Prevalence and factors affecting underweight, overweight and obesity using Asian and World Health Organization cutoffs among adults in Nepal: Analysis of the Demographic and Health Survey 2016

Abstract

Objective: There is a little published data on prevalence and determinants of underweight, overweight and obesity among adults in Nepal. This study analysed the cross-sectional Nepal Demographic and Health Survey (NDHS) 2016 to obtain these using the World Health Organization (WHO) and Asian-specific cutoffs of body mass index (BMI).

Methods: The 2016 NDHS used a multistage cluster-sampling design to obtain data on major health indicators in Nepal. The BMI cutoffs for underweight was <18.5kg/m². The BMI cutoffs for overweight/obesity as per the Asian and WHO classifications were ≥23, and ≥25kg/m², respectively. After reporting the prevalence according to sex and background characteristics, multilevel logistic regression was conducted to estimate odds ratios.

Subjects: This analysis included 12,652 adults (5283 males and 7369 females) with a median age of 40 years (interquartile range [IQR]: 28-54).

Results: The overall median BMI was 21.5kg/m² (IQR:19.3-24.3). The overall prevalence of underweight was 16.7% (15.1% among males and 17.1% among females). The Asian-specific BMI cutoffs found the prevalence of overweight and obesity as 26.4% (27.4% among males and 25.6% among females) and 11.0% (7.7% among males and 13.3% among females), respectively. The WHO-recommended BMI cutoffs found 18.2% people overweight (16.7% among males and 19.3% among females) and 4.3% (2.5% among males and 5.6% among females) people obese. The prevalence and odds of extreme body weight categories (i.e., underweight, overweight and obesity) varied according to age, sex, education level, household wealth status, place, ecological zone and provinces of residence as per both recommended cutoffs. Overall, higher education level and wealth status were positively associated with overweight/obesity and inversely associated with underweight as per both cutoffs.

Conclusion: A large proportion Nepalese adults have either underweight, overweight or obesity, and could be at a greater risk of mortality and morbidity due to these extreme body weight categories. It is essential to address the factors or characteristics that are associated with the higher prevalence and likelihood of these extreme body weight categories to reduce the overall burden of underweight and overweight/obesity in Nepal.

Keywords: Body mass index; Body weight; Factors; Nepal; Obesity/Overweight; Prevalence; Underweight.