas, [3] the sample used in this study was solely based on employees working in large industries and their families [4] , representing a very small minority of the Indian population. On the other hand, studies using nationally representative data on adults from India, show unequivocally that overweight is concentrated primarily among high socio-economic groups [Figure 1] [5],[6] . Indeed, a positive association between overweight and socio-economic status (SES) has also been replicated in more than 50 developing countries [7] . We are intrigued, and concerned, with regards to the discordance between the data and interpretation that has also has been prevalent in other studies on obesity in developing countries [8].
Figure 1 :Per cent underweight (BMI<18.5 kg/m2) and overweight (BMI ≥25 kg/m2) in 1998-1999 and 2005-2006 among adult women in the lowest and highest quintile of household wealth from the 1998-1999 and 2005-2006 Indian National Family Health surveys (Source: Adapted from Ref. 5).

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The idea that the association between SES and weight is initially positive and then flips to be being negative is seemingly drawn from experiences of rich, industrialized societies, even though our literature search did not yield a single empirical study that demonstrates this convincingly. Factors such as cheap availability of calorie-dense food, and food in general, dramatic shifts in occupational patterns from an agrarian to a service economy, high SES groups cutting down or shifting their dietary patterns, or economic growth spilling over to the low SES groups and improving their incomes in a substantial manner have to be occurring in order to anticipate a reversal in the SES-weight association. To our knowledge, there is little evidence of such changes occurring in India. On the contrary, inflation in food commodities has become an important concern [9] , economic growth has been extremely uneven and concentrated in a small minority [10] , and according to the 2001 Indian Census more than 70 per cent of the population continues to live in rural areas and more than half of the workforce remains engaged in labour-intensive agriculture activity [11] .

While increasing overweight prevalence is an important public health concern in India, it is premature and erroneous to characterize this as an emerging problem among the low SES groups in India.

 
   References Top

1.Jeemon P, Reddy KS. Social determinants of cardiovascular disease outcomes in Indians. Indian J Med Res 2010; 132 : 617-22.  Back to cited text no. 1
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2.Gupta R, Gupta VP, Sarna M, Prakash H, Rastogi S, Gupta KD. Serial epidemiological surveys in an urban Indian population demonstrate increasing coronary risk factors among the lower socioeconomic strata. J Assoc Physicians India 2003; 51 : 470-7.  Back to cited text no. 2
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3.Reddy KS, Prabhakaran D, Jeemon P, Thankappan KR, Joshi P, Chaturvedi V, et al. Educational status and cardiovascular risk profile in Indians. Proc Natl Acad Sci USA 2007; 104 : 16263-8.  Back to cited text no. 3
[PUBMED]  [FULLTEXT]  
4.Reddy KS, Prabhakaran D, Chaturvedi V, Jeemon P, Thankappan KR, Ramakrishnan L, et al. Methods for establishing a surveillance system for cardiovascular diseases in Indian industrial populations. Bull World Health Organ 2006; 84 : 461-9.  Back to cited text no. 4
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5.Subramanian SV, Perkins JM, Khan KT. Do burdens of underweight and overweight coexist among lower socioeconomic groups in India? Am J Clin Nutr 2009; 90 : 369-76.  Back to cited text no. 5
[PUBMED]  [FULLTEXT]  
6.Subramanian SV, Smith GD. Patterns, distribution, and determinants of under- and overnutrition: a population-based study of women in India. Am J Clin Nutr 2006; 84 : 633-40.  Back to cited text no. 6
[PUBMED]  [FULLTEXT]  
7.Subramanian S, Perkins JM, Ozaltin E, Davey Smith G. Weight of nations: a socioeconomic analysis of women in low- to middle-income countries. Am J Clin Nutr 2010: Nov. 10, 2010.  Back to cited text no. 7
    
8.Monteiro CA, Conde WL, Lu B, Popkin BM. Obesity and inequities in health in the developing world. Int J Obes Relat Metab Disord 2004; 28 : 1181-6.  Back to cited text no. 8
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9.Sen A. The rich get hungrier. The New York Times 2008; May 28, 2008.  Back to cited text no. 9
    
10.Dev MS, Ravi C. Poverty and Inequality: All-India and States, 1983-2005. Economic and Political Weekly 2007;42:509-21.  Back to cited text no. 10
    
11.Govt. of India. Census of India - 2001. New Delhi: Office of the Registrar General of India; 2001.  Back to cited text no. 11
    


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