The Double Burden of Malnutrition: Coexisting Undernutrition and Overweight/Obesity Among Adolescents in Tribal and Peri-Urban Dadra and Nagar Haveli — A Community-Based Comparative Study

Abstract

Background: India’s adolescents face persistent undernutrition alongside rising overweight. Tribal and fast-urbanising peri-urban communities may be at different stages of the nutrition transition, but they have rarely been compared within one district. Dadra and Nagar Haveli is a predominantly tribal, rapidly industrialising Union Territory with no published adolescent data on this double burden of malnutrition (DBM). Objective: To estimate and compare the prevalence of undernutrition (stunting, thinness), overweight/obesity and their coexistence among adolescents in tribal and peri-urban Dadra and Nagar Haveli, and to identify factors associated with thinness and overweight/obesity. Methods: Community-based comparative cross-sectional study (STROBE-compliant) conducted between July 2025 and July 2026 among 820 adolescents aged 10–19 years (tribal n = 412, peri-urban n = 408), selected by two-stage cluster sampling (30 clusters). Height, weight and waist circumference were measured with standardised methods, height-for-age (HAZ) and BMI-for-age (BAZ) z-scores were derived from the WHO 2007 growth reference. Prevalence ratios (PR) and cluster-adjusted multivariable logistic regression (adjusted odds ratios, aOR, with 95% CI) were computed. Results: Overall, 33.8% (30.6–37.1) of adolescents were undernourished and 9.1% (7.4–11.3) were overweight/obese. Compared with peri-urban peers, tribal adolescents had a higher prevalence of stunting (29.4% vs 17.2%, PR 1.71, 95% CI 1.32–2.22) and thinness (22.3% vs 7.1%, PR 3.14, 95% CI 2.12–4.66), and a lower prevalence of overweight/obesity (4.9% vs 13.5%, PR 0.36, 95% CI 0.22–0.59). Individual-level DBM (stunting with overweight/obesity) affected 1.2% and 3.2% respectively (p = 0.054), community-level coexistence was present in 2/15 tribal and 6/15 peri-urban clusters. Thinness was independently associated with tribal residence (aOR 1.94, 95% CI 1.15–3.28, p = 0.013), household food insecurity (aOR 1.69, 95% CI 1.08–2.66, p = 0.023) and inversely with adequate dietary diversity (aOR 0.60, 95% CI 0.40–0.89, p = 0.011). Recreational screen time >2 h/day was independently associated with overweight/obesity (aOR 1.77, 95% CI 1.13–2.76, p = 0.013). Conclusion: Tribal adolescents in Dadra and Nagar Haveli carry predominantly undernutrition, whereas peri-urban adolescents show an established double burden. Double-duty actions — food security and dietary diversity together with limits on screen time and processed-snack intake, delivered through school and RKSK platforms — should be tailored to each setting.