Anura V Kurpad, Liza Bowen, George Davey Smith, Kolli Srinath Reddy, Jenny A. Cresswell, Yoav Ben-Shlomo, Poppy Alice Carson Mallinson, Dorairaj Prabhakaran, Mario Vaz, Tanica Lyngdoh, Sanjay Kinra, and Shah Ebrahim
Background In common with many other low- and middle-income countries (LMICs), rural to urban migrants in India are at increased risk of obesity, but it is unclear whether this is due to increased energy intake, reduced energy expenditure, or both. Knowing this and the relative contribution of specific dietary and physical activity behaviours to greater adiposity among urban migrants could inform policies for control of the obesity epidemic in India and other urbanising LMICs. In the Indian Migration Study, we previously found that urban migrants had greater prevalence of obesity and diabetes compared with their nonmigrant rural-dwelling siblings. In this study, we investigated the relative contribution of energy intake and expenditure and specific diet and activity behaviours to greater adiposity among urban migrants in India. Methods and findings The Indian Migration Study was conducted between 2005 and 2007. Factory workers and their spouses from four cities in north, central, and south of India, together with their rural-dwelling siblings, were surveyed. Self-reported data on diet and physical activity was collected using validated questionnaires, and adiposity was estimated from thickness of skinfolds. The association of differences in dietary intake, physical activity, and adiposity between siblings was examined using multivariable linear regression. Data on 2,464 participants (median age 43 years) comprised of 1,232 sibling pairs (urban migrant and their rural-dwelling sibling) of the same sex (31% female) were analysed. Compared with the rural siblings, urban migrants had 18% greater adiposity, 12% (360 calories/day) more energy intake, and 18% (11 kilojoules/kg/day) less energy expenditure (P < 0.001 for all). Energy intake and expenditure were independently associated with increased adiposity of urban siblings, accounting for 4% and 6.5% of adiposity difference between siblings, respectively. Difference in dietary fat/oil (10 g/day), time spent engaged in moderate or vigorous activity (69 minutes/day), and watching television (30 minutes/day) were associated with difference in adiposity between siblings, but no clear association was observed for intake of fruits and vegetables, sugary foods and sweets, cereals, animal and dairy products, and sedentary time. The limitations of this study include a cross-sectional design, systematic differences in premigration characteristics of migrants and nonmigrants, low response rate, and measurement error in estimating diet and activity from questionnaires. Conclusions We found that increased energy intake and reduced energy expenditure contributed equally to greater adiposity among urban migrants in India. Policies aimed at controlling the rising prevalence of obesity in India and potentially other urbanising LMICs need to be multicomponent, target both energy intake and expenditure, and focus particularly on behaviours such as dietary fat/oil intake, time spent on watching television, and time spent engaged in moderate or vigorous intensity physical activity., Sanjay Kinra and colleagues assess the link between urbanisation and increased obesity in India, Author summary Why was the study done? People who migrate from villages to towns and cities in India and many other developing countries have more body fat, but whether this is because of more energy intake or less expenditure or both is unclear. Knowing this, and the contribution of specific diet and activity behaviours, would help policy makers to develop programmes to control the rise in obesity in India and possibly other developing countries. In the Indian Migration Study, we previously found that urban migrants have more obesity and diabetes compared with their siblings who still live in villages. What did the researchers do and find? In the Indian Migration Study, conducted between 2005 and 2007, we collected data on urban factory workers and their spouses in four cities in India, together with their siblings who were still living in a rural area. Data on diet, activity, and obesity for 2,464 participants (1,232 sibling pairs of the same sex) at an average age of 43 years (30% females) were analysed. We found that energy intake and expenditure contributed equally to greater body fat in urban migrants; fat/oil intake, time spent watching television, and performing moderate or vigorous intensity physical activity were found to be the most important behaviours contributing to greater adiposity of urban migrants. What do these findings mean? Energy intake and expenditure contribute equally to the increased body fat of urban migrants in India; behaviours such as fat/oil intake, time spent on watching television and performing moderate or vigorous intensity physical activity contributed most to more body fat among urban migrants. Programs for controlling the rise of obesity in India and possibly other developing countries should be multicomponent and target these behaviours that we have identified.