Underweight, overweight or obesity, diabetes, and hypertension in Bangladesh, 2004 to 2018

Abstract

Background and objectives: Bangladesh is experiencing a nutrition transition with an increase in the double burden of malnutrition and non-communicable diseases (NCDs). This study sought to: 1) examine trends and differences in underweight, overweight/obesity, hypertension and diabetes by gender, area of residence, and wealth in Bangladesh from 2004 to 2018, 2) assess what factors contributed to changes in these outcomes.

Methods: We used data from five rounds of the Bangladesh Demographic and Health Surveys (n = 76,758 women 15-49y and 10,900 men 18-95y in total). We calculated differences, slope index of inequality (SII) and concentration index (CIX) to examine trends over time and differences in outcomes by wealth and residence. We identified determinants and estimated drivers of changes in outcomes using regression-based decomposition.

Results: Between 2004 and 2018, underweight prevalence decreased in both women (33% to 12%) and men (26% to 18%), whereas overweight/obesity increased (17% to 49% in women and 21% to 34% in men). Hypertension also increased in both women (31% to 44%) and men (19% to 33%) while diabetes changed marginally (11% to 14%). In all years, underweight was concentrated in poorer and rural households while overweight/obesity, diabetes and hypertension were concentrated in wealthier and urban households. Wealth inequity decreased over time for underweight, changed little for overweight/obesity, and increased for hypertension and diabetes among men. Increases in wealth explained 35% to 50% of the reduction in underweight and 30% to 57% of the increase in overweight/obesity.

Conclusion: Our findings imply that double duty actions are required to sustain the decrease in undernutrition and slow the increase in overweight/obesity and NCDs across diverse socioeconomic sections of the population in Bangladesh.

Fig 1. Trends in BMI, overweight/obesity, and underweight among women and men by survey round, Bangladesh 2004–2018¹.

(A) Distributions of BMI by survey round. (B) Distributions of BMI by age and survey round. (C) Prevalence of underweight and overweight/obesity by survey round. ¹Underweight was defined as BMI < 18.5 kg/m² and overweight/obese as BMI ≥ 23 kg/m², according to the criteria for Asian populations. Values in (A) and (B) are mean and 95% confidence interval bands. Values in (C) are mean and 95% confidence interval points.

Fig 2. Trends in hypertension and diabetes among women and men by survey rounds, Bangladesh 2004–2018.

(A) Prevalence of hypertension by age and survey round. (B) Prevalence of diabetes by age and survey round. (C) Trends in hypertension and diabetes. Values in (A) and (B) are mean and 95% confidence interval bands. Values in (C) are mean and 95% confidence interval points.

Fig 3. Prevalance of underweight and overweight/obesity among women and men by division and survey round, Bangladesh 2004–2018.

(A) Women (15-49y): Underweight. (B) Women (15-49y): Overweight/obesity. (C) Men (18-95y): Underweight. (D) Men (18-95y): Overweight/obesity. Note: This map is created from the shapefile (an empty map) that is publicly available from http://gadm.org.

Fig 4. Prevalence of noncommunicable diseases among women and men by division and survey round, Bangladesh 2004–2018.

(A) Women (35-95y): Diabetes. (B) Women (35-95y): Hypertension. (C) Men (35-95y): Diabetes. (D) Men (35-95y): Hypertension. Note: This map is created from the shapefile (an empty map) that is publicly available from http://gadm.org.

Fig 5. Socio-economic and residential inequality in underweight, overweight/obesity, diabetes and hypertension among women and men by survey round, Bangladesh 2004–2018.

Fig 6. Regression decomposition analysis of factors that explain changes in underweight and overweight/obesity in women (2004–2018) and men (2011–2018).

Other factors include hygiene and sanitation in men, and household size, hygiene and sanitation, age, working status, and having children under 5 year in women.