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Obesity is a common issue across the globe, and recent studies have highlighted that deaths due to obesity have also increased rapidly. Obesity and the accompanying deficiency of iron nutrients in the diet has also become a nutritional disorder worldwide. This cross-sectional study was conducted district-wise across India in 2015-16, and in this pa...


Background Child marriage, defined as marriage before age 18 years, could impact women’s nutritional status through biological as well as environmental and socioeconomic attributes affecting diet and lifestyle behaviors. This study aims to examine whether women married as children have a differential risk of individual level double burden of overweight/obesity and anemia at adult age compared to women married as adults. Methods Using nationally representative data from India we estimated multinomial logistic regressions to obtain relative risk ratios (RRR) in favor of mutually exclusive anemia and overweight/ obesity conditions among women aged 20–49 years. We estimated the model for full sample and for sub-samples by household wealth groups. Results We find that women who were married as children had a lower relative risk (RRR=0.941) of the double burden of anemia and overweight/obesity in the full sample. However, when sociodemographic correlates were accounted for and assessed in sub-groups by wealth groups, they had a higher relative risk (ARRR ranging from 1.079 to 1.204) of the double burden compared to women married as adults. Conclusion Our results thus portray a classic case of the Simpson’s paradox by documenting a reversal of association between child marriage and occurrence of the double burden of malnutrition in the subgroup level than that in the general population. This finding provides a critical policy insight for effective public health interventions to improve women’s health and wellbeing, particularly in low resource settings.