Decomposing the rural-urban gap in overweight & obesity among reproductive age group women: a non-linear based fairlie decomposition analysis in indian context

Abstract

Overweight and obesity among women of reproductive age (15–49 years) have recently become pressing public health challenges in India, driven by rapid urbanization, economic development and lifestyle transitions. The co-existence of undernutrition and over nutrition reflects the country’s ongoing nutritional transition, disproportionately affecting women due to biological vulnerability, social roles, and unequal access to health resources. Notably, a marked rural-urban gap persists, with urban women experiencing a significantly higher burden of overweight and obesity. Understanding the underlying contributors to this gap is crucial for designing evidence-based and equity-oriented health interventions. This study utilized nationally representative data from the fifth round of National Family Health Survey (NFHS-5) to examine rural-urban differences in overweight and obesity among women aged 15–49 years, measured using Body Mass Index (BMI ≥ 25 kg/m²). Descriptive and bivariate analyses were conducted to assess prevalence across socio-demographic groups. A non-linear Fairlie decomposition technique was employed to quantify the extent to which selected characteristics such as age, education, household wealth quintile, marital status, parity, and media exposure explain the observed rural-urban gap. The prevalence of overweight and obesity was substantially higher among urban women than rural women. Fairlie decomposition analysis showed that 74.16% of the rural-urban gap was explained by differences in observed characteristics, while 25.84% remained unexplained. Household wealth emerged as the largest contributor to the explained gap (36.77%), followed by women’s education (19.35%) and age (14.84%), indicating that socioeconomic advancement and demographic differences are the principal drivers of rural-urban gap in overweight and obesity. The findings demonstrated that household wealth, women’s education, and age are the principal contributors to rural-urban gap in overweight and obesity among women of reproductive age in India. These results highlighted the need for equity-oriented public health strategies that address socioeconomic inequalities while promoting healthy diets, physical activity, and awareness particularly among economically transitioning populations, to reduce nutritional disparities and improve women’s health outcomes.