Skip to main content Accessibility help
×
Home

Double burden of underweight and overweight among women of reproductive age in Bangladesh

  • Raaj Kishore Biswas (a1), Nusma Rahman (a2), Rasheda Khanam (a3), Abdullah H Baqui (a3) and Saifuddin Ahmed (a4)...

Abstract

Objective:

Bangladesh, like many emerging economies of South-East Asia, has started to experience a double burden of continuing high rates of undernutrition and increasing rates of overweight and obesity. A lack of assessment of the nutritional shift leaves a gap in current policies: the growing overweight and obesity is yet to be addressed. The present paper investigates the change in nutritional status, particularly the shift in BMI, of Bangladeshi women of reproductive age (15–49 years) and characterizes the vulnerable households for both underweight and overweight status during a period of 10 years (2004–2014).

Design:

Generalized linear mixed-effect models were fitted for both urban and rural residents to assess underweight and overweight status.

Setting:

Bangladesh Demographic and Health Surveys.

Participants:

Women aged 15–49 years (n 53 077).

Results:

The proportion of overweight increased during 2004–2014 from 10·7 to 25·1 % and the proportion of underweight decreased from 32·6 to 18·2 %. Prevalence of underweight status remained high in rural areas and prevalence of overweight increased rapidly in both rural and urban areas, creating a double burden. The significant contributors to this double burden were the change in women’s level of education, increased household wealth, divisional location and rapid urbanization.

Conclusions:

The findings indicate that specific cohort- or area-based intervention policy studies in line with the UN Decade of Action on Nutrition are required to address the nutritional double burden in Bangladesh.

Copyright

Corresponding author

*Corresponding author: Email raajkishore.biswas@student.unsw.edu.au

References

Hide All
1.Finucane, MM, Stevens, GA, Cowan, MJ et al. (2011) National, regional, and global trends in body-mass index since 1980: systematic analysis of health examination surveys and epidemiological studies with 960 country-years and 9 1 million participants. Lancet 377, 557567.
2.Prentice, AM (2005) The emerging epidemic of obesity in developing countries. Int J Epidemiol 35, 9399.
3.Popkin, BM, Adair, LS & Ng, SW (2012) Global nutrition transition and the pandemic of obesity in developing countries. Nutr Rev 70, 321.
4.Loret de Mola, C, Quispe, R, Valle, GA et al. (2014) Nutritional transition in children under five years and women of reproductive age: a 15-years trend analysis in Peru. PLoS One 9, e92550.
5.Abdullah, A (2015) The double burden of undernutrition and overnutrition in developing countries: an update. Curr Obes Rep 4, 337349.
6.Shrimpton, R, Mbuya, NV & Provo, AM (2016) The Double Burden of Malnutrition in East Asia and the Pacific: Evidence and Lessons for a Multisectoral Response. Health, Nutrition, and Population (HNP) Discussion Paper. Washington, DC: World Bank Group; available at http://documents.worldbank.org/curated/en/185291487250172586/The-double-burden-of-malnutrition-in-East-Asia-and-the-Pacific-evidence-and-lessons-for-a-multisectoral-response (accessed September 2019).
7.Barquera, S, Pedroza-Tobias, A & Medina, C (2016) Cardiovascular diseases in mega-countries: the challenges of the nutrition, physical activity and epidemiologic transitions, and the double burden of disease. Curr Opin Lipidol 27, 329344.
8.Khan, SH & Talukder, SH (2013) Nutrition transition in Bangladesh: is the country ready for this double burden. Obes Rev 14, Suppl. 2, 126133.
9.Khanam, R, Lee, ASC, Ram, M et al. (2018) Levels and correlates of nutritional status of women of childbearing age in rural Bangladesh. Public Health Nutr 21, 30373047.
10.Nawaz, S (2010) Microfinance and poverty reduction: evidence from a village study in Bangladesh. J Asian Afr Stud 45, 670683.
11.Davis, P & Baulch, B (2011) Parallel realities: exploring poverty dynamics using mixed methods in rural Bangladesh. J Dev Stud 47, 118142.
12.Ahmed, T, Roy, S, Alam, N et al. (2012) Determinants of undernutrition in children under 2 years of age from rural Bangladesh. Indian Pediatr 49, 821824.
13.Chowdhury, AM, Bhuiya, A, Chowdhury, ME et al. (2013) The Bangladesh paradox: exceptional health achievement despite economic poverty. Lancet 382, 17341745.
14.Das, SK, Chisti, MJ, Malek, MA et al. (2015) Changing childhood malnutrition in Bangladesh: trends over the last two decades in urban–rural differentials (1993–2012). Public Health Nutr 18, 17181727.
15.National Institute of Population Research and Training, Mitra and Associates & ICF International (2016) Bangladesh Demographic and Health Survey 2014. Dhaka and Rockville, MD: NIPORT, Mitra and Associates, and ICF International.
16.Vos, T, Allen, C, Arora, M et al. (2016) Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet 388, 15451602.
17.Arifeen, SE, Hill, K, Ahsan, KZ et al. (2014) Maternal mortality in Bangladesh: a Countdown to 2015 country case study. Lancet 384, 13661374.
18.Liu, L, Oza, S, Hogan, D et al. (2016) Global, regional, and national causes of under-5 mortality in 2000–15: an updated systematic analysis with implications for the Sustainable Development Goals. Lancet 388, 30273035.
19.Akhter, S & Dasvarma, G (2017) Whither MDG 5 in Bangladesh and its regions? J Popul Res 34, 279301.
20.Islam, MM, Khan, AM & Islam, MM (2013) Textile industries in Bangladesh and challenges of growth. Res J Eng Sci 2278, 9472.
21.Gautam, M & Faruqee, R (2016) Dynamics of Rural Growth in Bangladesh: Sustaining Poverty Reduction. Washington, DC: World Bank Publications.
22.White, H (2005) Maintaining Momentum to 2015? An Impact Evaluation of Interventions to Improve Maternal and Child Health and Nutrition in Bangladesh. Washington, DC: World Bank Publications.
23.Nahar, S, Mascie-Taylor, CG & Begum, HA (2009) Impact of targeted food supplementation on pregnancy weight gain and birth weight in rural Bangladesh: an assessment of the Bangladesh Integrated Nutrition Program (BINP). Public Health Nutr 12, 12051212.
24.Belton, B, Mariana van Asseldonk, IJ & Thilsted, SH (2014) Faltering fisheries and ascendant aquaculture: implications for food and nutrition security in Bangladesh. Food Policy 44, 7787.
25.Subramanian, SV, Perkins, JM, Ozaltin, E et al. (2011) Weight of nations: a socioeconomic analysis of women in low- to middle-income countries. Am J Clin Nutr 93, 413421.
26.Jones-Smith, JC, Gordon-Larsen, P, Siddiqi, A et al. (2012) Is the burden of overweight shifting to the poor across the globe? Time trends among women in 39 low-and middle-income countries (1991–2008). Int J Obes (Lond) 36, 11141120.
27.Black, RE, Victora, CG, Walker, SP et al. (2013) Maternal and child undernutrition and overweight in low-income and middle-income countries. Lancet 382, 427451.
28.Barrett, CB (2010) Measuring food insecurity. Science 327, 825828.
29.Ha, DTP, Feskens, EJM, Deurenberg, P et al. (2011) Nationwide shifts in the double burden of overweight and underweight in Vietnamese adults in 2000 and 2005: two national nutrition surveys. BMC Public Health 11, 62.
30.Ruel, MT & Alderman, H; Maternal and Child Nutrition Study Group (2013) Nutrition-sensitive interventions and programmes: how can they help to accelerate progress in improving maternal and child nutrition? Lancet 382, 536551.
31.Headey, DD (2013) Developmental drivers of nutritional change: a cross-country analysis. World Dev 42, 7688.
32.Liu, S, Allen, A & Fraser, W (2008) Fetal and infant health outcomes. In Canadian Perinatal Health Report 2008 Edition, p. 123. Ottawa: Public Health Agency of Canada.
33.Han, Z, Mulla, S, Beyene, J et al. (2010) Maternal underweight and the risk of preterm birth and low birth weight: a systematic review and meta-analyses. Int J Epidemiol 40, 65101.
34.Ozaltin, E, Hill, K & Subramanian, SV (2010) Association of maternal stature with offspring mortality, underweight, and stunting in low-to middle-income countries. JAMA 303, 15071516.
35.Khanam, R, Lee, ACC, Mitra, DK et al. (2019) Maternal short stature and underweight status are independent risk factors for preterm birth and small for gestational age in rural Bangladesh. Eur J Clin Nutr 73, 733742.
36.Ahmed, T, Hossain, M & Sanin, KI (2012) Global burden of maternal and child undernutrition and micronutrient deficiencies. Ann Nutr Metab 61, Suppl. 1, 817.
37.Jaacks, LM, Slining, MM & Popkin, BM (2015) Recent underweight and overweight trends by rural–urban residence among women in low-and middle-income countries. J Nutr 145, 352357.
38.Ahmed, T, Mahfuz, M, Ireen, S et al. (2012) Nutrition of children and women in Bangladesh: trends and directions for the future. J Health Popul Nutr 30, 111.
39.Ng, SW, Zaghloul, S, Ali, HI et al. (2011) The prevalence and trends of overweight, obesity and nutrition-related non-communicable diseases in the Arabian gulf states. Obes Rev 12, 113.
40.Ng, M, Fleming, T, Robinson, M et al. (2014) Global, regional, and national prevalence of overweight and obesity in children and adults during 1980–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 384, 766781.
41.Look AHEAD Research Group, Gregg, EW, Jakicic, JM et al. (2016) Association of the magnitude of weight loss and changes in physical fitness with long-term cardiovascular disease outcomes in overweight or obese people with type 2 diabetes: a post-hoc analysis of the Look AHEAD randomised clinical trial. Lancet Diabetes Endocrinol 4, 913921.
42.Lavie, CJ, Schutter, AD, Parto, P et al. (2016) Obesity and prevalence of cardiovascular diseases and prognosis – the obesity paradox updated. Prog Cardiovasc Dis 58, 537547.
43.Basu, S, McKee, M, Galea, G et al. (2013) Relationship of soft drink consumption to global overweight, obesity, and diabetes: a cross-national analysis of 75 countries. Am J Public Health 103, 20712077.
44.Neuman, M, Kawachi, I, Gortmaker, S et al. (2013) Urban–rural differences in BMI in low- and middle-income countries: the role of socioeconomic status. Am J Clin Nutr 97, 428436.
45.Biswas, T, Uddin, MJ, Mamun, AA et al. (2017) Increasing prevalence of overweight and obesity in Bangladeshi women of reproductive age: findings from 2004 to 2014. PLoS One 12, e0181080.
46.Kamal, SM, Hassan, CH & Alam, GM (2015) Dual burden of underweight and overweight among women in Bangladesh: patterns, prevalence, and sociodemographic correlates. J Health Popul Nutr 33, 92105.
47.Rutstein, SO, Johnson, K & ORC Macro MEASURE et al. (2004) The DHS Wealth Index. Calverton, MD: ORC Macro, MEASURE DHS.
48.World Health Organization (2000) Obesity: Preventing and Managing the Global Epidemic. Report of a WHO Consultation. WHO Technical Report Series no. 894. Geneva: WHO.
49.Bangladesh Bureau of Statistics (2015) Population Monographs of Bangladesh: Age–Sex Composition of Bangladesh Population. Dhaka: BBS, Statistics and Informatics Division, Ministry of Planning.
50.Thomas, DR & Decady, YJ (2004) Testing for association using multiple response survey data: approximate procedures based on the Rao–Scott approach. Int J Test 4, 4359.
51.Rabe-Hesketh, S & Skrondal, A (2008) Generalized linear mixed-effects models. In Longitudinal Data Analysis: A Handbook of Modern Statistical Methods, pp. 79106[Fitzmaurice, G, Davidian, M, Verbeke, G et al., editors]. Boca Raton, FL: Chapman & Hall/CRC.
52.Balarajan, Y & Villamor, E (2009) Nationally representative surveys show recent increases in the prevalence of overweight and obesity among women of reproductive age in Bangladesh, Nepal, and India. J Nutr 139, 21392144.
53.Mostafa Kamal, SM & Islam, A (2010) Socio-economic correlates of malnutrition among married women in Bangladesh. Malays J Nutr 16, 349359.
54.Corsi, DJ, Kyu, HH & Subramanian, SV (2011) Socioeconomic and geographic patterning of under-and overnutrition among women in Bangladesh. J Nutr 141, 631638.
55.Mohsena, M, Goto, R & Mascie-Taylor, CN (2016) Maternal nutritional status (as measured by height, weight and BMI) in Bangladesh: trends and socio-economic association over the period 1996 to 2007. Public Health Nutr 19, 14381445.
56.Howe, LD, Hargreaves, JR, Gabrysch, S et al. (2009) Is the wealth index a proxy for consumption expenditure? A systematic review. J Epidemiol Community Health 63, 871877.
57.NCD Risk Factor Collaboration et al. (2019) Rising rural body-mass index is the main driver of the global obesity epidemic in adults. Nature 569, 260264.
58.Khan, MM & Kraemer, A (2009) Factors associated with being underweight, overweight and obese among ever-married non-pregnant urban women in Bangladesh. Singapore Med J 50, 804813.
59.Hoque, ME, Hasan, MT, Rahman, M et al. (2017) Double burden of underweight and overweight among Bangladeshi adults differs between men and women: evidence from a nationally representative survey. Public Health Nutr 20, 21832191.
60.Mummery, WK, Schofield, GM, Steele, R et al. (2005) Occupational sitting time and overweight and obesity in Australian workers. Am J Prev Med 29, 9197.
61.Kabeer, N, Mahmud, S & Tasneem, S (2011) Does Paid Work Provide a Pathway to Women’s Empowerment? Empirical Findings from Bangladesh. Brighton: Institute of Development Studies.
62.Kumar, D, Hossain, A & Gope, MC (2015) Role of micro credit program in empowering rural women in Bangladesh: a study on Grameen Bank Bangladesh Limited. Asian Bus Rev 3, 114120.
63.Schmidhuber, J & Shetty, P (2005) The nutrition transition to 2030. Why developing countries are likely to bear the major burden. Acta Agric Scand Sec C 2, 150166.
64.Baker, P & Friel, S (2014) Processed foods and the nutrition transition: evidence from Asia. Obes Rev 15, 564577.
65.Das, S, Fahim, SM, Islam, MS et al. (2019) Prevalence and sociodemographic determinants of household-level double burden of malnutrition in Bangladesh. Public Health Nutr 22, 14251432.
66.Rahman, S (2014) Obesity in junk food generation in Asia: a health time bomb that needs early defusing! South East Asia J Public Health 3, 12.
67.Morgan, K & Sonnino, R (2010) The urban foodscape: world cities and the new food equation. Camb J Regions Econ Soc 3, 209224.
68.Islam, N, Angeles, G, Mahbub, A et al. (2006) Slums of Urban Bangladesh: Mapping and Census 2005. Dhaka and Chapel Hill, NC: Centre for Urban Studies, National Institute of Population Research and Training, and MEASURE Evaluation.
69.Kabir, I, Khanam, M, Agho, KE et al. (2012) Determinants of inappropriate complementary feeding practices in infant and young children in Bangladesh: secondary data analysis of demographic health survey 2007. Matern Child Nutr 8, Suppl. 1, 1127.
70.Tareque, MI, Begum, S & Saito, Y (2014) Inequality in disability in Bangladesh. PLoS One 9, e103681.
71.Kutob, RM, Yuan, NP, Wertheim, BC et al. (2017) Relationship between marital transitions, health behaviors, and health indicators of postmenopausal women: results from the Women’s Health Initiative. J Womens Health 26, 313320.
72.Biswas, RK, Kabir, E & Khan, HT (2019) Socioeconomic transition and its influence on body mass index (BMI) pattern in Bangladesh. J Eval Clin Pract 25, 130141.
73.Chowdhury, MAB, Adnan, MM & Hassan, MZ (2018) Trends, prevalence and risk factors of overweight and obesity among women of reproductive age in Bangladesh: a pooled analysis of five national cross-sectional surveys. BMJ Open 8, e018468.
74.Popkin, BM (2014) Nutrition, agriculture and the global food system in low and middle income countries. Food Policy 47, 9196.
75.Neiderud, CJ (2015) How urbanization affects the epidemiology of emerging infectious diseases. Infect Ecol Epidemiol 5, 27060.
76.Harun, MA, Ahmed, F & Maniruzzaman, (2013) Customer hospitality: the case of fast food industry in Bangladesh. World J Soc Sci 3, 88104.
77.Ashraf, MA, Akhter, S & Noor, SI (2014) Consumer behavior in fast food marketing in Bangladesh: a case study. Develop Countr Stud 4, 3444.
78.Reardon, T, Boughton, D, Tschirley, D et al. (2015) Urbanization, diet change, and transformation of the downstream and midstream of the agrifood system: effects on the poor in Africa and Asia. Faith Econ 66, 4363.
79.Neupane, S, Prakash, KC & Doku, DT (2016) Overweight and obesity among women: analysis of demographic and health survey data from 32 sub-Saharan African countries. BMC Public Health 16, 30.
80.Melby, CL, Orozco, F, Ochoa, D et al. (2017) Nutrition and physical activity transitions in the Ecuadorian Andes: differences among urban and rural dwelling women. Am J Hum Biol 29, e22986.
81.Goryakin, Y & Suhrcke, M (2014) Economic development, urbanization, technological change and overweight: what do we learn from 244 Demographic and Health Surveys? Econ Hum Biol 14, 109127.
82.Feldman, S (2015) Bangladesh in 2014. Asian Surv 55, 6774.
84.Taylor, L (2012) The Nutrition Agenda in Bangladesh: ‘Too Massive to Handle’? Analysing Nutrition Governance: Bangladesh Country Report. Brighton: Institute of Development Studies.
85.Headey, D, Hoddinott, J, Ali, D et al. (2015) The other Asian enigma: explaining the rapid reduction of undernutrition in Bangladesh. World Dev 66, 749761.
86.Hossain, SM, Duffield, A & Taylor, A (2005) An evaluation of the impact of a US $60 million nutrition programme in Bangladesh. Health Policy Plan 20, 3540.
87.Levinson, FJ & Rohde, JE (2005) Responses to: ‘an evaluation of the impact of a US $60 million nutrition programme in Bangladesh’. Health Policy Plan 20, 405406.
88.White, H (2005) Comment on contributions regarding the impact of the Bangladesh integrated nutrition project. Health Policy Plan 20, 408411.
89.Sack, DA, Roy, SK, Ahmed, T et al. (2005) An evaluation of the impact of a US $60 million nutrition programme in Bangladesh (letter) (reply). Health Policy Plan 20, 406407.
90.Islam, MS (2016) The NGOs sector in Bangladesh: emergence, contribution and current debate. Adv Asian Soc Sci 7, 11821188.
91.Hasan, MT, Soares Magalhaes, RJ, Williams, GM et al. (2016) Long-term changes in childhood malnutrition are associated with long-term changes in maternal BMI: evidence from Bangladesh, 1996–2011. Am J Clin Nutr 104, 11211127.
92.Gillespie, S & Haddad, L (2001) Attacking the Double Burden of Malnutrition in Asia and the Pacific. Manila and Washington, DC: Asian Development Bank and International Food Policy Research Institute.
93.Kraak, VI, Swinburn, B, Lawrence, M et al. (2011) The accountability of public–private partnerships with food, beverage and quick-serve restaurant companies to address global hunger and the double burden of malnutrition. United Nations System Standing Committee on Nutrition: News 39, 1124.
94.Reardon, T, Timmer, CP, Barrett, CB et al. (2003) The rise of supermarkets in Africa, Asia, and Latin America. Am J Agric Econ 85, 11401146.
95.Reardon, T, Timmer, CP & Minten, B (2012) Supermarket revolution in Asia and emerging development strategies to include small farmers. Proc Natl Acad Sci U S A 109, 1233212337.
96.Tzioumis, E, Kay, MC, Bentley, ME et al. (2016) Prevalence and trends in the childhood dual burden of malnutrition in low-and middle-income countries, 1990–2012. Public Health Nutr 19, 13751388.
97.Motlagh, ME, Kelishadi, R, Amirkhani, MA et al. (2011) Double burden of nutritional disorders in young Iranian children: findings of a nationwide screening survey. Public Health Nutr 14, 605610.
98.Demaio, AR & Branca, F (2018) Decade of action on nutrition: our window to act on the double burden of malnutrition. BMJ Glob Health 3, Suppl. 1, e000492.
99.World Health Organization (2016) The Double Burden of Malnutrition: Policy Brief. Geneva: WHO.
100.Gray, LJ, Yates, T, Davies, MJ et al. (2011) Defining obesity cut-off points for migrant South Asians. PLoS One 6, e26464.
101.Bahk, JY, Jung, JH, Jin, LM et al. (2010) Cut-off value of testes volume in young adults and correlation among testes volume, body mass index, hormonal level, and seminal profiles. Urology 75, 13181323.
102.Bahat, G, Tufan, F, Saka, B et al. (2012) Which body mass index (BMI) is better in the elderly for functional status? Arch Gerontol Geriatr 54, 7881.
103.Razak, F, Anand, SS, Shannon, H et al. (2007) Defining obesity cut points in a multiethnic population. Circulation 115, 21112118.

Keywords

Double burden of underweight and overweight among women of reproductive age in Bangladesh

  • Raaj Kishore Biswas (a1), Nusma Rahman (a2), Rasheda Khanam (a3), Abdullah H Baqui (a3) and Saifuddin Ahmed (a4)...

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed