Overweight in children under five in urban and wealthier households in Bangladesh: trends and inequalities across three Multiple Indicator Cluster Surveys, 2012-13 to 2025
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Background
Childhood overweight is often expected to emerge first among urban and wealthier populations during the nutrition transition. However, evidence on temporal trends in childhood overweight and the independent contributions of household wealth and urban residence in Bangladesh remains limited.
Methods
We analysed data from 63,972 children aged 0-59 months with valid weight-for-height z-scores (WHZ) from the Bangladesh Multiple Indicator Cluster Surveys (MICS) of 2012-13, 2019 and 2025. Overweight was defined as WHZ >+2 according to the 2006 WHO Child Growth Standards. We estimated survey-weighted prevalence, absolute and relative wealth inequalities, and prevalence ratios for urban versus rural residence using regression models adjusted for household wealth and other measured characteristics. We also assessed anthropometric data quality and conducted sensitivity analyses.
Results
National overweight prevalence was 1.6% (95% CI 1.4-1.9) in 2012-13, 2.4% (2.2-2.7) in 2019 and 1.7% (1.5-2.0) in 2025. The 2019 peak was concentrated in urban Dhaka district, where one measurer recorded all 67 overweight cases and WHZ variability was high. Excluding this area, prevalence was 1.5%, 1.9% and 1.7%, respectively. The fully adjusted relative index of inequality for wealth remained similar across surveys: 3.66 (1.93-6.93), 3.55 (2.21-5.71) and 3.35 (2.02-5.54), with no evidence of temporal change (interaction p=0.974). The wealth-adjusted urban-to-rural prevalence ratio was 1.44 (1.01-2.06) in 2012-13 and 1.77 (1.40-2.24) in 2019, then fell to 0.72 (0.54-0.95) in 2025. Mean WHZ decreased by 0.16 (95% CI-0.19 to -0.13) between 2019 and 2025, while wasting prevalence increased from 9.8% to 12.9%. In 2025, 41.4% (35.3-47.7) of overweight children were also stunted.
Conclusions
Childhood overweight showed no sustained national increase, but persistent wealth inequalities remained. The changing association with urban residence and concerns about measurement quality highlight the need for continued surveillance and stronger anthropometric quality assurance.
