Beyond undernutrition: tracking the surge of obesity among younger population in Bihar, India

Background: The increasing prevalence of overweight and obesity among children and adolescents in Bihar has become a critical public health concern, coexisting with the state’s long-standing challenge of undernutrition. This study aimed to investigate the prevalence trends, key determinants, and demographic disparities of overweight and obesity among children and adolescents in Bihar to identify actionable insights for public health strategies. Methods: Data from the National Family Health Surveys (NFHS-4, 2015–16, and NFHS-5, 2019–21) were analyzed along with supplementary reports from WHO and UNICEF. The study included children aged 5–9 years and adolescents aged 10–19 years, with overweight and obesity classified using WHO growth standards (BMI-for-age > +1 SD and > +2 SD, respectively). Descriptive statistics were employed to assess prevalence trends, while multivariate logistic regression identified behavioral and environmental risk factors, including screen time, physical activity, and dietary habits. Results: Overweight prevalence doubled among children aged 5–9 years (1.2% to 2.4%) and increased among adolescents (3.2% to 4.5%). Obesity among adolescents also doubled, rising from 1.1% to 2.3%. Urban children exhibited higher rates of overweight (6.2%) compared to rural children (2.8%). Behavioral factors such as physical inactivity (<30 minutes/day; OR=3.2) and prolonged screen time (>4 hours/day; OR=2.5) were significant predictors. Frequent consumption of fast food and sugary beverages further increased the risk. Conclusions: The findings highlight the urgent need for targeted interventions, including promoting physical activity, regulating unhealthy food environments, and embedding nutrition education in schools. A multisectoral approach is critical to addressing the dual burden of malnutrition in Bihar’s children and adolescents.