2.  Body mass index is an useful indicator to the status of adult health  It shows the current nutritional status and is an effective predictor of morbidity and mortality rates.  Women with low BMI (< 18.5) leads to chronic energy deficiency (CED) which ultimately leads to higher rate of mortality, low birth weight etc  In India, 29 % women have a BMI less than 18.5 (NFHS-3)

3. On the other hand, in the twentieth century, BMI is increasing, resulting to a good proportion of people suffering from obesity. It is regarded that due to increase of urbanization, availability of processed and fast foods and dependence on Television for leisure, people are fast adopting less physical activities and consuming ‘energy-dense, nutrient-poor’ diets leads to overweight and obese (WHO, 2003; Bell et al. 2002; Popkin, 2002; 2001; Popkin et al. 2001 and Drewnowski & Popkin, 1997). Obesity has a great effect on mortality because it is associated with hypertension, diabetes, gallstones, gout and some type of cancers.

5. Data set: Second National Family Health Survey (NFHS-2) data, conducted in 1998-99 by International Institute for Population Sciences and to see the temporal trend, NFHS-3 (2005-6) have been considered. Sample size 81,712 (NFHS-2) and 1,18,781 (NFHS-3). Criteria of the data: Ever married reproductive aged (15-49 years) women along with their husbands of all states in India.

6. Body Mass Index (BMI) Obese :  30.0 Overweight : 25.0 – 29.9 Normal : 18.5 – 24.9 Chronic energy deficient (CED) : <18.5 Weight in kilogram divided by height in meters squared (kg / m 2 )

7.  Besides BMI, the other variables are:  Women’s Age  Women’s Education  Drinking Water  Toilet Facilities  Electricity  Religion and Caste  Husband’s Educational Level  Husband’s Occupation  Women’s Occupation  Standard of Living Index (SLI) Variables taken:

8. Clarification of each variables Age group 15-2425-3435-49 Women’s education IlliteratePrimarySecondaryHigher Drinking water OpenClose Toilet facility YesNo Electricity YesNo

9. Religion and Caste STSCHinduMuslimOthers Husband’s education IlliteratePrimarySecondaryHigher Husband’s occupation NilProfessionalAgricultureManual Women’s occupation NilProfessionalAgricultureManual Standard of Living Index HighMediumLow Clarification of each variables

10. Methodology Individual percentage distribution of all the variables Association of BMI with different socio-economic variables is done : through percentage and multivariate linear regression analysis Statistical package used : SPSS, version 12.0

11. Results Percentage of women according to classification of BMI in India during NFHS-2 & NFHS-3 NFHS-2NFHS-3

12. Results Percentage distribution of CED among women in different zones of India NFHS-2 NFHS-3

13. Results Percentage distribution of normal women in different zones of India

14. Results Percentage distribution of obese & Overweight among women in different zones of India NFHS-2 NFHS-3

15. Results Percentage distribution of CED and Obesity in different zones of India by rural/urban differences (NFHS-2)

16. Results Low prevalence of CED (< 20 %) among women are found in the following states of India during NFHS-2 & NFHS-3

17. Results High prevalence of CED (> 35 %) are found among women in the following states of India during NFHS-2 & NFHS-3

18. Results Temporal trends of CED in India between NFHS-2 & NFHS-3

19. Results Low prevalence of overweight & obesity (<10 %) among women are found in the following states of India during NFHS-2 & NFHS-3 NFHS-2 NFHS-3

20. Results High prevalence of overweight & obesity (>20 %) among women are found in the following states of India during NFHS-2 & NFHS-3 NFHS-2NFHS-3

21. Results Temporal trends of overweight & obese in India between NFHS-2 & NFHS-3

22. Features of Socio-economic development: A) Education

23.  Illiterate Women (Zone-wise) Features of Socio-economic development:

24. Maximum occurrence of different occupational categories among women in different states of India Categories of work UnemployedPunjab (91.1 %) ProfessionalManipur (21.6 %) AgricultureArunachal Pradesh (50.0%) ManualManipur (17.4 %) B) Occupation

25. Household development indicators (highest occurrence, followed in descending order): Drinking water Toilet facility Electricity Open Closed Not available Available Not available Available (State-wise) Kerala (73.9 %) Punjab (99.2 %) Bihar (83.0 %) Mizoram (97.8 %) Bihar (82.3 %) New Delhi (98.3 %) Nagaland (52.5 %) New Delhi (98.9 %) Orissa (82.0 %) New Delhi (94.3 %) West Bengal (59.5 %) Himachal Pradesh (98.1 %) Manipur (51.5 %) West Bengal (91.1 %) Madhya Pradesh (76.4 %) Manipur ((92.9 %) Orissa (58.8 %) Punjab (97.0 %) (Zone-wise) North-east (34.8 %) West (84.3 %) Central (74.6 %) North-east (77.7 %) East (67.3 %) West (88.3 %) Central (25.1 %) North (83.1) East (72.4 %) West (53.8 %) Central (42.7 %) North (85.5 %)

26. Relationship of CED and Obesity with some socioeconomic variables: India VariablesCEDOverweight/ Obese N Age-group 15-2435.9 3.5 20578 25-3432.010.530960 35-4927.119.130184 Place of residence Rural36.06.556333 Urban20.424.125399 Women’s education Illiterate38.55.740098 Primary31.511.214158 Secondary23.018.119924 Higher13.230.4 7532

27. VariablesCED Overweight/ Obese N ________________________________________________________________ Husband’s education Illiterate41.04.621140 Primary35.78.015040 Secondary28.513.130210 Higher 18.623.515322 Drinking water Open 34.36.2018022 Closed 30.313.6 Toilet facility NA40.44.445680 Pit+Flush19.521.536032

28. Variables CED Overweight/ Obese N___ Electricity: No41.32.626406 Yes26.316.355306 Religion_Caste ST38.87.014016 SC32.94.610040 Hindu 30.113.444831 Muslim29.313.6 9205 Others15.329.2 3620

29. Variables CED Overweight/ Obese N___ Husband’s Occupation Professional 20.721.423512 Unemployed 29.813.321140 Manual32.311.026459 Agriculture38.8 4.929266 Women’s occupation Professional 16.625.4 4552 Unemployed 28.414.252007 Manual35.7 9.4 6392 Agriculture40.9 3.218761 SLI Low44.0 2.722741 Medium31.6 9.139275 High 15.528.219696

30. Relationship of CED and Obesity with some socioeconomic variables: India, Rural Variables CEDOverweight/Obese N___ Age-group 15-2437.4 2.1 15649 25-3436.95.621038 35-4934.0 10.819646 Women’s education Illiterate40.23.933409 Primary34.28.010026 Secondary28.010.810802 Higher19.216.5 2096

31. Variables CED Overweight/Obese N____ Husband’s education Illiterate42.43.218123 Primary38.05.511463 Secondary32.48.219896 Higher 26.411.4 6851 Drinking water Open 35.45.216042 Closed 36.36.940291 Toilet facility NA40.64.041551 Pit+Flush23.113.214782 Electricity: No41.32.524634 Yes31.99.531699

32. Variables CED Overweight/Obese N___ Husband’s Occupation Professional 26.8 11.6 10886 Unemployed 34.5 7.9 1596 Manual 36.8 6.1 16068 Agriculture 39.3 4.6 27783 Religion_Caste ST 42.6 3.7 10421 SC 35.2 3.2 8337 Hindu 35.7 6.8 29808 Muslim 33.6 7.8 5630 Others 18.1 23.1 2137

33. Variables CED Overweight/ Obese N___ Women’s occupation Professional 23.315.3 1801 Unemployed 33.47.932675 Manual 40.05.5 3993 Agriculture 41.33.117864 SLI Low 44.4 2.219963 Medium 34.46.027980 High 21.618.0 8390

34. Relationship of CED and Obesity with some socioeconomic variables: India, Urban VariablesCEDOverweight/ Obese N___ Age-group 15-2431.2 8.1 4929 25-3421.721.2 9912 35-4914.134.410538 Women’s education Illiterate29.8 14.3 6689 Primary24.918.8 4132 Secondary17.026.7 9122 Higher10.935.7 5436

35. VariablesCED Overweight/Obese N__ Husband’s Occupation Professional15.429.912626 Unemployed21.423.2 879 Manual25.318.7 10391 Agriculture 27.911.9 1483 Religion_Caste ST27.816.4 3595 SC21.712.0 1703 Hindu18.826.315023 Muslim22.522.8 3575 Others11.338.0 1483

36. VariablesCEDOverweight/Obese N___ Women’s occupation Professional 12.332.0 2751 Unemployed20.024.819332 Manual28.515.9 2399 Agriculture32.9 6.7 897 SLI Low41.1 5.8 2778 Medium24.716.911295 High11.035.711306

37. Regression analysis of women’s BMI on socio-economic variables : Independent variables BMI ________________________________________ Rural Urban (R + U) _______________________________________________________________ Women’s age37.15***26.77***7.361*** Women’s educational level17.38***33.90***28.676*** Drinking water-6.71347.02***9.751*** Toilet facility81.000***63.45***97.728*** Electricity 37.48***53.28***40.896*** Religion _caste14.56***23.63***15.331*** Husband’s education level 4.883***7.922**5.791*** Husband’s occupation13.29***14.17***18.705*** Women’s occupation 18.19***33.55***22.7222*** Standard of living index 31.42***39.08***50.578*** _________________________________________________________________________ <0.01 = 1% level ***

38. Findings: Socio-economic variables Body mass index

39. Findings  70 to 85 % normal health women are found in most of the North-eastern states (both NFHSs).  Highest percentage of chronic energy deficient (CED) women are found from east to west through its central part.  Thus, it appears that the middle belt of India is mostly affected region of CED.  North-east zones of India are in a better position in respect of BMI than the other zones of India.

40. The facts which support the precondition of this findings are: 1.The highest percentage of women are working in North-eastern states. For ex. Manipur (70 %), Nagaland (64%) and Arunachal Pradesh (60 %) which gives the financial support for the betterment of their families. 2.Self employment is the most important employment (28 %) among women in Manipur which indicates the better standard of living among them. 3.Percentage of educated women is highest in North-eastern states. 4.The main inhabitant of North-east zone are tribes. But religiously, In Mizoram. Nagaland and Maghalaya, 82 to 96 % and in Manipur, 37% are Christian and Christianity may be one of the reason for enhancement of education. 5.Toilet facility is also highest in North –east India which reflects the awareness and indicates the resultant of education. 6.Literacy gap between male and female is least in Mizoram and Meghalaya.

41.  Central and Eastern part of India where percentage of illiterate women (mainly in Bihar and Jharkhand) and toilet facilities are least. Ethnicity is also the regulatory factor for CED because Madhya Pradesh is one of the state of Central India which is mainly inhabited by Tribes. East India is possessing 30 % SC people, Bihar is concentrated of 50% OBC. So this zones are mainly inhabitation of low caste and tribal people which reflects the causes of lowest literacy and less awareness. It is also evident that in Bihar, impact of mass media like TV, Radio are very low.

42. Kerala and Goa have high percentage of obese women, associated with higher literacy rate : Proportion who do not belongs to SC, ST and OBC are higher in Goa (87 %) and Delhi (66 %) Regular exposure to TV is highest in Delhi (90 %).

43. Rural–urban differences a)nearly fifty percent or more women are malnourished in rural areas. b) nearly six times more overweight & obese women are found in urban than rural areas. It may be due the effect of urbanization, processed and fast food, dependence on TV, Radio etc. less physical activity and consuming ‘energy-dense, nutrient –poor’ diets.

44. Summary of the study:  According to BMI indicator, most of the states of north-eastern zone are normal health women  Temporal trend indicates that 6.45 % undernourished have decreased and 33% Overweight & obesity have increased among women between NFHS-2 and NFHS-3  Bihar, Orissa and Central India are least privileged in respect of adult female nutritional status which ultimately focus the poor health of women.  On the other hand, New Delhi, Kerala, Punjab, Goa, are taking upper rung of overweight & obesity due to over nutrition.  Nutritional deficiency is acute among the women in rural areas, illiterate, younger women and also from low standard of living households.

45.  Women health status is associated with many socio-economic indicators.  Education and awareness are the two most important catalyst for socio-economic changes.  The best example is the North east zone of India because North-east zone can boast of having the lowest percentage of illiterate mother and highest percentage of toilet facility though this zone is not privileged so far as electricity connection or high standard of living. Conclusion