Food and Physical Activity Environments and their Impacts on Diabesity in South India Adults

Abstract Background: Non-communicable diseases (NCDs), including diabetes and obesity, are serious global health concerns. India, impacted by rapid urbanization, has seen a shift in dietary habits and physical activity (PA) patterns, contributing to the rise of “diabesity” (the coexistence of diabetes and obesity). The evolving food environment—with a surge in processed foods and fast-food outlets—and limited spaces for PA have discouraged active healthy lifestyles, placing a strain on healthcare resources. Objective: This study examined the association of food and PA environments with diabesity among adults in urban Chennai. Materials and Methods: This cross-sectional study included 1138 adults across two electoral wards in Chennai, selected using multistage sampling. Diabesity prevalence was assessed using anthropometric (e.g., body mass index (BMI) and waist circumference) and biochemical (e.g., fasting plasma glucose, HbA1, or current use of diabetes medication) measurements; environmental influences were assessed using the Retail Food Environment Index (RFEI) and proximity to spaces for PA. Reduced rank regression (RRR) was used to identify lifestyle-environment patterns. Results: Diabesity prevalence was 32.5%, with higher rates observed among females, older adults, and physically inactive individuals. Multivariable analysis confirmed age, RFEI, and distance to space for PA as independent risk factor while PA was protective. RRR revealed two patterns, with “Passive Lifestyle and Unfavorable Environment” showing the highest diabesity risk. Conclusion: The findings highlight the need for urban planning and public health strategies to promote healthier food environments and increased PA opportunities to mitigate the burden of diabesity in urban Chennai.