Rates of overweight exceed that of underweight in South Asia: Study on pre-pregnancy malnutrition
Highlighting a growing burden of malnutrition among married women in South Asia prior to conceiving, an analysis shows that prevalence of being overweight has surpassed that of being underweight.
Key findings
The analysis, published in The Lancet Regional Health Southeast Asia journal, also finds that short stature continues to be an issue, especially in India and Bangladesh, pointing to persistent concerns about malnutrition during early childhood and its long-term effects.
Researchers, including those from University College London, UK, and Population Council, India, analysed data collected through national surveys of South Asian countries -- such as the National Family Health Survey in India -- to understand the nutritional status of women before becoming pregnant.
The team published a series of papers related to aspects of pre-pregnancy nutrition, including prevalence of anaemia and micronutrient deficiency in population. They also reviewed public policies and programmes that deliver interventions on preconception nutrition.
"Our analysis of nationally-representative survey data reveals a growing double burden of malnutrition among preconception women in South Asia, as the prevalence of overweight (ranging from 29 per cent to 57.8 per cent) now surpasses that of underweight (4.6 per cent to 15.7 per cent) among married women," the authors wrote.
Prevalence of short stature was estimated to be 10.7 per cent in India.
Lifestyle and diet associated health risks across South Asia
Urbanisation, migration, along with an increased availability of ultra-processed foods, even in rural areas, have driven a higher intake of fats, sugars, and calories, contributing to a worsening nutritional status, the authors said. They added that anaemia remains persistently high in South Asia, despite intervention efforts.
Anaemia prevalence in India has stagnated at 53.2 per cent during 2015-16 to 54 per cent during 2019-21, while it has marginally increased in Bangladesh (26 per cent in 2011-12 to 28.9 per cent in 2019-20), the study found. The team also looked at micronutrient deficiencies -- another critical aspect of malnutrition among women in South Asia -- by reviewing previously published studies.
For example, low serum ferritin -- a marker of iron deficiency -- is common in India (31 per cent to nearly 88 per cent) but much lower in Bangladesh, the researchers said. Deficiency of serum folate were found to be the highest in Sri Lanka (up to 52.5 per cent) and Pakistan (over 50 per cent), and lower in India (up to eight per cent) and Bangladesh (up to 30 per cent).
However, looking at red blood cell folate deficiency, the researchers found a high prevalence in India -- ranging from 22 per cent to nearly 80 per cent -- and Bangladesh (over 76 per cent). Vitamin D deficiency is a key concern, the authors said, with studies reporting over two thirds of women in South Asia being deficient.
Policy gaps and cultural barriers limit nutrition support
National survey data of Afghanistan shows that over 95 per cent of women in Afghanistan are low on vitamin D, the study said. Estimates of vitamin D deficiency appear to have reduced over time in India, but remain high in Pakistan and Afghanistan -- both predominantly Muslim countries where most women wear clothing that reduces their skin's exposure to the sun, the authors said.
Looking at public policies and programmes related to preconception nutrition in eight South Asian countries, the authors said that most countries, except Sri Lanka, lack a universal programme for health and nutrition screening and at providing essential micronutrients. The countries also lack a counselling on healthy eating and treatment for at-risk women, the authors said.
They added that in countries where supportive policies are present, implementation of comprehensive nutrition services for pre-pregnant women faces significant bottlenecks. Addressing these barriers is critical to improving intervention effectiveness, programme implementation, and informed decision-making, the team said.
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'Understanding when to check your AMH levels can really help you make informed choices about your fertility," Rajotia adds. 'While there aren't any clear symptoms of low AMH, women who experience irregular periods, have a family history of early menopause, or struggle with conceiving should think about getting tested. It is also helpful for those who are planning to delay pregnancy or are considering egg freezing." Misra reinforces this sentiment by saying that there is a lot of increase in the awareness regarding the utility of AMH. 'Most women are getting it done on medical advice for investigation into infertility. However, there is an increasing number of young women who are now, as a part of their life planning—both personally and professionally—getting the test done to know their ovarian reserve and plan their future pregnancy or egg freezing," she adds. Both experts agree that fertility awareness should be part of school and college curriculums, not just restricted to biology textbooks but as part of practical health literacy. Rajotia puts it plainly: 'Education about AMH is incredibly important, not just for women dealing with fertility challenges, but for all women out there. Understanding AMH is key to becoming more aware of your reproductive health, allowing you to plan for the future with confidence." GET YOUR BASICS RIGHT Dr Parul Prakash, head, reproductive medicine (Unit I), Artemis Hospitals, Gurgaon answers basic questions on the anti-Müllerian hormone (AMH). What is AMH? AMH is produced by small follicles in the ovaries. A blood test measures AMH levels to assess the number of eggs remaining. Because AMH remains stable throughout the menstrual cycle, it is considered a reliable fertility marker. Is it normal for AMH to decline with age? Yes. AMH peaks in the mid-20s and gradually declines. By 35, the average AMH is 1.5 ng/mL (nanograms per milliliter), and by 40, it dips to around 1.0 ng/mL. Levels below 1.0 suggest a diminished reserve but don't automatically imply infertility. Why do Indian women's ovaries age faster? Studies suggest Indian women experience menopause nearly six years earlier than their Western counterparts. Factors may include genetics, environmental stressors, and lifestyle habits. Can lifestyle changes help? While we can't reverse aging, lifestyle adjustments—balanced diet, exercise, stress management, and reducing toxin exposure—can support reproductive health. Tanisha Saxena is a Delhi-based independent journalist. She writes stories that are on the intersection of art, culture and lifestyle. Also read: Magnesium mania: Understanding the hype behind the wellness trend
