Spousal Concordance in Overweight and Obesity among Indian Couples: A Nationwide Analysis of Socioeconomic and Dietary Determinants

Abstract

Objective

This study examines the level and determinants of spousal concordance in overweight/obesity among married couples in India.

Background

The rising prevalence of overweight/obesity is a growing public health concern globally. While spousal concordance in obesity is recognized in developed countries, less is known about this phenomenon in low- and middle-income countries. Understanding the shared risk factors within couples is crucial for effective intervention.

Methods

We analyzed data from 52,737 married couples using the nationally representative National Family Health Survey (NFHS)-5 (2019–2021). This study used the Asian body mass index (BMI) (in kg/m²) cutoff for overweight/obesity (≥23.0) concordance. Descriptive statistics were used to assess sociodemographic characteristics. The log-binomial regression model was used to estimate the adjusted risk ratio (ARR) of spousal concordance in overweight/obesity.

Results

Overall, 27.4% of couples exhibited concordance for overweight or obesity. Concordance was more prevalent among couples belonging to the richest wealth quintile (47.6%), residing in urban areas (38.4%), living in nuclear families (28.9%), sharing similar age (28.8%) or higher (28.9%), or having similar education levels (31.4%). Higher concordance was also associated with couples not engaged in paid work (33.9%) and those who frequently used media (newspapers: 39.6%, television: 32.8%) or consumed nonvegetarian foods weekly—eggs (30.7%), chicken (29.9%). Geographically, the highest concordance was observed in the southern (37.2%) and northern (33.5%) regions, with Kerala, Jammu and Kashmir, Manipur, Delhi, Goa, Tamil Nadu, and Punjab reporting the highest state-level prevalence (≥42%). Multivariable analysis showed significantly increased risk of spousal overweight/obesity concordance among couples in the richest wealth quintile (ARR = 4.311; 95% CI: 3.757, 4.947), urban areas (ARR = 1.085; 95% CI: 1.016, 1.159), other religious groups (ARR = 1.185; 95% CI: 1.089, 1.291). Regular consumption of eggs (14%), fish (25%), chicken (9%), fried foods (6%), and alcohol (98%) were also linked to higher concordance.

Conclusions

Spousal concordance in overweight/obesity is strongly influenced by shared socioeconomic status, lifestyle behaviors, and dietary patterns. Couples in urban, affluent, media-exposed, and nonvegetarian households are particularly at risk. Public health strategies should prioritize couple-based interventions, especially among high-risk subgroups, to curb the dual burden of overweight/obesity and associated chronic diseases.