'Family Matters': A multilevel analysis of household-level clustering of overweight and obesity among adults in India.

Objectives: To examine the clustering of overweight and obesity among adults within Indian households.

Study Design: Nationally representative cross-sectional study.

Methods: Data from the fifth round of the National Family Health Survey (NFHS-5, 2019-21) were analyzed to assess the prevalence of overweight and obesity among adults aged 15-54 years. The study encompassed 636,699 households and 761,885 individuals. Households were categorized based on the presence of overweight or obese members, and multilevel logistic regression was used to evaluate variations at the household, community, district, and regional levels.

Results: Nearly 20 % (95 % CI:19.1-19.5) of households in India had all adults classified as overweight, and 10 % (95 % CI:9.4-9.7) had all adults classified as obese. In states, such as Manipur, Kerala, Arunachal Pradesh, and Sikkim, over 30 % of households had all adults overweight. Additionally, in Tamil Nadu and Punjab, two out of every five households had all adults classified as obese. Among the households belonging to the richest wealth quintile, one in four had all members overweight, and 17.3 % (95 % CI:16.8-17.7) had all members classified as obese. The proportion of households with all obese members was nearly twice as high in urban areas (14.3-15.0 %) compared to their rural counterparts (7.1-7.4 %). Households belonging to Scheduled Tribes reported the lowest proportion of households with all members classified as obese, at only 4.2% (95% CI: 3.9-4.5), while households belonging to forward ('others') social group recorded the highest proportion, at 12.2% (95% CI: 11.8-12.5).

Conclusion: The clustering of overweight and obesity within households, particularly in southern states, among affluent populations, and in urban settings, underscores the importance of family-centered approaches to obesity prevention and intervention.