In this note, the Myanmar Agriculture Policy Support Activity (MAPSA) reports results on the prevalence of underweight, overweight and obesity among mothers of young children using data collected in Yangon and Ayeyarwady as part of the Rural-Urban Food Security Survey (RUFSS). This in-person study, conducted between October– November 2023, surveyed mothers who were registered from antenatal clinics in peri-urban Yangon in early 2020. In this latest survey round, researchers from MAPSA revisited this sample of mother-child pairs to gather anthropometric data (along with other nutrition-relevant indicators). MAPSA successfully collected anthropometric data for 646 mothers.
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The COVID-19 pandemic in 2020 and the military takeover in early 2021 has made collection of anthropometric data extremely difficult in Myanmar. To redress this evidence gap, we implemented an in-person Rural-Urban Food Security Survey (RUFSS) of caregivers and their young children in urban and peri-urban Yangon and rural Ayeyarwady in October and November 2023, collecting data on maternal anthropometric outcomes (height and weight) for 642 mothers, as well as many other individual and household socioeconomic characteristics. Here we report results for maternal body mass index (BMI): underweight (BMI<18.5) and overweight (BMI 25.0-29.9) and obesity (BMI≥30) using global cut-offs.
We find that 7 percent of mothers were underweight, while 42 percent were overweight/obese, including 30 percent overweight and 12 percent obese. Overweight/obesity rates are higher for wealthier households (54 percent) but are still high in absolute terms among the poorest (32 percent). When comparing to the 2015–16 DHS Yangon sub-sample, overweight and obesity prevalence in the 2023 RUFSS is 2 percentage points higher than the DHS. Given that the RUFSS sample is relatively poor, and that obesity rises with wealth, we can infer that the true prevalence of obesity among mothers of young children in Yangon is higher than the 11 percent estimate from RUFSS, and therefore that obesity is rising since 2015–16.
We then explore potential explanations. RUFSS data indicates that maternal diets are characterized by infrequent consumption of nutrient-dense foods and frequent consumption of unhealthy foods. Surprisingly, though, obese women are less likely to report consumption of unhealthy food in the past 24 hours, though without data on consumption quantities it is difficult to infer calorie intake. Looking at meso- and macro-data, palm oil and sugar consumption has risen dramatically in the past two decades: in 2019/20, palm oil consumption was almost 6 times higher than it was a decade earlier, while sugar consumption was double. Since 2021, sugar consumption has fallen sizably while palm oil consumption has only fallen modestly. Price data show that palm oil is easily the cheapest source of calories, followed by rice and sugar, while processed unhealthy foods are calorically much cheaper than unprocessed healthy foods (except pulses). Once preparation times and cooking fuel costs are factored in, unhealthy foods become even more economically unattractive for poor or time-constrained women.
In policy and programmatic terms, rising obesity in Myanmar is a serious public health concern, since obesity is a major risk factor for a wide range of non-communicable diseases (heart disease and diabetes in particular) that increase mortality and morbidity risks and impose large costs on the health system and the economy at large. Poor diets in Myanmar require “double duty” interventions that address undernutrition as well as “overnutrition”: social behavioral communications change (SBCC) to improve nutritional knowledge and dietary practices, nutrition-sensitive social protection, taxation and tariffs, regulation of unhealthy foods (e.g. food labelling, preventing unhealthy food consumption in schools), and agricultural policies to improve productivity and year-round consumer access to healthy foods.
