title: Factors associated with BMI, underweight, overweight, and obesity among adults in a population of rural south India: a cross-sectional study.
abstract: BACKGROUND
  Overweight, obesity, and related chronic diseases are becoming serious public health concerns in rural areas of India. Compounded with the existing issue of underweight, such concerns expose the double burden of disease and may put stress on rural healthcare. The purpose of this article was to present the prevalence and factors associated with underweight, overweight, and obesity in an area of rural south India.
  
  
  METHODS
  During 2013 and 2014, a random sample of adults aged 20-80 years were selected for participation in a cross-sectional study that collected information on diet (using a food frequency questionnaire), physical activity (using the Global Physical Activity Questionnaire), socioeconomic position (using a wealth index), rurality (using the MSU rurality index), education, and a variety of descriptive factors. BMI was measured using standard techniques. Using a multivariate linear regression analysis and multivariate logistic regression analyses, we examined associations between BMI, overweight, obesity, and underweight, and all potential risk factors included in the survey.
  
  
  RESULTS
  Age and sex-adjusted prevalence of overweight, obesity class I, and obesity class II were 14.9, 16.1, and 3.3 % respectively. Prevalence of underweight was 22.7 %. The following variables were associated with higher BMI and/or increased odds of overweight, obesity class I, and/or obesity class II: Low physical activity, high wealth index, no livestock, low animal fat consumption, high n-6 polyunsaturated fat consumption, television ownership, time spent watching television, low rurality index, and high caste. The following variables were associated with increased odds of underweight: low wealth index, high rurality index, and low intake of n-6 PUFAs.
  
  
  CONCLUSIONS
  Underweight, overweight, and obesity are prevalent in rural regions of southern India, indicating a village-level dual burden. A variety of variables are associated with these conditions, including physical activity, socioeconomic position, rurality, television use, and diet. To address the both underweight and obesity, policymakers must simultaneously focus on encouraging positive behaviour through education and addressing society-level risk factors that inhibit individuals from achieving optimal health.
authors.affiliation: Department of Population Medicine, University of Guelph, Guelph, ON Canada.
authors.forename: Matthew
authors.initials: M
authors.lastname: Little
authors.affiliation: Department of Sociology and Anthropology, University of Guelph, Guelph, ON Canada.
authors.forename: Sally
authors.initials: S
authors.lastname: Humphries
authors.affiliation: Department of International Development Studies, Menno Simons College, University of Winnipeg, Winnipeg, MB Canada.
authors.forename: Kirit
authors.initials: K
authors.lastname: Patel
authors.affiliation: Department of Population Medicine, University of Guelph, Guelph, ON Canada.
authors.forename: Cate
authors.initials: C
authors.lastname: Dewey
keywords: Diabetes; Diet; India; Obesity; Overweight; Physical activity; Rural; Tamil Nadu; Underweight