Spatial inequality and explaining the urban-rural gap in obesity in India: Evidence from 2015–16 population-based survey

Objective: This study assessed the spatial dimension of urban-rural disparity in obesity prevalence and identified the determinants explaining the urban-rural gap in obesity prevalence in India. Methods: Using cross-sectional survey data from the 2015–16 National Family Health Survey, the prevalence rates of obesity were calculated for aged 15–49 years. Two multiscale geographically weighted regressions were performed separately from rural and urban spaces for Indian districts to examine the spatial relationship of the outcome variable and covariates at different geographical scales. Fairlie decomposition analysis was carried out to explore the contribution of each variable in the urban-rural gap. Results: The rural-urban obesity prevalence difference has increased in a decade time for India from 13.0 to 14.6. Urban counterparts tended to have more people with excess weight. 15 states had an urban-rural prevalence ratio of 2 or higher. The MGWR model showed that varying covariates operated at different scales, i.e. global, regional and local scales, and determined the spatial heterogeneity of obesity prevalence. The only variable, i.e. age (9.49 per cent), had contributed in reducing the gap. Conversely, the socioeconomic variables, i.e. income (96.39 per cent), education (4.95 per cent), caste (4.78 per cent) and occupation (3.11 per cent), had widened the gap. Conclusions: Even though this study evidenced the rural-urban gap in obesity prevalence, it indicated the gap’s closing shortly, as it was witnessed in a few states. It is urgent to address the obesity epidemic, especially in urban India, due to its higher prevalence and prevent the further increase of prevalence in rural India, mainly because it shelters nearly 70 per cent of the Indian population.